Obesity is a major global health problem. The comorbidities associated with obesity (for example: diabetes mellitus type 2 and cardiovascular disease) are multisystem and require continual medical management which places a great strain on the healthcare system. Australia is ranked the 5th most obese population in the world and deaths associated with obesity and obesity related illnesses are estimated at 7,200 per year (Medibank, 2010). This lifestyle disease is now the leading cause of premature death in Australia. The obesity epidemic is blamed on changes in the social, economic and physical environment (obesogenic environments) which have influenced people to over-consume high-energy, processed food at the expense of fresh nutritious food. The World Health Organisation (2011) describes poverty and obesity as inextricably linked.
As the prevalence of obesity increases globally, so does the demand for bariatric surgery. In Australia, hospital admissions for bariatric surgery increased from 500 in1998 to 17,000 in 2007-2008, at a cost to the public and private sectors of more than $108 million (Australian Institute of Health and Welfare, 2010). Many physicians and bariatric surgeons promote bariatric surgery as a safe procedure which can result in significant weight loss, thereby reducing the co-morbidities associated with obesity and possible premature death. However, there is an array of surgical and anaesthetic complications associated with bariatric surgery which are directly attributable to the fact the patient is obese.
The attempt to balance the possible risks and benefits of a relatively new treatment such as bariatric surgery becomes a concern for many nurses. According to an American study by Camden (2009/2010) this benefit versus burden debate may give rise to ethical concerns for nurses involved in the care of bariatric surgery patients. The purpose of this present study is to determine if Australian nurses reflect the same or similar concerns as their US counterparts.
This aim of this exploratory qualitative study was to determine if registered nurses expressed any ethical concerns in relation to caring for bariatric surgery patients in the perioperative anaesthetic and recovery room environment. The purposive sample group consisted of nine experienced anaesthetic and recovery room RNs who consented to an interview which was based upon a vignette of a potential bariatric surgery patient. Analysis of data was undertaken with reference to the ethical principles of beneficence, non-maleficence, autonomy, justice, veracity, fidelity and confidentiality. Themes and concepts were identified in relation to these ethical concepts to determine if the participants had any ethical concerns in relation to the bariatric surgical procedures orcaring for the bariatric patients.
Results from the data revealed the participants expressed concern in relation to; a perceived lack of informed consent process, the inequity of access to bariatric surgery for the low socio-economic group without private health insurance, the perception of bariatric surgery being used as a “quick fix”, the view there is a lack of psychological preparation and treatment for bariatric surgery patients, perceived education deficits of nurses related to bariatric surgery and associated health care ethics, the cost of this intervention including the financial impact of equipment, the manual handling risks and the stress of providing high acuity care, the balance of benefits to risks of this surgery, obesity stigma and the lack of longitudinal studies into bariatric surgery patient outcomes.
Findings of this study have implications for nurse education, nurse retention and patient outcomes. Given the current trends in obesity and the trajectory of bariatric surgery, educators need to include into the nursing curriculum and staff development programs, teaching about bariatric surgery including the serious surgical and anaesthetics risks. Also ethical issues need to be highlighted specifically for this surgical intervention such as informed consent, equity of access and resource allocation given the financial cost to the health care system
