A morbidly obese patient was admitted to this unit with bilateral leg swelling and was diagnosed with cellulitis. At the onset of his admission, multiple challenges hindered a smooth admission. Due to his weight and size, patient safety was immediately raised as a concern, especially with transporting the patient using the hospital elevators. The width capacity of the elevators will not safely accommodate the movement of the patient. As such, a decision was made to admit the patient in a ground floor setting where the elevator use can be avoided. On day one of the patient's admission, the nursing challenges focused on maintaining the patent's dignity while accommodating the patient's medical and nursing needs. The primary clinical challenges included the prevention of immobility-related complications, including attention to skin integrity. In order to achieve this, a dedicated care plan was instituted to include meticulous skincare and scheduled cleaning schedule. However, the unit was presented with a challenge, especially that the unit's regular staffing matrix did not support the required manpower to turn and move the patient safely. Added to that mix was the concern for preventative measures on caregiver injury as they provide care to the patient. The patient's weight was over the current weight capacity limit for overhead lifts in the facility. To achieve these goals in patient care and staff safety, recommendations from facility leadership were absolute - the unit needs to collaborate with other units to manage the patient safely. The need to usher in the participation of other staff from different units in the hospital in supporting the turning, lifting, and moving the patient for daily care was a process in itself but was readily implemented by the staff in the unit with the support of the hospital administration. A scheduled routine was devised by the unit staff and communicated to the nursing supervisors to gather a "mobility team" that can augment the manpower in the unit. Regardless of the time of day, six people were always involved in turning or moving the patient. This intervention has resulted in "no staff injuries", prevention of wound deterioration, and enhanced healing of skin tears that the patient already has prior to admission.
However, despite the challenges, the staff in the unit did not lose the capacity to show respect to the patient and to the members of his family that repeatedly visited him. The high value placed on the concept of respect by each team member helped create an environment in which the patient feels cared for as an individual and as a person that is in need of help despite all the challenges that his care presents. As the staff comes in to provide care, a careful explanation of each procedure was given to the patient and his family. The patient was encouraged and coached to participate with his care as he was expected to use his upper body strengths to shift his weight on a regular basis. As the length of his stay lingers, the value of respect kept the staff engaged with the task ahead, collaborating with the nursing supervisors and other staff from different units in the facility in order to give the best care to the patient with the commitment of ensuring the protection of their safety as workers and that of the patient. With this experience, the staff validated that a deep-rooted culture of respect can transform people to perform better and display greater resilience with accepting challenging tasks in nursing care.
Also displayed by the unit staff is the capacity to showcase sensitivity in caring for patients with weight problems. Knowing full well that the patient was very uneasy and hesitant about openly discussing his condition, the staff in the unit treated the patient with no qualms and hesitation and accepted him and treated him just like any other patients in the unit but very firm on supporting the plan of care for his recovery. Despite his unhealthy body weight, this patient was talked to and cared for by the staff with professionalism and care.
To the staff, expressing compassion is a universal nursing value that any patient they receive in the unit must receive. However, the ability to adequately provide safe, competent care for patients with a severe weight problem and show respect, dignity, and sensitivity is the very essence of nursing. Clinical situations like this do not happen too often for nurses in this unit. But this situation tested the resolve of each care team members in the unit to follow "out of the box" interventions that can provide the best clinical measures in providing care to a challenging patient. Despite the challenges, the staff realized that it is possible for any clinician to deliver high-quality care if teamwork in the context of a collaborative spirit is generated towards a common goal.