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Caring for Patients Who Have Bariatric Surgery

Roux-en-Y gastric bypass. Image courtesy of Ethicon Endo-Surgery, Inc.

By Sylvia Foley, AJN senior editor

People who are obese (BMI of 30 kg/m2 or greater) are prone to a laundry list of ills. They’re not only at greater risk for diseases such as type 2 diabetes, coronary heart disease, stroke, and osteoarthritis—they’re also more apt to experience discrimination and psychological abuse, and to suffer from anxiety and depression. Many have repeatedly tried to lose weight through diet, exercise, psychotherapy, and pharmacotherapy, to no avail. Until recently, there was little else providers could offer them.

But bariatric surgery, known to be an effective treatment for obesity and obesity-related comorbidities, is becoming an increasingly common option. In 1998, only about 13,000 bariatric procedures were performed in the United States; by 2007 that figure had jumped to 200,000, and it continues to rise. With prevalence rates for overweight and obesity also at record highs in this country, more nurses will likely find themselves caring for patients who have undergone such procedures.

In this month’s CE, “Outcomes and Complications after Bariatric Surgery,” authors Lauren Gagnon and Emily Karwacki Sheff explain the two main types of bariatric surgery and outline five of the most common procedures in the United States: 

2017-07-27T14:52:43-04:00August 30th, 2012|Nursing|1 Comment
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Like ‘Being in Jail in a Way’: A Study Investigates How Anorexic Adolescents and Their Nurses View Inpatient Treatment

By Sylvia Foley, AJN senior editor

Bar the View by HereStanding, via Flickr

For adolescents with severe anorexia, experts have long relied on treatment in specialized pediatric acute care settings, using programs that are based on behavior modification principles and that promote stability through refeeding.

But what is it like to be a young inpatient in such a program? And how does the behavior modification approach affect the nurse–patient relationship? To learn more, nurse researcher Lucie Michelle Ramjan and colleague Betty I. Gill conducted a study in an Australian acute care facility. Their findings are reported in this month’s CE: Original Research feature, “An Inpatient Program for Adolescents with Anorexia Experienced as a Metaphoric Prison.”

The research. Ramjan, the study’s principal investigator, conducted in-depth, face-to-face interviews with 10 adolescent patients being treated for anorexia and 10 pediatric nurses. The interviews were audiotaped; the tapes were then transcribed verbatim, read and reread, and subjected to thematic analysis. As another writer has noted elsewhere, in qualitative research, metaphors often “illuminate the meanings of experiences.” In this study, the researchers found that both nurses and patients “consistently used the metaphor of prison life to articulate their experiences.”

That striking metaphor offered Ramjan and Gill a framework for interpreting […]

2016-11-21T13:09:31-05:00August 6th, 2012|nursing research, patient engagement|3 Comments
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An NP’s Plea: Hold That Specialist

By Karen Roush, MS, RN, FNP-C, AJN clinical managing editor

Recently someone I know woke up in the middle of the night with severe foot pain. In the morning he headed to the ED, where he was diagnosed with a fracture of one of the sesamoid bones in his foot and sent to an orthopedist. Over the three days between the ED visit and the orthopedist appointment, the pain began to ease. At the orthopedist it was determined that the problem wasn’t that little sesamoid bone, but gout.

And then they sent him to a rheumatologist.

Why? The condition was already improving and he had no comorbidities. So, why the need for a specialist visit at a cost of $500 just to walk through the door as a first-time patient? A primary care provider should be competent to manage a straightforward case of gout—order and review bloodwork, prescribe medications, educate the patient about their diet, and follow up on their progress. Then if the patient doesn’t respond to treatment or anything unusual develops, call in the specialist.

This happens all the time. When I was first diagnosed with hypothyroid I was sent off to an endocrinologist (under protest). There was nothing unusual in my presentation and I had no comorbidities or history […]

2018-03-28T10:35:59-04:00August 2nd, 2012|nursing perspective|5 Comments
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Researchers Ask: How Do Nurses Perceive Their Use of Clinical Practice Guidelines?

By Sylvia Foley, AJN senior editor

You’ve probably heard about the “knowledge translation” gap that exists between the care that patients often receive and the evidence for best practice. Clinical practice guidelines, which can help clinicians close that gap, are often underused, and most of the existing research on guideline use has focused on physicians. Nurse researcher Kathleen A. Abrahamson and colleagues wanted to learn more about how nurses perceived their use of guidelines. Their findings are reported in this month’s original research CE, “Facilitators and Barriers to Clinical Practice Guideline Use Among Nurses.”

Abrahamson and colleagues examined free-text responses to two open-ended survey questions provided by 575 RNs at 134 Veterans Affairs medical centers: “What are the facilitators to CPG use?” and “What are the barriers to CPG use?” Conventional content analysis of the data allowed several thematic categories and subcategories of responses to emerge.

Among the findings were the following. […]

2012-07-13T09:15:48-04:00July 13th, 2012|nursing perspective, nursing research|0 Comments
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Women’s Health: Paying Attention to an Invisible Group

By Karen Roush, MS, RN, FNP-C, AJN clinical managing editor

My sister Ellen is getting married in two weeks, so last Sunday I threw a surprise bridal shower. We had all the traditional trappings—flowers and favors and (much to another sister’s chagrin) a shower game and prizes. The only thing not traditional: at this shower there were two brides, my sister and her fiancée, Pat.

After years of standing by invisible while sisters and brothers married, danced with their partners at each other’s weddings, celebrated births and graduations, now it’s their turn. No longer on the periphery, no longer the ‘other,’ at least for this day, these few weeks, they are finally able to celebrate their love and commitment to each other just like the rest of us.

Why am I writing about this in a nursing blog? Because this invisibility, this sidelining of lesbians like my sister and her fiancée, doesn’t only affect their family life—it extends into their health care as well. Neither Ellen nor Pat ever got routine women’s health care—no Pap smears, no clinical breast exams or mammograms, no routine assessment for osteoporosis risk. They were never hooked into the health care system by reproductive health needs, contraception, chlamydia testing or pregnancy […]

2018-03-28T10:36:45-04:00July 5th, 2012|nursing perspective|1 Comment
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Views expressed on the blog are solely those of the authors or persons quoted. They do not necessarily reflect AJN’s views or those of Wolters Kluwer Health/Lippincott Williams and Wilkins.
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