| Purpose: The purpose of this study was to explore nurses’ perceptions and experiences regarding
caring for severely obese patients and factors that affect quality care of these patients in Critical
Access Hospitals (CAHS).
Background: Class III or severe obesity is on the rise in the world and in the United States.
More obese patients are seen in rural communities than in urban communities. Urban hospitals
have looked at caring for this population, but rural settings have not. Nurses spend a significant
amount of time with patients and therefore have expertise and knowledge in caring for specific
populations.
Methods: This study was an exploratory, qualitative design using phenomenological interpretive
description. The theoretical framework of Total Quality Management (TQM) was used to create
a model and questionnaire for semi-structured interviews. Convenience and snowball recruitment
was done through email via the Oregon Nurses Association and the principal investigator (PI)
email. Interviews were performed through Zoom video and audio recording and transcripts were
edited for clarity and conciseness. Data analysis was done using directed content analysis
approach with TQM framework to create coding categories. The study sample were Oregon
Nurses who currently worked in CAHs, at least 18 years of age, and had access to a phone or
computer for video interviews. Nurses came from a variety of regions in Oregon and were
interviewed in their preferred setting.
Results: Fifteen Oregon Nurses currently working in CAHs were participants in semi-structured
interviews. The TQM Framework was used to create coding categories under customer focus,
teamwork, and continuous improvement. Data revealed factors that affect care of the severely
obese individual. Some were lack of staff to run specialized equipment or assist in positioning or
transferring patients, difficulty with bariatric transport, poor attitudes of team members, and lack
of specialized equipment to name a few.
Conclusion:
Severely obese individuals are a population that is on the rise in the last many years. There is a
lack of resources to provide quality care to this population. Caring for this population has many
complexities and is challenging for nursing teams in Critical Access Hospitals.
Keywords: critical access hospitals, lack of resources, nurses, rural, severely obese patients,
total quality management |