NURSE PRACTITIONERS' EXPERIENCES WORKING WITH PATIENTS LIVING WITH MORBID OBESITY
Morbid obesity is recognized as a complex chronic medical disease which has been increasing at an alarming rate in the U.S. The etiologies of this disease involve a complex interplay of genetics, physiological, psychological, behavioral, socioeconomic, and environmental factors. Serious medical consequences are associated with morbid obesity including diabetes, hyperlipidemia, hypertension, cardiovascular disease, and increasing the risk of certain cancers. Research has shown individuals with
... rbid obesity have higher incidence of depression and are subjected to stigmatizing and biases across society including health care professionals. The monumental cost of health care associated with morbid obesity places enormous burden on our health care systems involving billions of dollars. Currently, 69% of nurse practitioners employed in the U.S. are working in primary care and are at the forefront in providing care for patients with morbid obesity. Little is known about the experiences of nurse practitioners caring for patients with morbid obesity in primary care. The aim of this inductive, qualitative descriptive research study was to explore the experiences of nurse practitioners providing care to patients with morbid obesity in the primary care setting. The research questions that guided this study were: What are the experiences of nurse practitioners working with patients who have morbid obesity? How do nurse practitioners describe their clinical practice with patients who have morbid obesity? What facilitators and barriers, if any, have nurse practitioners encountered in delivering care to patients who have morbid obesity? What recommendations do nurse practitioners have for working with patients who have morbid obesity? Data collection consisted of two semi-structured interviews with 10 nurse practitioners with experiences providing care to patients with morbid obesity. The years of experience ranged from at least three years to over 15 years. All of the nurse practitioners spoke of morbid obesity as a complicated, challenging, and time-consuming condition. The nurse practitioners' descriptions of their clinical practice involved their own personal experiences with weight, differences in their approach to addressing weight, and several specific components of care. Facilitators that helped the nurse practitioners were a patient's motivation, as well as access and usage of resources for delivery of care. Several barriers were found to impede the delivery of care by the nurse practitioners including difficulties experienced by patients adapting and maintaining positive lifestyle changes, traumatic events, co-morbidities, as well as social and physical determinants of health. Recommendations expressed by the nurse practitioners included having an open-minded, nonjudgmental attitude, open communication, establishing a trusting relationship with the patient, approaches to address the obesity, and close follow up clinical visits. iv ACKNOWLEDGMENTS As I reflect on the beginning to the final stage of this dissertation, many recollections come to mind. My earliest memory of wanting to pursue advance study was many years ago, however, as they say, life gets in the way. Pursuing a PhD is no small undertaking, it demands a great deal of commitment meeting the challenges that comes with the process. I am well aware I would not have been able to complete this program of study without the support of others who gave their time, thoughts, and encouragement along the way.