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This project involves exploring obesity as a serious public health problem that touches many people around the whole world. The issue of obesity, its reasons, and methods for controlling weight bother not only patients who directly suffer from this condition but also family members and caregivers who think about possible changes. Such characteristics of obesity and preoperative diets as one of the possible methods to manage weight control and succeed in bariatric surgery prove the chosen topic is a significant clinical problem in local hospitals. The aim of this paper is to investigate the peculiar features of preoperative care and the worth of special diets in particular. This clinical audit describes a quality improvement process in terms of which it is possible to develop a plan of care and improve outcomes through a review of interventions, observations of patient involvement, and criteria for change.
In addition to a literature review based on recent clinical studies and trials about obesity and associated lifestyle changes, the audit report about the importance of preoperative diets and patients’ awareness proves that not all people recognize the role of this intervention. Three main criteria are introduced in this report, including a patient’s participation in preoperative diet programs, the creation of preoperative diet diaries, and the level of knowledge about lifestyle changes and feeding processes. Communication and cooperation with nurses, discussion of the details of preoperative dietary interventions, and promotion of self-management are proved to be effective solutions to improve the care offered to adult patients in bariatric clinics. It is expected to achieve certain improvements within the next month.
Obesity is one of the most serious and dangerous problems around the whole world. Individuals who suffer from obesity have a tendency to create families and raise children who have to live with obesity and related comorbidities with time (Lent et al., 2016). Unfortunately, today, despite numerous attempts to decrease obesity rates among different populations, approximately 2 billion adults are reported to be overweight, and about 13% are obese (Dagan et al., 2017). Therefore, many adults of different ages become the patients of bariatric clinics, meaning that they receive treatment in the form of surgery. Pre- and post-operative care plays an important role in a patient’s well-being, and dietary requirements cannot be neglected. This clinical audit aims at evaluating and promoting healthy preoperative diets for adults who are currently bariatric patients. This report helps to identify the main benefits and shortages of bariatric dietary therapies and develop recommendations on how to improve care outcomes through observations, dietary diaries, and systematic reviews based on properly established criteria.
Millions of people are eager to gain control over their weight. Bariatric surgery is an appropriate solution for morbidly obese patients that may be introduced as volume restriction or nutrient malabsorption (Meany, Conceição, & Mitchell, 2014). Dagan et al. (2017) mention such bariatric procedures as gastric banding, sleeve gastrectomy, or biliopancreatic diversion. All these approaches contribute to excess weight loss and the resolution of weight-associated complications.
However, certain concerns still exist. Recent investigations prove that adult parents feel nervous and unconfident about a diet progression that should follow weight loss surgery or liver problems that may occur because of new full-liquid meal plans (Mackie, n.d.). Therefore, some patients may refuse surgery or neglect preoperative care because of such psychosocial factors as binge eating or low motivation that is required for behavior change (Dagan et al., 2017). Preoperative diet is characterized by a number of benefits, and patients have to learn all of them to make the right decisions.
Bariatric patients have to be ready to follow specific rules and recommendations. Preoperative outcomes can be successful in case of adherence to dietary guidelines and physical activities, which indicate weight loss and behavioral changes (Dagan et al., 2017). Diets that may be offered to preoperative patients can vary, and the investigations of Mackie (n.d.) show that a liquid diet is one of the most terrifying for patients. This type of diet promotes an adequate intake of fluids and electrolytes that give the body enough time and opportunities to get prepared for surgery. A carbohydrate eating plan is an alternative that can be followed (Mackie, n.d.). However, not all patients are sure that they can keep to it the required period and question the need for bariatric surgery due to possible postoperative complications.
Preoperative diets may be organized in a variety of ways, with certain criteria being taken into consideration. For example, the Highland Hospital Bariatric Surgery Center (n.d.) develops a nutrition program in terms of which nurses and patients learn how to accept not only a diet but surgery as a whole. The developers of the program underline that surgery should never be defined as a diet or a tool to lose weight and gain control over food intake. A preoperative diet, as well as surgery, is a lifestyle change where many things depend on how prepared patients can be (Highland Hospital Bariatric Surgery Center, n.d.). Adult patients should be consulted by medical and healthcare specialists to know how to evaluate the level of proteins in different meals and decide what kind of food is harmful or helpful to them.
Preoperative diets may depend on a variety of factors. One of them includes a home environment and the presence or absence of certain genetic factors. For example, Hirsch et al. (2014) explain the development of obesity because of the existing generic and family environment influence. The investigations of Lent et al. (2016) provide information that most obese patients who address bariatric clinics are males according to established percent body fat standards. Dagan et al. (2017) underline the quality of life as one of the contributing to obesity factors. Therefore, the audit of the program based on preoperative diets for adults in bariatric clinics should touch upon the level of patient knowledge as well.
Rationale and Methods
The main objective of this report is to ensure that adult patients have enough knowledge to understand the worth of a preoperative diet and make correct decisions regardless of their family history, and received statistical data about bariatric surgery outcomes. The stakeholders of this program are all the staff of the dietary department in the local bariatric clinic where patients (who are the main participants of the program) receive preoperative care and develop a nutritional evaluation that shows if a patient meets all the criteria for bariatric surgery (Dagan et al., 2017). Evaluations are based on interviews with patients, covering people’s expectations, knowledge, and eating behaviors. Patients’ dietary diaries and nursing reports that include the details of preoperative weight management serve as evidence of the program’s quality. This audit should help to check if patients follow a special preoperative diet, make notes in their diaries, and cooperate with the medical staff to improve their knowledge and develop correct expectations.
There are three main categories to be included in the audit:
- Patients participate in a preoperative dietary program: standard – 100%, audit finding: 43%;
- Patients keep their diaries individually: standard – 100%, audit finding – 20%;
- Patients give correct answers about healthy lifestyle and feeding using their own knowledge: standards – 100%, audit finding – 10%.
The methods that can be offered to preoperative patients are focused on the improvement of their knowledge about diets, healthy lifestyles, and the ability to control their weight independently. The causes of why adults do not meet the standards of the program are as follows:
- The lack of knowledge;
- No participation in special education programs;
- Inability or unwillingness to change the already chosen lifestyles;
- The poor motivation of nurses to communicate with patients who are not aware of the medical terms, healthcare complications because of obesity, and true outcomes of bariatric surgery.
Actions to improve the quality of preoperative diets for adult patients in bariatric departments are:
- Explain to the staff that adults should be educated like children at schools about all the details of bariatric surgery and the impact of preoperative diets on it;
- Discuss the details of dietary diaries and nursing reports on weight management and behavioral changes directly with patients and involved healthcare workers;
- Cooperate with patients in terms of a behavioral lifestyle intervention to underline the role of self-management and address the factors that may be related to further weight control.
Results and Practice Implementation
New initiatives and steps to work closely with adult patients bring positive results, change personal attitudes to preoperative diets, and improve the level of knowledge. It is wrong to neglect the role of emotional and psychological factors in preoperative care and diet management. Therefore, nursing or other medical staff’s assistance should gain a better and more serious meaning. During one month, cooperation with adult patients has to be developed. With the intentions to meet 100% standards of care, the following results can be achieved:
- Instead of 43% of the patients who agree to participate in a dietary program, 89% of the patients joined the initiative;
- Instead of 20% of the patients who find it normal to keep a diary, 95% of adults choose this idea;
- Instead of 10% of correct answers given by the patients about healthy lifestyles and preoperative bariatric diets, 66% of the participants give proper answers and demonstrate their desire to be personally involved in preoperative care.
The results and implemented practices prove that the quality of care offered for preoperative patients in bariatric departments can be considerably improved from several perspectives. First, it is important to motivate the staff and show how their recommendations and guidelines can influence patients and their decisions. Second, this program and its audit help to recognize the main cause of why preoperative diets do not always lead to positive results. Finally, adult patients get a chance to learn about obesity and its causes, bariatric surgery and its consequences, and preoperative diets and their urgency.
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In general, preoperative diets have an almost equal amount of supporters and opponents. On the one hand, diets aim at decreasing stress before surgery and guide patients in the intention to control their weight and negative habits. On the other hand, the same interventions can create standards that may be inappropriate or even offensive to patients. Therefore, the question of preoperative diets remains open and requires constant audits. The quality of care, patients’ knowledge, and people’s readiness to participate in weight control and lifestyle interventions may change the working process of bariatric nursing and doctors. However, when patients understand the goals of treatment and the worth of their decisions, there is a chance to meet all the standards and make sure that positive results are achieved and serious health complications are avoided.
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Meany, G., Conceição, E., & Mitchell, J. E. (2014). Binge eating, binge eating disorder and loss of control eating: Effects on weight outcomes after bariatric surgery. European Eating Disorders Review, 22(2), 87-91. Web.