Best practices for perioperative nursing care for weight loss surgery patients.
OBJECTIVE
To describe the unique nursing responsibilities involved in providing nursing care to severely obese weight loss surgery patients and to develop evidence-based guidelines for safe patient care.


METHODS
We performed a systematic review of the scientific literature using MEDLINE and CINAHL. A specific search of nursing journals from 1985 to 2004 identified 134 articles; 16 were found to be pertinent. These were reviewed in detail and used in the context of this report. The quality of the evidence was graded according to a system derived from established evidence-based models. Recommendations were developed from published evidence and expert opinion.


RESULTS
This Task Group found that safe and competent nursing care requires assessment of, and provision for, the complex physical and psychological needs of weight loss surgery patients. We developed evidence-based guidelines for preoperative, perioperative, and postoperative care that address risk factors unique to severely obese patients. We also addressed issues related to the use of proper body mechanics and positioning to avoid on-the-job injury to nursing staff.


CONCLUSIONS
We found that patient safety is best served when nurses are specifically trained to deal with the physical, medical, and psychosocial needs of severely obese patients and when they play an integral role in the multidisciplinary healthcare team. This role should start with a patient's first contact with the system and continue through discharge and follow-up. Special attention needs to be paid to the widespread bias and discrimination that severely obese individuals often experience.
Mulligan
Ann
A
Department of Nursing, Newton-Wellesley Hospital, 2014 Washington Street, Newton, MA 02462, USA. amulligan@partners.org
Young
Lorraine S
LS
Randall
Sheldon
S
Raiano
Carol
C
Velardo
Priscilla
P
Breen
Catherine
C
Bushee
Laura
L
D000758:Anesthesia; D013505:Digestive System Surgical Procedures / Q000009:adverse effects; D019317:Evidence-Based Medicine; D006801:Humans; D016239:MEDLINE; D019300:Medical Errors / Q000517:prevention & control; D009765:Obesity / Q000601:surgery; D019990:Perioperative Care / Q000379:methods*; D013527:Perioperative Nursing / Q000193:education / Q000379:methods*; D011300:Preoperative Care / Q000379:methods; D015431:Weight Loss