1. Zuzelo, Patti Rager EdD, APRN, BC, CNS

Article Content

Problem and Significance

Bariatric patients have a body mass index greater than 40% or are 100 pounds over ideal body weight. Obese individuals experience stigma throughout their lives, including in their interactions with health professionals. Patient-nurse interactions may have the potential to be constructive or destructive processes, perhaps related to nurse attitudes. Bariatric focused educational programming may be more effective if RNs' attitudes are known and addressed. This study measured RNs' attitudes toward obese adult patients using a nonexperimental design with survey instrumentation.


Research Questions

What are the attitudes of RNs toward obese adults? Is there a relationship between RN attitudes toward obese adult patients to educational preparation, self-reported body size, years of experience, type of unit, and work setting? Are there differences in attitudes toward obese adult patients between RNs working in hospital, acute rehabilitation, or skilled care facilities?



Full-time RNs employed in a medical center, acute rehabilitation institution, and skilled nursing facility responded to The Nurses' Attitudes Toward Obese Adult Patients Scale, a 28-item survey with established content validity. An open-ended statement was added to the instrument to elicit comments.



Overall RN response rate was 16.2%, with institutional response rates ranging from 14.9% to 28.6%. The overall attitude score (M = 3.32) demonstrated a positive attitude toward obese adults. There were no statistically significant relationships between demographic variables to attitude scores. Test of homogeneity of variance justified the assumption of equal variances for the three groups (Levene statistic = 1.454; P = .238). One-way ANOVA revealed statistically significant differences in mean score based upon institutional type (F = 11.935; P = .000). Posthoc Scheffe procedure (P = .000) identified a statistically significant difference between the mean scores of acute rehabilitation RNs (M = 2.91; SD = 0.499) versus medical center RNs (M = 3.41; SD = 0.376). Analysis of RN comments revealed several themes, including the following: believing obese patients deserve equal treatment, recognizing unique care needs, feeling overwhelmed by care needs, and making an effort to avoid hurtful encounters.


Implications for Practice

CNSs should acknowledge RNs' safety concerns and workload worries when addressing bariatric nursing care. Many RNs are ambivalent about obesity and need to improve their knowledge base. Stigmatizing behaviors, verbal and nonverbal, may not be recognized by RNs. Discussion may encourage self-awareness and promote improved practice.


Section Description

This year's annual NACNS conference is planned for Orlando, Fla, March 9-12, 2005. Over 300 clinical nurse specialists (CNSs) are expected to attend, and as with past conferences, attendees will also include graduate faculty from CNS programs, nurse administrators, and nurse researchers. The theme of the conference, CNS Leadership: Navigating the Healthcare Environment Toward Excellence, was selected to showcase the many ways CNSs acquire and disseminate knowledge and innovative practices in their specialty areas. Two preconference sessions are scheduled. One session, sponsored by NACNS Legislative/Regulatory Committee, targets information for CNSs interested in understanding the legislative/regulatory process as it deals with the practice of nursing, and will also help build skills CNSs need to engage in the process. The second session, sponsored by NACNS Education Committee, focuses on CNS education issues, and as with the education preconferences of past years, anticipates informative dialogue and much sharing among CNS educators around curriculum design, teaching strategies, and indicators of quality in the curriculum that link to the NACNS education standards to program review and excellence. The conference planning committee is proud and pleased to have Jeanette Ives Erickson, MS, RN, CNA, Senior Vice President for Patient Care Services and Chief Nurse Executive of Massachusetts General Hospital as the opening keynote speaker. She will begin the conference by highlighting the importance of CNS practice on patient safety. The planning committee is equally proud and pleased to have NACNS past-president Rhonda Scott, PhD, RN, Chief Nursing Officer of Grady Health System as the closing speaker. Dr Scott will challenge attendees to use the information from the conference to shape quality care delivered in a safe environment and to advance the profession of nursing through direct care to clients, influencing standards of care delivered by other nurses, and influencing the healthcare delivery system to be to support innovative, cost-effective, quality nursing care. A total of 64 abstracts for podium and poster presentations were selected in addition to graduate student posters. The abstracts address the 3 spheres of CNS practice with a strong emphasis on clinical practice improvements. As you will note from the abstracts published in this issue of the journal, specialty practice areas represented in the abstracts include children, adults, and gerontological patient groups; hospital, outpatient, and home care settings, and community health. In addition, a wide variety of specialty topics including smoking cessation programs, end-of-life care issues, and protocols outlining nursing approaches to improved diabetes, cardiovascular and ventilator management. A number of the abstracts described hospital and healthcare system level innovations that resulted from CNS practice. Collectively, these abstracts reflect the breadth, depth, and richness of CNS contributions to the well-being of individuals, families, groups, and communities. The following abstracts are from those presenters who elected to have their work published in the journal so those who are unable to attend this year's conference can share in the knowledge of the conference. As you read each abstract, consider the talent and clinical scholarship of your CNS colleagues who are advancing the practice of nursing and contributing to improved outcomes for patients and healthcare organizations. You may want to contact individual presenters to network, collaborate, consult, or share your own ideas about these topics. Watch for next year's call for abstracts and consider submitting an abstract for presentation at NACNS's next conference in Salt Lake City, Utah, March 15-18, 2006.