For one of my classes, we had to write a forum post about specific instances of bias in healthcare that we have either experienced or have witnessed. I wrote about weight bias in healthcare - specifically on L&D.
Obesity is a huge issue. Not just in one area of nursing, but in all fields. Bias against obese people is also another huge issue. (No pun intended.)
Without totally copying and pasting what I wrote for my assignment, I'll just hit the highlights.
Nurses have biases. We are not supposed to, but we're human. It doesn't make it right though.
I get frustrated when trying to maintain continuous EFM on obese pregnant women. It's frustrating for me because: the signal for the fetal heart rate doesn't stay consistently in place due to the difficulty in transmission through the extra adipose tissue. Sometimes I cannot even find a FHR on a very obese woman - that is just how difficult it can be, at extremes. I find that I cannot "allow" the woman to move out of a supine position, or I cannot trace her baby. This is especially so if she is on pitocin. If I can't trace the baby, I can't run the pitocin.
Physically, it's getting harder and harder on my own body to push a 300+ pound woman on a stretcher. It just about kills my back, legs, knees and feet.
Same thoughts on holding a leg on an obese woman when she has an epidural and is pushing. I just don't do it anymore. I need to save my back.
The irony of my own biases and judgments that I sometimes think in my mind: I used to be that 300+ woman! How can I - of ALL PEOPLE - make assumptions and judgments on obese women?
Some interesting reading:
Puhl, R., Moss-Racusin, C., Schwartz, M., & Brownell, K. (2007, September 19). Weight stigmatization and bias reduction: perspectives of overweight and obese adults. Health Education Research. doi:10.1093/her/cym052
Schwartz, M., Chambliss, H., Brownell, K., Blair, S., & Billington, C. (2003). Weight bias among health professionals specializing in obesity. Obesity Research, 11 (9), 1033-1039.
16 comments:
My sweet cousin (who was there when I had my first born and she was in the school of education) is an L&D nurse. She weighs approx 120 lbs and now has terrible back damage from all the strain. She has been on pain medication for months and is going through the hospital workman's comp/medical and needs surgery. Lifting/pushing/moving heavy women did it to her. (I'm a heavy woman and have been one of those L&D patients at 240 lbs). I think the biases can easily come from fear of damage to your body. I think you are aware of bias though, and it seems you work to overcome them as best you can.
I think there is a bias against laboring moms as uneducated or in need of babying or bossing or something. Don't know what this is, but I've had nurses/doctors treat me like an idiot. What's weird is I don't fight back, I respond like an obedient person. This past birth (and it was great except for these few moments) the triage nurse wouldn't trust me when I said the midwife was coming and would check me. She said, "we don't do it that way here" and insisted on checking me...on putting in the hep lock. She even mislead me to believe they had spoken to my midwife and she wanted me to be checked in triage. What is that about? Why lie to me like I'm a child? Because you think I'm stupid and can be tricked, that's why.
I've had many nurses though treat me well...and assist me through the pain of labor. They've tried to help me when I cannot cope, and led me to have the unmedicated birth I wanted. It's possible to get past biases or not have them and serve the women who come in.
Of course, you nurses deal with plenty of issues with patients. Drug addicts, angry women, demanding women...I'm sure they don't help much with the biases.
Blessings!
Dawn
You're having real problems with some people you work with, true medical issues. That isn't a bias, it's just the plain honest truth. Some times the truth isn't flattering, but there you go. Persons of weight DO have more issues. There's nothing mean about acknowledging that ( and also nothing wrong with not enjoying the extra work that goes along with it.)
Wow... I can identify with that. My husband is obese, and it drives me crazy. It really bothers him, and all I can think about is get off your fat lazy ass and do something about it! I'm not skinny myself, being somewhat overweight, but honestly, I'm tired of the whole thing. Time for a change for everyone!
Why aren't you biased against the hospital that forces you to move a 300lb+ person without assistance? Including standards of workplace safety for nurses to reduce workplace injuries? Like lifts in room that can handle up to above 500lbs?
In manufacturing and other places ergonomics and proper body mechanics are a cost saving thing, it is to the companies benefit if workers remain uninjured. Sorry, I just don't think that has anything to do with the patient and has a whole heck of a lot to do with policies in place that harm nurses and other staff.
You did not describe biases. It is science that it is easier to lift a 150 pound woman compared to a 300 pound woman. It is easier to lift an item that weighs half as much as another object. It is science that lifting heavy objects strains the back, knees, and other joints.
I agree there are many biases in healthcare, especially in labor and delivery where I also work. Weight bias is a big one (again no pun intended as well)
I don't think what you described are judgments though. You are stating what it is like for you to care for the obese patients. I agree, that is my experience as well.
I am not making any judgments about their lifestyle, personhood, parenting, etc. I love my job and I love the women I care for!
Do I hear my coworkers make judgments? All the fricking time. It makes me sick. And it's not just about the obese patients either... another patient population that gets it hard are the little teens. I am especially sensitive there as I was a teen mother myself.
I'm rambling. Sorry.
I don't see the obese thing in labor and delivery as a bias necessarily, because you have real health issues because of it. It's not like you're saying "Oh god, I don't want to take care of that fat ass because she's fat."
Ya know?
It's very difficut to move, reposition, help ambulate, etc very obese people. If the same were true about thin people, everyone would complain about that as well. That, to me, isn't bias. It just is what it is.
oh, but I do hear many comments (negative) towards obese women.
I see negative comments re: any obese patient. One person on my unit no longer attends monthly staff meetings because things got so heated over this issue.
Rehab is a strenuous practice and we have to take precautions to protect our backs.
But do you think people will help one another if they have to take care of a heavy patient who can't help you?
Of course not. I nearly fell over recently when one of our charge nurses talked about putting a 300 lb.+ patient to bed by herself.
Sure, she had a lift, but it is not only dangerous to her if something happens, but also to the patient.
If I am working, and I possibly can, I help people, especially if the patient cannot help you. It is just not right, for the nurse, or the patient.
Atyourcervix,
What are your thoughts obese women and labor? It seems like most have csections? Is that true?
If so, is that because they have metabolic conditions that label them high risk and therefore are pressured to have csections? Because being on their backs is more dangerous to the baby and hospitals, in general, put women on their backs? Because they don't have the support of the nursing staff, which is so important to the laboring mama?
What are your thoughts?
Where I work, the physicians are computing BMIs on almost every pregnant woman at her initial prenatal visit. We're also seeing an increase of inductions for high BMIs. You're just asking for trouble, in my opinion, to induce for that reason! Yes, I have noted an increase in obese first time mothers being induced and needing a c-section for "failure to progress". Without a doubt, the bogus induction reason for the high BMI leads directly to the failed labor induction. Yes, having to limit the positioning of the mother for continuous EFM (required for an induction) leads to malpositioning of the baby, which leads to.....you guessed it: more pain, more interventions, and more c-sections.
ETHEL: hospitals are generally short staffed and in a emergent situation you cannot wait for someone to come in and help out - if u have a decel....to turn the mom-reposition...standards are in place for workers safety but tell that to a mom who's baby is crashing and she expects (never mind every one else) to do something NOW. In my utopia I would have someone just standing around waiting to help but in real life that doesn't happen.
I am another one of those L&D RNs who can no longer do L&D just because of the heavy lifting involved....
If it's not already on your list, you might be interested in The Well-Rounded Mama. There are a lot of posts that I think you'd agree with; this one springs to mind.
Like other people said, the issue isn't saying how obesity makes your job harder (because it does), but the nasty comments by staff. But staff tend to make nasty comments about anybody who makes their jobs harder, including people like the first commenter who are trying to tell the staff how to do their job (albiet justifiably!). So I think the real issue isn't "fat bias" or any bias but a general paternalistic attitude that extends to the obese, the self-willed patient, etc.
This is a great post on a controversial subject. I agree with the other responders that its not bias to acknowledge that there are limitations on your own strength, and that being obese poses additional risks during labor for mom and baby. Of course it would hurt my feelings if someone started talking about how my weight was so unhealthy at what should be a very exciting moment, but its a truth that can't be ignored- esp. when it puts the hospital staff at risk of injury.
btw AYC: to auscultate an obese woman, try putting her on her side (which is a better position anyway) and instead of putting the monitor piece on the bulk of her belly, try placing it closer to her body( as in away from the navel and closer toward the spine)....that is usually where u will find the heartbeat...I wish i could demonstrate. :(
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