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Morbidly obese patients’ experiences of mobility during hospitalisation and rehabilitation: A qualitative descriptive study
Ngā wheako oreore o ngā tūroro tino mōmona i roto i te hōhipera, me te whakamātūtūtanga: He rangahau whakaahua kounga
Caz Hales, PhD, RN, Lecturer, Victoria University, Wellington, NZ
Nicky Curan, Dip OSH, RN, Health & Safety Advisor, Hutt Valley DHB, Lower Hutt, NZ
Kay de Vries, PhD, MSc, PgCEA, BS (Hon), RN, Deputy Head of Journal Research, University of Brighton, School of Health Sciences, UK
Hales, C., Curan, N., & de Vries, K. (Published online - early view December 2017). Morbidly obese patients’ experiences of mobility during hospitalisation and rehabilitation: A qualitative descriptive study. Nursing Praxis in New Zealand.
Morbid obesity is strongly linked to declining mobility and is a main risk factor for mobility disability. Little is known about morbidly obese patients’ experience of mobility during hospital admission and the specific rehabilitation needs of this patient population. The aim of the study was to explore the mobility experiences and needs of morbidly obese patients before and during hospital admission. A qualitative descriptive methodology was used where semi-structured interviews with morbidly obese patients were undertaken and content analysis conducted. Seven people who were morbidly obese and admitted to one tertiary level hospital in New Zealand for various medical and surgical reasons in the previous six months participated in the study. Key findings revealed that pre-existing mobility had a significant impact on the experiences and needs of morbidly obese patients during hospitalisation. The physical environment of the hospital compounded and intensified mobilisation difficulties. Two categories were identified, these were: ‘compromised pre-existing mobility’, with a subcategory of ‘accessing services prior to admission’; and ‘mobilisation difficulties during hospitalisation’, with a subcategory of ‘dissonance between dependency and need for assistance’. Bariatric care pathways for the morbidly obese patient need to be developed to take into consideration mobility status and include a comprehensive mobility assessment prior to or on hospital admission, for both elective and acute admissions. This would inform the use of appropriate equipment, and support patient independence and rehabilitation. Professional development focusing on patient-centred rehabilitation for morbidly obese patients is needed to improve quality of care and patient satisfaction.
Keywords / Ngā kupu matua
Bariatric care/Ngā mahi ārai i te mate mōmona, content analysis/ngā kupu matua, descriptive qualitative design/te tātari whakautu, hospitalisation/te hoahoa whakaahua kounga, mobility/te urunga ki te hōhipera, morbid obesity/te oreore; te mate tino mōmona, patient agency/ngā mahi a te tūroro, rehabilitation/te whakamātūtūtanga.
Ngā Ariā Matua
E mōhiotia ana he pūtake tino nui te tino mōmona nō te hekenga o te oreore, ā, he tino take nō ngā hauātanga oreore. He iti noa iho te mōhio o te tangata mō ngā wheako o te tangata tino mōmona mō te oreore i te urunga ki te hōhipera, me ngā hiahia whakamātūtū motuhake o tēnei wehenga o ngā tūroro. Ko te tino whāinga ia o te rangahau he tūhura i ngā wheako oreore me ngā hiahia o ngā tūroro tino mōmona i mua, i roto hoki i te urunga ki te hōhipera. I whakamahia he tikanga whakaahua kounga, i kawea ai ētahi uiuinga āhua ōkawa ki ngā tūroro tino mōmona, i āta tātaritia ai hoki ngā whakautu. Tokowhitu ngā tāngata tino mōmona i whai wāhi ki te rangahau. He tāngata katoa ēnei kua whakaurua atu ki tētahi hōhipera taumata tuatoru i Aotearoa mō ētahi take tiaki tinana, poka tinana hoki i roto i te ono marama i mua atu i te uiuinga. Ko ētahi o ngā kitenga matua, he tino wāhi matua te kaha o te oreore o mua i te urunga, ki ngā wheako me ngā hiahia o ngā tūroro tino mōmona i te wā o te noho ki te hōhipera. Nā te taiao kikokiko o te hōhipera i kaha ake ai, i taumaha ake ai ngā uauatanga o te oreore. E rua ngā wehenga i tautuhitia, inā rā: ‘te kahakore o te oreore o mua’ me tōna wehenga tuarua o roto ' he whakapā atu ki ngā ratonga i mua i te urunga', me te 'whai uauatanga oreore i roto i te noho ki te hōhipera’, me tōna wehenga whakaroto o te ‘taupatupatu o te whirinaki ki te tino hiahia o te tūroro kia āwhinatia.’ Me mātua whakarite huarahi ārai i te mate tino mōmona e whakaarotia ai te āhua o te kaha o te tūroro ki te oreore, e uru atu ai hoki he aromatawai oreore i mua, i te wā tonu rānei o te urunga ki te hōhipera, mō ngā urunga kōwhiri, me ngā urunga mate taumaha hoki. Mā konei e mōhiotia ai ko ēhea ngā taputapu tika hei whakamahi, e tautokona hoki te tū pakari o te tūroro, me tōna whakamātūtūtanga. Me āta whakarite akoranga whakapakari i ngā kaimahi mō te whakamātūtūtanga hāngai ki ngā hiahia o te tūroro, hei whakapiki i te kounga o te tiaki me te hari o te tūroro i te mutunga.