Obesity among adolescents has increased in the past decade. Although obesity is considered as an adult disease, its manifestations have become common among adolescents. The rate of obesity among children has increased exponentially in both developed and underdeveloped nations of the world. Most children, adolescents, and young adults suffer from comorbid conditions of obesity such as type 2 diabetes, fatty liver disease, obstructive sleep apnea, and dyslipidaemia. Nurses play a major role in the care and management of children and adolescents who are overweight or obese. The conventional and recommended strategy to manage children and adolescents with obesity include lifestyle changes, diet, physical activity, and support from a multidisciplinary team of experts. Based on current evidence, the nurse should play a primary role in the care and management adolescents who would be undergoing gastric bypass surgery (Hofmann 2013).
It is empirical to assess the need of the bariatric adolescents, specifically those who undergo gastric bypass surgery. The nurse not only plays a supportive role in the care and management of such patients but also helps in improve overall outcome in the perioperative care. The PICOT based on current evidence is as follows:
Population (P): Bariatric adolescents who are considering gastric bypass surgery.
Intervention (I): The nurse as a primary member in the multidisciplinary team for the perioperative care of bariatric adolescent patient.
Comparison (C): The role of the nurse as a secondary member as part of the multidisciplinary team. Nurses would not receive specialized training or involved in the perioperative care of such patients, specifically those receiving gastric bypass surgery.
Outcome (O): An improved and better continuity of care is observed among bariatric adolescent patients who are involved as a primary member of the multidisciplinary team
Time (T): 6-week post-recovery including the perioperative period
PICOT Question:
Does including the nurse as a primary member of the multidisciplinary team improve the continuity of care post-operative and perioperative among bariatric adolescent patients who undergo gastric bypass surgery compared to nurses who play a role as a secondary member in the multidisciplinary team. In the latter, the nurse would not receive specialized training and education to care and manage the patients.
Current Evidence
The treatment and management of obese adolescents and young adults is highly complex and challenging. However, based on current evidence most researchers and healthcare professionals recommended dietary interventions, behavioural modifications, and lifestyle interventions. In severe cases, wherein combination of intensive lifestyle and behavioural modifications do not suffice, the use of pharmacotherapy and surgical interventions are recommended. There are certain drugs that are approved by the US Food and Drug Administration for the treatment and management of obesity among adolescents (Matson & Fallon 2012). However, some researchers have cited the clinical benefit of bariatric surgery for obese adolescents. The scope of the nurse in perioperative and postoperative care is often neglected in current clinical practice. Most nursing professionals are considered as secondary members of the interdisciplinary team who care and manages for such patients. However, it is suggested that nurses should be part as the primary member of the interdisciplinary team to improve outcomes and better continuity of care.
There is clear evidence on the clinical benefits and safety of bariatric surgery among severely obese adolescents. In the past decade, among adolescents who have not improved after conventional strategies such as lifestyle and dietary interventions, surgical options such as gastric bypass has gained significant demand in the healthcare sector (Barnett 2013).
Role of nurse in the care and management of bariatric adolescents
The nurse plays a key role in the care and management of adolescents with respect to perioperative and post-operative needs. It is empirical for adolescent patients to receive emotional support, motivation, and encouragement during the perioperative stage which is often provided by the nurse in the multidisciplinary team (Coppock, Ridolfi, Hayes, St Paul, & Wilfley 2014). The nurse can help adolescent patients and their family members on the various diagnostic procedures, their rationale, and clinical benefits of medical/surgical interventions. Most obese/bariatric adolescents would hesitate to undergo surgery or medical interventions. However, it is through the help, motivation, and education by nurses that help them understand the various terminologies involved in bariatric surgery. The perioperative experience is stated by the nurse who provides a friendly and comfortable environment to the patient. The nurse plays a key role in the interdisciplinary team since he/she would act as a motivator and educator on lifestyle change, body image, dietary interventions, post-surgical care, and perception of other family members and friends. Since there would be many healthcare personnel and staff involved in the care and management of the patient, the nurse would act as a direct point of contact to address all needs of the patient. The nurse would specifically help in addressing the referral support system. The perioperative care and support is likely to be improved if the nurse is involved as a primary member of the bariatric adolescent (Michalsky, et al. 2014).
The post-surgical acute care is often short and requires limited attention by the healthcare staff. However, the patient and the family member/caregiver would require vital information such as wound/skin care, caring for drainage tubes, self-care protocol, drinking/eating regimen, ambulation, and addressing signs/symptoms. The nurse would help in assessing the patient’s progress report and coordinate with the primary physician. Thus, the nurse should be trained, educated, and involved in the care and management of bariatric adolescents (Barnett. 2013).
References
Barnett SJ (2013). Bariatric surgical management of adolescents with morbid obesity. Curr
Opin Pediatr. 25(4):515-20.
Coppock, J. H., Ridolfi, D. R., Hayes, J. F., St Paul, M., & Wilfley, D. E. (2014). Current
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Hofmann, B. (2013). Bariatric surgery for obese children and adolescents: a review of the moral
challenges. BMC Medical Ethics, 14, 18.
Koyuncuoğlu Güngör, N. (2014). Overweight and Obesity in Children and
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Matson, K. L., & Fallon, R. M. (2012). Treatment of Obesity in Children and Adolescents. The
Michalsky, M. P., Inge, T. H., Teich, S., Eneli, I., Miller, R., Brandt, M. L., Buncher, C. R.
(2014). Adolescent Bariatric Surgery Program Characteristics: The Teen Longitudinal Assessment of Bariatric Surgery (Teen-LABS) Study Experience. Seminars in Pediatric Surgery, 23(1), 5–10.
