Moving Bariatric Patients: Understanding the Patient's Perspective

Patient handling injuries can frequently occur with patients whose weight interferes with the care worker’s ability to provide aid. Often bariatric patients put workers at higher risk because of their low level of mobility and the need for turning, lifting, and repositioning, which can become dangerous without proper tools or equipment.

Although most clinicians are aware of their colleagues’ experience moving bariatric patients, they are not as familiar with their patients' mindsets and fears, both of which can also impact handling outcomes.

During a recent multi-part webinar for the Trust Funds, Dr. Susan Gallagher, who authored the ANA Implementation Guide to the SPHM Interprofessional Standards (2013), discussed foundational must-haves to create a robust safe patient handling and mobility program. During the series, she posed an array of questions to Tracey Carr, a bariatric advocate. Dr. Gallagher frequently travels the world with Carr, educating healthcare workers about the actual experiences of a bariatric patient relating to the mechanism of lifting, turning, and repositioning. Below is an excerpt of their interview.

SG: Tracy, can you please tell us about yourself?

TC: I am fifty-four. I work full time. I live independently. There are no adaptations in my house. I drive an ordinary car. I have a social life. You know, there are family considerations and work considerations. I am a very ordinary busy person, and my life only gets complicated really when it comes to accessing health care.

Currently, I weigh about 450 pounds. At my heaviest, I was about 550 pounds. I grew up skinny with a family full of thin people who are all still thin. My weight arrived in my thirties. After my partner died in an accident, I fell into a depression. My prior slight tendency to overeat through anxiety and unhappiness increased. It eventually became out of control. At that point, I went from about 200 pounds up to 550 pounds. So, life changed since then.

I am a fan of being a self-advocate. I speak up, and I try to access healthcare in an open and positive way. However, I am still very conscious that every time I speak to a new healthcare professional, I am dealing with a sort of prejudice or discrimination.

I understand that as a patient I probably make their lives a lot more complicated. I feel very guilty about that. One of the things Susan has been talking about is using technology. I firmly believe that if I'm in a healthcare situation where I need help and happen to break a piece of equipment, I’ll be very upset and embarrassed. However, if I injure a person helping me, and impact their career, I'm going to be devastated.

SG: We've worked together with diverse types of equipment. So, can you tell us a little about what it feels like to be in the slings? You know, we have talked about repositioning slings. We have talked about transfer slings, toileting, bed, chair, and fitted slings. What does it feel like to be in a sling?

TC: Yes, I have been doing medical demonstrations for 20 years now. There are loads of equipment on the market that I have tried, like beds, slings, and hoists. Bear in mind, that I am modeling as a demonstration model, and I am paid to be there. I am there of my own free choice, I am fitted, and I have complete agency over the process. I am empowered to say stop at any time. With all these factors in place, I still hate it. I am afraid. I still find it scary. I hate the lack of independence.

I have had hospital experiences and quite long stays where I have been very resistant to being lifted because I hate the process so much. There are several improvements that can be made around comfort such as getting the correct equipment, proper training, and effective communication with the patient about what is happening at each stage. All these things can be improved, but the actual process itself is always going to be uncomfortable and undignified.

It is hard to make it anything else. No matter how valuable it is, or how grateful I am l to be lifted or turned, for example, I would much rather be lifted to a commode than to use a bed pad, all of those factors in place, it's still quite a difficult experience to go through.

I recommend that if you ever lift people or if you have ever operated a hoist, please get in and try it yourself. You will learn a lot, especially if you have never been hoisted, about how it feels and the emotional reaction of your clients.

SG: Have you ever had the experience of being in a sit-to-stand or vertical lying lift?

TC: Yes! My main problem with them is that I cannot bear pressure on my actual knees and frequently when people are fitting them and adjusting the support that goes on the front of the leg it will be too high. It is important to communicate with me and ask, how does that feel? Because obviously, the shape of your leg changes if you stand up and if you are carrying weight on the outside of your knee, which of course I am. As I stand up, it can become extremely uncomfortable.

In my experience, the supports usually need to be lower. The other thing I would say is to bear in mind things like the sound of the equipment that is lifting me. If I am using a piece of equipment that sounds like it is under a heavy mechanical load, I may lose confidence in it. If your equipment is going to be creaking and groaning, I am likely to say no, not today, I am not doing this. It would be purely due to a lack of confidence in the equipment. Talk to me at the beginning about the expected outcome and what is going to happen. For example, if you say to me, this equipment will make a banging sound when you are halfway standing, I am ready, and I'm fine. However, if that happens unexpectedly, I can genuinely feel my blood pressure rising and get upset.

SG: What happens if a patient experiences a fall, and what would be your expectation of the care staff if a fall occurred either in the clinic or the acute care facility?

TC: I have not fallen in a medical facility, but I have fallen in the entranceway of a major DIY store on a holiday weekend. It was one of the most embarrassing experiences of my life! I would really want people to be calm about it. I do not want anyone to let me see that they are concerned about what the next steps are. If you are dealing with clients who are regularly over 500 pounds, you should have a strategy for getting somebody of that weight off the floor. Obviously, in a medical setting, we are fairly prone to falling anyway.

One thing I can share with you is that as a larger person, gaining or losing more than about five pounds affects my center of gravity and my balance. I might be losing weight for good reasons, but in the process of losing weight, I’m more prone to falling. Have a strategy in place, have equipment in place and keep prying eyes away from me, especially if there’s any hint of public access.

I’d be incredibly grateful for the privacy, but I will be too embarrassed, and shocked even, to be honest about the extent of any injuries. It is entirely possible that if you ask me if I am hurt, I will say no, no, I am fine. I will say I am fine because I am so desperate to get up and get myself out of that situation. Somebody who's fully prepared and calm can bring a little calm to the situation and say, “we need you to sit there to catch your breath.”

Make it clear that this is not a big deal and treat it the same as anybody else falling. As a medical facility, you should be set up for it as if it's just business as usual. That is helpful.

Want to Learn More?

SPHM is the 2022 key initiative of the LHA Trust Funds’ Workplace Safety Funds Grant. Eligible members can use these funds to assist in creating or improving a safe patient handling and mobility program at their facility. To find out how to participate in the initiative or gain full access to Dr. Susan Gallagher's 8-part SPHM training series, contact Stacie Jenkins, Vice President of Patient Safety and Risk, at staciejenkins@lhatrustfunds.com for more information.