Week 2: Local Practice Problem Exploration

Week 2 Discussion Questions

· From a local perspective, how does the practice problem impact nurses, nursing care, healthcare organizations, and the quality of care being provided?

· Identify the local key stakeholders related to the selected practice problem.

· Describe one approach used at your unique setting to address this problem. From your perspective, is this intervention effective in addressing the problem? Why or why not? If this practice problem is not addressed at your workplace, propose an intervention that could be implemented on a local scale to address the problem.

In Skagit County, WA, where I live and work, the prevalence of obesity is on the rise. According to the Institute for Health Metrics and Evaluation (2020), in 2012, the prevalence of obesity was 36.48% for women in Skagit county, 34.81% in Washington, and 33.85% in the U.S. For males, in Skagit county, the prevalence was 33.79%, 33.6% for Washington, and 33.85% for the U.S. This means that more than 1/3 of the population in my area is obese. This is not just a health problem felt by the individual, but repercussions are noted within the entire realm of health care.

Obesity itself is an epidemic. But there are many co-morbidities that accompany obesity such as cardiovascular disease, diabetes, kidney disease, cancer, and respiratory illnesses. In obstetrics, obesity often leads to pregnancy-induced hypertension, gestational diabetes, preeclampsia/eclampsia, and thromboembolisms. The risks are higher for cesarean section, failed induction, and other delivery complications such as shoulder dystocia (Cochrane, 2019). These threaten the lives of both mother and baby. Because care for obese patients is more complex, they are at a very high risk of developing pressure ulcers and wound infections (Hahler, 2002). Simple acts of getting out of bed, mobilization, and even changing the bed linens require the help of at least 2 or more nurses. This is not just to protect the nurses from physical injury, but to also avoid adverse events such as patient falls. In a recent study, it was concluded that there must be an increase in nursing staff in order to provide adequate care to the ever-increasing obese patient population (Carrara, et al., 2016). Therefore, the nursing staff is overworked, especially on Med/Surg units where nurse-to-patient ratios are 1:6. In addition, if one of those 6 patients requires 70% of the nurse’s time, patient care for the other 5 will suffer. This will lead to adverse events such as falls, medication errors, and death which can end up costing the hospital large amounts of money in litigation. Morale in the nursing unit will decrease leaving many unhappy nurses who are burnt out. It is important that more nurses be hired to accommodate the growing numbers of obese patients. This will also cost money for the health care organization as the amount of reimbursement will not increase.

The key stakeholders in all this are first and foremost the patient and family. The poor health of yourself or a loved one can cause great stress to all those involved. And it is important that they receive high-quality health care. Those participants in the micro-, meso-, and macrosystems are all stakeholders. This includes nurses and other clinicians who work at the bedside, middle management, upper management and administration, and board of directors of the health care organization. Even further, leaders at the local level, such as politicians, lobbyists, clergy, and public health officials can help create and support local health initiatives in the community (Folta, et al., 2015).

As discussed earlier, obesity has many negative implications in pregnancy. Therefore, it is important, that as providers, we address this problem during the first intake visit and at every subsequent prenatal visit. When the patient meets with the nurse at approximately 8 weeks gestation, they discuss BMI and appropriate weight gain throughout the pregnancy. If the patient is obese, a referral to the nutritionist is ordered along with first-trimester glucose screening and TSH. The nurse also informs the provider to update the problem list to indicate a high-risk pregnancy. Whether or not this is an effective means to control obesity in pregnancy remains to be seen. Most women welcome the referral to nutrition because they want to take an active part in the health of the pregnancy. Also, they usually adopt a more nutritious diet when pregnant. There are still those women who refuse to follow up appropriately or, follow provider recommendations. And because I practice in a rural setting, transportation issues are prominent.

Carrara, F., Zanei, S., Cremasco, M., & Whitaker, I. (2016). Outcomes and Nursing Workload Related to Obese Patients in the Intensive Care Unit. Intensive and Critical Care Nursing 35, pp 45-51.

Cochrane, L., Brumpton, K., Winter, S., Bell, K., Brunham, H., Wadwell, K., & Kitchener, S. (2019). Prevalence and Outcomes of Overweight and Obesity among Pregnant Women in Rural Queensland. Australian Journal of Rural Health, 27, pp 164-169.

Folta, S., Koomas, A., Metayer, N., Fullerton, K., Hubbard, K., Anzman-Frasca, S., Hofer, T., Nelson, M., Newman, M., Sacheck, J., & Economos, C. (2015). Engaging Stakeholders from Volunteer-Leg Out-of-School Time Programs in the Dissemination of Guiding Principles for Healthy Snacking and Physical Activity. Preventing Chronic Disease, 12, pp 1-7.

Hahler, B. (2002). Morbid Obesity: A Nursing Care Challenge. Dermatology Nursing, 14(4), pp 249-256.

Institute for Health Metrics and Evaluation. (2020). US health. http://www.healthdata.org/us-health

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