An Innovative, Multimodal Approach to Help Obstetric Nurses Realize That Caring for Bariatric Patients Is a Challenge

Abstract

Obesity rates have increased dramatically worldwide over the past 20 years, and it is known that obesity negatively impacts obstetric and neonatal outcomes. Accurate determination and documentation of body mass index (BMI) at hospital admission are crucial for guiding appropriate patient care and nursing preparation. Work-related injuries are major safety concerns in the nursing profession, and risk for injury increases when caring for patients who are obese. Knowledge and use of safe patient handling techniques and safe patient mobilization devices have been shown to decrease risk for nurse injury and have the potential to prolong nursing career viability. Interpersonal, situational, organizational, and environmental influences impact nurses’ willingness to engage in safe patient handling and mobility. The purpose of this evidence-based practice project was to use innovative educational strategies to increase knowledge related to caring for obstetric patients who are obese. Results of a preintervention survey guided development of unit- and population-specific training to improve patient care and safety, increase use of safe patient mobilization techniques, reduce rate of nurse injury, and improve nursing documentation in the electronic medical record to accurately indicate the patient’s BMI. After a preintervention survey was administered, focused video and hands-on training was provided to nurses regarding how to safely care for obstetric patients who are obese. Content included correct BMI determination and documentation on admission, use of bed features and ergonomics to prevent nurse injury, and techniques to prevent postdelivery infection. The information also addressed the organizational and cultural influences that impact nurses’ willingness to engage in safe patient handling techniques. Significant improvements in knowledge and performance were noted at 1-, 3-, and 6-months postintervention, and nurse injury rates related to sprains and strains decreased. Pre- and postintervention evaluations included nurses’ level of knowledge, practice, and confidence related to caring for obstetric patients who are obese; rate of nurse injury on the involved nursing units; and compliance rates of documentation of BMI in the electronic medical record. Knowledge of appropriate safe patient handling and mobilization techniques is not enough to ensure consistent use during intrapartum patient care. The reduction of interpersonal and organizational barriers can improve patient care and decrease nurse injury.