Top

BMC Health Services Research

Published in:

Open Access 01-12-2024 | Research

Can equity in care be achieved for stigmatized patients? Discourses of ideological dilemmas in perioperative care

Authors: Maria Härgestam, Lenita Lindgren, Maritha Jacobsson

Published in: BMC Health Services Research | Issue 1/2024

Abstract

Background

In the perioperative care of individuals with obesity, it is imperative to consider the presence of risk factors that may predispose them to complications. Providing optimal care in such cases proves to be a multifaceted challenge, significantly distinct from the care required for non-obese patients. However, patients with morbidities regarded as self-inflicted, such as obesity, described feelings of being judged and discriminated in healthcare. At the same time, healthcare personnel express difficulties in acting in an appropriate and non-insulting way. In this study, the aim was to analyse how registered nurse anaesthetists positioned themselves regarding obese patients in perioperative care.

Methods

We used discursive psychology to analyse how registered nurse anaesthetists positioned themselves toward obese patients in perioperative care, while striving to provide equitable care. The empirical material was drawn from interviews with 15 registered nurse anaesthetists working in a hospital in northern Sweden.

Results

Obese patients were described as “untypical”, and more “resource-demanding” than for the “normal” patient in perioperative care. This created conflicting feelings, and generated frustration directed toward the patients when the care demanded extra work that had not been accounted for in the schedules created by the organization and managers.

Conclusions

Although the intention of these registered nurse anaesthetists was to offer all patients equitable care, the organization did not always provide the necessary resources. This contributed to the registered nurse anaesthetists either consciously or unconsciously blaming patients who deviated from the “norm”.

Available only for authorised users

Ramos Salas X, Alberga AS, Cameron E, Estey L, Forhan M, Kirk SFL, Russell-Mayhew S, Sharma AM. Addressing weight bias and discrimination: moving beyond raising awareness to creating change. Obes Rev. 2017;18(11):1323–35. https://doi.org/10.1111/obr.12592.CrossRefPubMed

Lawrence BJ, Kerr D, Pollard CM, Theophilus M, Alexander E, Haywood D, et al. Weight bias among health care professionals: a systematic review and meta-analysis. Obesity. 2021;29(11):1802–12. https://doi.org/10.1002/oby.23266.CrossRefPubMed

Nutter S, Ireland A, Alberga AS, Brun I, Lefebvre D, Hayden KA, et al. Weight bias in educational settings: a systematic review. Curr Obes Rep. 2019;8:185–200. https://doi.org/10.1007/s13679-019-00330-8.CrossRefPubMed

Gerend MA, Patel S, Ott N, Wetzel K, Sutin AR, Terracciano A, et al. A qualitative analysis of people’s experiences with weight-based discrimination. Psychol Health. 2022;37(9):1093–110. https://doi.org/10.1080/08870446.2021.1921179.CrossRefPubMed

Mattson I, Petersson O, editors. Svensk författningspolitik [Swedish constitutional politics]. Stockholm: SNS Förlag; 2003. Chapter 1, Sect. 2.

Ng M, Fleming T, Robinson M, Thomson B, Graetz N, Margono C, et al. Global, regional, and national prevalence of overweight and obesity in children and adults during 1980–2013: a systematic analysis for the global burden of Disease Study 2013. The Lancet. 2014;384(9945):766–81. https://doi.org/10.1016/S0140-6736(14)60460-8.CrossRef

Folkhälsomyndigheten [Public Health Agency of Sweden]. Övervikt och fetma [Overweight and obesity]. Stockholm: Folkhälsomyndigheten; 2022. https://www.folkhalsomyndigheten.se/livsvillkor-levnadsvanor/mat-fysisk-aktivitet-overvikt-och-fetma/overvikt-och-fetma/.

Jerpseth H, Knutsen IR, Jensen KT, Halvorsen K. Mirror of shame: patients experiences of late-stage COPD. A qualitative study. J Clin Nurs. 2021;30(19/20):2854–62. https://doi.org/10.1111/jocn.15792.CrossRefPubMed

Vaughn-Sandler V, Sherman C, Aronsohn A, Volk ML. Consequences of perceived stigma among patients with cirrhosis. Dig Dis Sci. 2014;59(3):681–6. https://doi.org/10.1007/s10620-013-2942-0.CrossRefPubMed

10.

Shahar E, Maor C, Moshe-Eilon Y. Medical personnel knowledge and stigmatic attitude toward HIV patients in a high-income country. AIDS Care. 2020;32(8):1023–9. https://doi.org/10.1080/09540121.2020.1734172.CrossRefPubMed

11.

Brewis AA, Bruening M, Weight, Shame. Social connection, and depressive symptoms in late adolescence. Int J Env Res Pub He. 2018;15(5):891. https://www.mdpi.com/1660-4601/15/5/891.CrossRef

12.

Panza GA, Puhl RM, Taylor BA, Zaleski AL, Livingston J, Pescatello LS. Links between discrimination and cardiovascular health among socially stigmatized groups: a systematic review. PLoS ONE. 2019;14(6):e0217623. https://doi.org/10.1371/journal.pone.0217623.CrossRefPubMedPubMedCentral

13.

Schwenke M, Luppa M, Pabst A, Welzel FD, Löbner M, Luck-Sikorski C, et al. Attitudes and treatment practice of general practitioners towards patients with obesity in primary care. Bmc Fam Pract. 2020;21(1):169. https://doi.org/10.1186/s12875-020-01239-1.CrossRefPubMedPubMedCentral

14.

Bucher Della Torre S, Courvoisier DS, Saldarriaga A, Martin XE, Farpour-Lambert NJ. Knowledge, attitudes, representations and declared practices of nurses and physicians about obesity in a university hospital: training is essential. Clin Obes. 2018;8(2):122–30. https://doi.org/10.1111/cob.12238.CrossRefPubMed

15.

Darling R, Atav AS. Attitudes toward obese people: a comparative study of nursing, Education, and Social Work Students. J Prof Nurs. 2019;35(2):138–46. https://doi.org/10.1016/j.profnurs.2018.07.009.CrossRefPubMed

16.

Fang V, Gillespie C, Crowe R, Popeo D, Jay M. Associations between medical students’ beliefs about obesity and clinical counseling proficiency. BMC Obes. 2019;6(1):1–8. https://doi.org/10.1186/s40608-018-0222-4.CrossRef

17.

Phelan SM, Burgess DJ, Yeazel MW, Hellerstedt WL, Griffin JM, van Ryn M. Impact of weight bias and stigma on quality of care and outcomes for patients with obesity. Obes Rev. 2015;16(4):319–26. https://doi.org/10.1111/obr.12266.CrossRefPubMedPubMedCentral

18.

Holmgren M, Sandberg M, Ahlström G. To initiate the conversation–public health nurses’ experiences of working with obesity in persons with mobility disability. J Adv Nurs. 2019;75(10):2156–66. https://doi.org/10.1111/jan.14081.CrossRefPubMedPubMedCentral

19.

Jeffrey CA, Kitto S. Struggling to care: nurses’ perceptions of caring for obese patients in an Australian bariatric ward. Health Sociol Rev. 2006;15(1):71–83. https://doi.org/10.5172/hesr.2006.15.1.71.CrossRef

20.

Robstad AN. Intensive care nurses’ attitudes and behavioural intentions toward obese intensive care patients. 2020. https://doi.org/10.5172/hesr.2006.15.1.71.

21.

Goffman E. Stigma: notes on the management of spoiled identity. Simon and Schuster; 2009.

22.

Swift JA, Hanlon S, El-Redy L, Puhl RM, Glazebrook C. Weight bias among UK trainee dietitians, doctors, nurses and nutritionists. J Hum Nutr Dietetics. 2013;26(4):395–402. https://doi.org/10.1111/jhn.12019.CrossRef

23.

Scheff TJ. Shame in self and society. Symb Interact. 2003;26(2):239–62. https://doi.org/10.1525/si.2003.26.2.239.CrossRef

24.

Janoff-Bulman R. Characterological versus behavioral self-blame: inquiries into depression and rape. J Pers Soc Psychol. 1979;37(10):1798.CrossRefPubMed

25.

Larson F, Nyström I, Gustafsson S, Engström Å. Key factors for successful general anesthesia of obese adult patients. J Perianesth Nurs. 2019;34(5):956–64. https://doi.org/10.1016/j.jopan.2019.01.009.CrossRefPubMed

26.

John N, Martin D, Hoy L. Anaesthetic nurse specialist role in perioperative anaesthetic management of patients who are morbidly obese. Br J Nurs. 2023;32(13):644–51. https://doi.org/10.12968/bjon.2023.32.13.644.CrossRefPubMed

27.

Carron M, Safaee Fakhr B, Ieppariello G, Foletto M. Perioperative care of the obese patient. J Br Surg. 2020;107(2):e39–e55. https://doi.org/10.1002/bjs.11447.CrossRef

28.

Bluth T, Pelosi P, de Abreu MG. The obese patient undergoing nonbariatric surgery. Curr Opin Anesthesiology. 2016;29(3):421–9. https://doi.org/10.1097/aco.0000000000000337.CrossRef

29.

SR, SA, Ryn M, SM. Comparisons of explicit weight bias across common clinical specialties of US Resident Physicians. J Gen Intern Med. 2023;1–8. https://doi.org/10.1007/s11606-023-08433-8.

30.

Barter C, Renold E. The use of vignettes in qualitative research. Social Res Update. 1999;25(9):1–6.

31.

Morgan DL. Focus groups. Ann Rev Sociol. 1996;22(1):129–52.CrossRef

32.

Wetherell M. Positioning and interpretative repertoires: conversation analysis and post-structuralism in dialogue. Discourse Soc. 1998;9(3):387–412. https://doi.org/10.1177/0957926598009003005.CrossRef

33.

Potter J, Wetherell M. Discourse and social psychology: beyond attitudes and behaviour. London: Sage; 1987.

34.

Staunæs D. Where have all the subjects gone? Bringing together the concepts of intersectionality and subjectification. NORA - Nordic Journal of Feminist and Gender Research. 2003;11(2):101–10. https://doi.org/10.1080/08038740310002950.CrossRef

35.

Seymour-Smith S. Discursive psychology. J Posit Psychol. 2017;12(3):309–10. https://doi.org/10.1080/17439760.2016.1262621.CrossRef

36.

Edley N. Conversation analysis, discursive psychology and the study of ideology: a response to Susan Speer. Feminism & Psychology. 2001;11(1):136–40. https://doi.org/10.1177/0959353501011001007.CrossRef

37.

Dubois A, Gadde L-E. Systematic combining: an abductive approach to case research. J Bus Res. 2002;55(7):553–60. https://doi.org/10.1016/S0148-2963(00)00195-8.CrossRef

38.

Billig M, Condor S, Edwards D, Gane M. Middleton D, Radley A. Ideological dilemmas: a social psychology of everyday thinking. London: Sage; 1988.

39.

Robstad N, Soderhamn U, Fegran L. Intensive care nurses’ experiences of caring for obese intensive care patients: a hermeneutic study. J Clin Nurs. 2018;27(1–2):386–95. https://doi.org/10.1111/jocn.13937.CrossRefPubMed

40.

Blanchet Garneau A, Browne AJ, Varcoe C. Understanding competing discourses as a basis for promoting equity in primary health care. BMC Health Serv Res. 2019;19(1):764. https://doi.org/10.1186/s12913-019-4602-3.CrossRefPubMedPubMedCentral

41.

Alberga AS, Pickering BJ, Alix Hayden K, Ball GDC, Edwards A, Jelinski S, et al. Weight bias reduction in health professionals: a systematic review. Clin Obes. 2016;6(3):175–88. https://doi.org/10.1111/cob.12147.CrossRefPubMed

42.

Myers A, Rosen JC. Obesity stigmatization and coping: relation to mental health symptoms, body image, and self-esteem. Int J Obes. 1999;23(3):221–30.CrossRef

43.

Scott JC. Weapons of the weak: everyday forms of peasant resistance. yale university Press; 1985.

44.

Griffiths L. Humour as resistance to professional dominance in community mental health teams. Sociol Health Illn. 1998;20(6):874–95.CrossRef

45.

Mazurkiewicz N, Lipowski M, Krefta J, Lipowska M. Better if they Laugh with me than at me: the role of humor in coping with obesity-related stigma in women. Int J Env Res Pub He. 2021;18(15):7974. https://www.mdpi.com/1660-4601/18/15/7974.CrossRef

46.

Crawford P, Gilbert P, Gilbert J, Gale C, Harvey K. The language of compassion in acute mental health care. Qual Health Res. 2013;23(6):719–27. https://doi.org/10.1177/1049732313482190.CrossRefPubMed

47.

Webster F, Rice K, Dainty KN, Zwarenstein M, Durant S, Kuper A. Failure to cope: the hidden curriculum of emergency department wait times and the implications for clinical training. Acad Med. 2015;90(1):56–62. https://doi.org/10.1097/ACM.0000000000000499.CrossRefPubMed

48.

Morgan DL, Bottorff JL. Advancing our craft: Focus group methods and practice. Los Angeles, CA: SAGE Publications Sage CA; 2010.

49.

McDermid F, Peters K, Jackson D, Daly J. Conducting qualitative research in the context of pre-existing peer and collegial relationships. Nurse Res. 2014;21(5). https://doi.org/10.7748/nr.21.5.28.e1232.

50.

Wetherell M, Potter J. Mapping the language of racism: discourse and the legitimation of exploitation. Hemel Hempstead: Harvester Wheatsheaf; 1992.

Title: Can equity in care be achieved for stigmatized patients? Discourses of ideological dilemmas in perioperative care
Authors: Maria Härgestam
Lenita Lindgren
Maritha Jacobsson
Publication date: 01-12-2024
Publisher: BioMed Central
Published in: BMC Health Services Research / Issue 1/2024
Electronic ISSN: 1472-6963
DOI: https://doi.org/10.1186/s12913-024-10580-5

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Can equity in care be achieved for stigmatized patients? Discourses of ideological dilemmas in perioperative care

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2024

Legal issues in digital oral health: a scoping review

The impact of the education program based on dimensions of quality of work life among emergency medical services providers

Non-violent communication as a technology in interpersonal relationships in health work: a scoping review

Perspectives of key informants before and after implementing UPSIDES peer support in mental health services: qualitative findings from an international multi-site study

Behavioral sciences applied to acute care teams: a research agenda for the years ahead by a European research network

The relationship between community social risk factors and regional hospital-reported cash, negotiated, and chargemaster prices for 14 common services