Bariatric SPHM: Understanding Ethical and Outcome Opportunities

1. Bariatric SPHM: Understanding Ethical and Outcome Opportunities Susan Gallagher PhD susangallagher@hotmail.com 626-733-6242

2. Disclaimer Statement • Susan Gallagher (planner/presenter) has not declared any conflicts of interest regarding this presentation. • All participants are required to be present for the full webinar and complete the associated evaluation to receive the designated contact hour for this activity.

3. Bariatrics A term derived from the Greek word baros, and refers to the practice of healthcare relating to the treatment of obesity and associated conditions…

4. Bariatrics …the implication for caregivers is that activities such as turning, lifting, and repositioning can predispose caregivers to physical injury…

5. Bariatrics …additionally, failure to provide adequate patient activity and mobility leads to issues of patient safety.

6. Demographics 74.1% overweight 40% obese (Category I and II) 6.2% morbidly obese (Category III) Over 65-year-olds 40% teens are overweight Children

8. Costly Economically Emotionally

9. What’s happening in the USA?

10. Obesity Trends* Among U.S. AdultsBRFSS, 1985 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14%

11. Obesity Trends* Among U.S. AdultsBRFSS, 1986 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14%

12. Obesity Trends* Among U.S. AdultsBRFSS, 1987 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14%

13. Obesity Trends* Among U.S. AdultsBRFSS, 1988 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14%

14. Obesity Trends* Among U.S. AdultsBRFSS, 1989 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14%

15. Obesity Trends* Among U.S. AdultsBRFSS, 1990 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14%

16. Obesity Trends* Among U.S. AdultsBRFSS, 1991 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19%

17. Obesity Trends* Among U.S. AdultsBRFSS, 1992 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19%

18. Obesity Trends* Among U.S. AdultsBRFSS, 1993 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19%

19. Obesity Trends* Among U.S. AdultsBRFSS, 1994 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19%

20. Obesity Trends* Among U.S. AdultsBRFSS, 1995 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19%

21. Obesity Trends* Among U.S. AdultsBRFSS, 1996 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19%

22. Obesity Trends* Among U.S. AdultsBRFSS, 1997 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% ≥20%

23. Obesity Trends* Among U.S. AdultsBRFSS, 1998 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% ≥20%

24. Obesity Trends* Among U.S. AdultsBRFSS, 1999 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% ≥20%

25. Obesity Trends* Among U.S. AdultsBRFSS, 2000 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% ≥20%

26. Obesity Trends* Among U.S. AdultsBRFSS, 2001 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

27. Obesity Trends* Among U.S. AdultsBRFSS, 2003 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

28. Obesity Trends* Among U.S. AdultsBRFSS, 2004 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

29. Obesity Trends* Among U.S. AdultsBRFSS, 2005 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

30. Obesity Trends* Among U.S. AdultsBRFSS, 2006 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

31. Obesity Trends* Among U.S. AdultsBRFSS, 2007 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

32. Obesity Trends* Among U.S. AdultsBRFSS, 2008 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

33. Obesity Trends* Among U.S. AdultsBRFSS, 2009 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

34. Obesity Trends* Among U.S. AdultsBRFSS, 2010 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

35. Purpose • Define the term ethical dilemma. • Identify three ethical dilemmas that emerge from SPHM practice. • Describe outcome opportunities associated with bariatric safe patient handling and mobility.

36. Ethical dilemma occurs when there are two or more equally unacceptable choices and a decision must be made

37. Impact in the PLWO Complex nature of care Inadequate policies and procedures Lack of size-appropriate technology and resources Complex nature of the individual Weight bias

38. Common dilemmas Refusal – is this a communication issue Vulnerability Dignity Access

39. Ethical principles Beneficence Nonmaleficence Autonomy Justice

40. Beneficence - doing good for the individual, who may be a patient, family member, caregiver or other stakeholder. Beneficience refers to seeking the greatest benefit as balanced against risk.

41. “Above all, do no harm” Nonmaleficience - active prevention of harm to the individual

42. Autonomy - freedom of personal decision making

43. Justice – just distribution of healthcare goods and services

44. Power as a factor Moral courage Silence • Balancing principles: autonomy and beneficence • Seven Step Model

45. Power as a factor Moral courage Silence • Balancing principles: autonomy and beneficence • Seven Step Model

46. Power as a factor 1)To what extent do healthcare workers have a right to adequate SPHM resources necessary to provide safe care to the person who is obese? 2)To what extent do frontline caregivers have a responsibility to identify and report unsafe size-sensitive patient care situations to the leadership team? 3)What is the responsibility of the leadership team to ensure a safe environment for patients and caregivers

47. Power: One step further Social danger – threat to social status Confirmation bias - a phenomenon wherein decision makers seek out and assign more weight to evidence that confirms their hypothesis, and ignore evidence that could disconfirm their hypothesis

48. The threat of Paternalism Balance between autonomy and beneficence Case study: Patient/resident Organizational

49. Rights and responsibilities 1)To what extent should healthcare facilities provide SPHM technology, training, policies and support in caring for certain vulnerable patient populations? 2)What is the responsibility of caregivers to gain skill and knowledge pertaining to size-sensitive SPHM technology and policies? 3)What is the responsibility of patients and their families to participate in assessment-driven, technology-assisted mobility when it becomes available? 4)What is the right of patients to expect safe handling, activity, and mobility?

50. Does SPHM make a difference?