Examination of Attitudes of Nurses Working in Surgical Services Toward Obesity and Obese Patients

Abstract

Background:

Communication toward obese patients and negative attitudes in the time allotted to patients can decrease the quality of care provided to obese patients. Determining the attitudes of nurses who care for obese patients is very important for obese patients to benefit from health services effectively. The purpose of the study was to examine the attitudes and affecting factors of nurses working in surgical services toward obesity and obese patients.

Methods:

This descriptive research was conducted with 204 nurses who worked in surgical services. Data were collected using Identifying Information Form, and Nurses' Attitude Toward Obesity and Obese Patients Scale (NATOOPS) was used.

Results:

In the study, it was seen that the mean score of the NATOOPS was 105.68 ± 21.80, the lowest score being 41 and the highest being 150. It was found that the nurses who had the most positive point of view of obesity were between the ages of 50 and 59, male, had 1–5 years of working experience, worked the night shift, worked 50–59 h per week, and provided care to none or 1–2 obese patients per day.

Conclusion:

In the study, it was determined that nurses had positive perspective toward obesity and obese patients.

Introduction

Obesity caused by the accumulation of fat in the body in a way that impairs health causes a decrease in self-esteem, depression, disability, and death.^1–4 In recent years, obesity has been defined as having a body mass index of 30 or above and has been associated with chronic diseases such as malignant neoplasia, cerebrovascular disease, heart disease, and diabetes.⁵

In the report published by the World Health Organization (WHO) in 2018, it was claimed that the number of obese individuals had increased thrice compared to 1975, and this increase in obesity would continue.⁶ There also appears to be an increase in the prevalence of obesity in Turkey, and the obese population is reported to be 19, 6%.⁷

In addition, as obesity is associated with an increased incidence of cancer and heart disease, the number of obese patients has also been increasing in the field of surgery. The influences of obesity on surgery are made even more complex by various categories of operative outcomes and surgical procedures. Therefore, it is important to appropriately evaluate obesity.⁸

Obesity, which affects every organ in the body, also has a negative effect on the functional status and quality of life of individuals. This situation also increases the special care needs of the patients. Obesity leads to various complications such as cardiovascular system diseases, diabetes, metabolic syndrome, musculoskeletal diseases, and psychiatric problems. Therefore, the preoperative preparation of the obese patients and their care during and after the surgery differ from other patient groups.⁹ In the postoperative period, it is very important to apply nursing interventions such as positioning the patient appropriately, providing ambulation, providing pain control, and performing deep breathing and coughing exercises. Many physical and psychosocial problems prevent the delivery of the necessary nursing care in obese patients.¹⁰ Among the causes of social and psychological problems that occur with obesity, individuals' exposure to prejudice and discrimination is the most common situation.¹¹ Nurses play an important role in consulting obese patients, as well as other patients. However, it is seen in the literature that nurses are unwilling to care for obese individuals and have negative attitudes such as not wanting to care.^12–14 Communication toward obese patients and negative attitudes in the time allotted to them can decrease the quality of care provided to obese patients.¹⁵

The lack of special equipment and physical hardware negatively affects the quality of nursing care, patient satisfaction, and the safety of caregivers. In addition, obese patient care is tiring and time consuming and causes employee dissatisfaction. In a compilation of the literature investigating nurses' attitudes toward obese people, Pervez and Ramonaledi¹⁶ determined that the lack of knowledge on the part of nurses regarding obesity and its causes, communication with obese people, and workload difficulties when caring for obese people contributed to nurses' negative attitudes. In studies examining the attitudes of health care professionals toward obese patients, 45% of the nurses stated that they would not prefer to care for obese patients,¹⁷ and 52% of the nurses were reluctant to care for obese patients.^10,13,18 Therefore, obese patients do not want to benefit from health services due to the negative attitudes of nurses.¹⁹

Determining the attitudes of nurses who care for obese patients is very important for obese patients to benefit from health services effectively. In the literature, there is a limited number of studies on nurses' attitudes toward obesity and obese patients, and no studies on this issue have been found, especially in nurses working in surgical services. This issue requires further investigation to increase the awareness of nurses toward obesity and the quality of care provided to obese patients. This study aimed to examine the attitudes of nurses working in surgical services to obesity and obese patients.

Research questions

(1)

What are the attitudes of nurses working in surgical services toward obesity and obese patients?

(2)

What are the factors that affect the attitudes of nurses working in surgical services to obesity and obese patients?

Methods

Study design

The research was carried out in a descriptive design to examine the attitudes and affecting factors of nurses working in surgical services toward obesity and obese patients.

Sample size

The universe of the research consisted of 220 nurses working and providing care to obese patients in the surgical services of a public hospital, education and research hospital, and two medical faculty hospitals located in Istanbul between January 2017 and January 2018. The sampling method was not used, and it was aimed to reach the whole universe.

The sample of the research: The sample of the study consisted of 204 nurses, and 92.72% (204/220) of the universe was reached. They worked and cared for obese patients in the surgical services of a public hospital, education and research hospital, and two medical faculty hospitals in Istanbul between the same dates.

Data collection

The data were collected by the researchers in 10–15 min by face-to-face interviews with the nurses on their working days and at certain hours not to interfere with their work after obtaining written and verbal permission from the participants. In the data collection, the Identifying Information Form, which was developed by the researcher in line with the relevant literature, and the Nurses' Attitude Toward Obesity and Obese Patients Scale (NATOOPS) were used. Before starting the study, a pilot study was applied to 18 nurses. Comprehensibility and applicability of the questions were tested. Nurses selected for the pilot study were not included in the sample.

Data collection tools

Identifying information form

It is a form consisting of a total of 12 questions, including the questions that determine the descriptive characteristics (age, gender, marital status, education level, etc.) of the nurses included in the research.

Nurses' Attitude Toward Obesity and Obese Patients Scale

It was developed in 2008 by Watson et al. This scale, composed of 36 items, consists of 5 factors that evaluate patients in terms of their cognitive, emotional, and behavioral aspects and affect the control of obesity and obesity practices. These factors include the response of obese patients (14 items), characteristics of obese individuals (9 items), obesity-related control factors (8 items), typical features of obese patients (2 items), and supporting roles in the care of clinically obese patients (3 items).²⁰ Turkish validity and reliability study of the scale was carried out by Menekli et al. in 2018. Cronbach's alpha coefficient of the scale is 0.92. In this study, the reliability coefficient of the scale (Cronbach's alpha) was found to be 0.867. Each item in the scale gets points from 0 to 5, and the total score of the scale is between 0 and 180.²¹ The higher the score obtained from the scale, the better the attitude toward obese patients.

Statistical analysis

The data obtained from the study were evaluated using the IBM SPSS Statistics 21 program (IBM SPSS-Statistical Package for the Social Sciences for Windows). While evaluating the study data, in addition to descriptive statistical methods (mean, standard deviation, median, frequency, ratio, minimum, maximum), for the comparison of quantitative data, Mann–Whitney U test was used in unpaired two group comparisons of parameters that showed abnormal distribution detected by one sample Kolmogorov–Smirnov test, and Kruskal–Wallis test was used to evaluate the difference between three and/or more than three groups. Results were evaluated at p < 0.05 significance level and 95% confidence interval.

Ethics

Written permission was obtained from the institutions (December, 2016; 18235917-903.07.01) and the ethics committee (November, 2016; 59491012-604.01.02) before starting the research. The nurses were informed that all information written on the forms would be kept by the researchers, that their answers would remain confidential, and that they would only be used for scientific purposes. Written and verbal approval was obtained from the nurses participating in the study.

Results

The mean age of the nurses participating in the study was 29.50 ± 6.984, and the total working time in their clinic was 4.68 ± 5.538 (years).

It was determined that 61.8% (n = 126) of the nurses were between 20 and 29 years old, 82.8% (n = 169) were female, 48.5% (n = 99) were married, 63.7% (n = 130) were university graduates, 33.8% (n = 69) had nursing experience between 1 and 5 years, 45.6% (n = 93) were working as clinical nurses, 75.5% (n = 154) worked in both day and night shifts, 75% of them worked between 40 and 49 h a week, and 57.8% of them were engaged in the care of one or two obese individuals per day (Table 1).

Table 1.

Characteristics of Nurses (N = 204)

Characteristics	n	%
Age
20–29	126	61.8
30–39	53	26.0
40–49	24	11.8
50–59	1	0.5
60 and over	0	0
Gender
Female	169	82.8
Male	35	17.2
Marital status
Married	99	48.5
Single	105	51.5
Educational status
Health vocational high school	16	7.8
Associate degree	21	10.3
Bachelor's degree	130	63.7
MsC	31	15.2
PhD	6	2.9
Total working time as a nurse
Less than a year	34	16.7
1–5 years	69	33.8
6–10 years	46	22.5
11–15 years	27	13.2
16 years and above	28	13.7
Position in which s/he works
Charge nurse	21	10.3
Clinic nurse	93	45.6
Intensive care nurse	76	37.3
Surgical nurse	11	5.4
Clinical training nurse	3	1.5
Shifts
Day	39	19.1
Night	11	5.4
Both	154	75.5
Weekly working time
Less than 40 h	6	2.9
40–49 h	153	75.0
50–59 h	43	21.1
60 h and over	2	1.0
Education status about obesity
Yes	29	14.2
No	175	85.8
Number of obese individuals who are given daily care
0	66	32.4
1–2	118	57.8
3 and more	20	9.8

In the study, it was seen that the mean score of the NATOOPS was 105.68 ± 21.80, the lowest being 41 and the highest being 150.

In the study, it was observed that there was a significant difference between the age ranges of the nurses and the mean score of attitude toward obesity and obese patients scale (p < 0.05). It was determined that nurses who had the most positive perspective on obesity were at the age between 50 and 59, and the nurses who had the most negative point of view were between the ages of 40 and 49.

It was concluded that there was a difference between female and male nurses in terms of the mean score of nurses' attitudes toward obesity and obese patients (p < 0.05). It was determined that the females' mean score of attitude scale was lower compared with male nurses. It was concluded that there was a significant difference between the mean scores of the nurses' attitudes toward obesity and obese individuals in terms of the working year (p < 0.05). Nurses with the most negative outlook on obese patients were found to have 16 years or more working experience, and the nurses with the most positive perspective had work experience between 1 and 5 years (Table 2).

Table 2.

Comparison of the Scores Obtained from Nurses' Attitude Toward Obesity and Obese Patients Scale in Terms of Descriptive Characteristics (N = 204)

Descriptive characteristics	n	%	Mean ± SD	Test
Age
20–29	126	61.8	108.47 ± 21.07	X² = 12.026 p = 0.007
30–39	53	26.0	105.90 ± 20.95
40–49	24	11.8	90.29 ± 22.33
50–59	1	0.5	111.00 ± 0.00
60 and over	0	0	0
Gender
Female	169	82.8	102.73 ± 21.09	Z = −4.144 p = 0.000
Male	35	17.2	119.91 ± 19.71	Z = −4.144 p = 0.000
Marital status
Married	99	48.5	104.54 ± 22.11	Z = −0.604 p = 0.546
Single	105	51.5	106.75 ± 21.56	Z = −0.604 p = 0.546
Educational status
Health vocational high school	16	7.8	99.50 ± 15.83	X ² = 3.277 p = 0.513
Associate degree	21	10.3	111.23 ± 20.23
Bachelor's degree	130	63.7	105.56 ± 22.43
MsC	31	15.2	106.58 ± 22.94
PhD	6	2.9	100.66 ± 21.85
Total working time as a nurse
Less than a year	34	16.7	100.58 ± 22.08	X² = 11.112 p = 0.025
1–5 years	69	33.8	111.76 ± 20.51
6–10 years	46	22.5	107.19 ± 18.41
11–15 years	27	13.2	103.37 ± 24.37
16 years and above	28	13.7	96.60 ± 23.64
Position in which s/he works
Charge nurse	21	10.3	98.38 ± 27.55	X² = 19.504 p = 0.001
Clinic nurse	93	45.6	102.95 ± 20.29
Intensive care nurse	76	37.3	113.50 ± 19.60
Surgical nurse	11	5.4	95.18 ± 19.07
Clinical training nurse	3	1.5	81.66 ± 28.29
Shifts
Day	39	19.1	96.87 ± 20.84	X² = 8.386 p = 0.015
Night	11	5.4	111.09 ± 16.24
Both	154	75.5	107.52 ± 21.91
Weekly working time
Less than 40 h	6	2.9	91.83 ± 20.45	X² = 8.789 p = 0.032
40–49 h	153	75.0	104.16 ± 20.75
50–59 h	43	21.1	113.27 ± 24.18
60 h and over	2	1.0	100.00 ± 18.38
Education status about obesity
Yes	29	14.2	103.34 ± 21.22	Z = −0.401 p = 0.689
No	175	85.8	106.06 ± 21.93	Z = −0.401 p = 0.689
Number of obese individuals who are given daily care
0	66	32.4	100.40 ± 20.57	X² = 9.335 p = 0.009
1–2	118	57.8	109.77 ± 21.38
3 and more	20	9.8	98.95 ± 23.80

Bold values indicate p < 0.05.

F, one way analysis of variance; SD, standard deviation; t, independent samples t-test; X², Kruskal–Wallis test; Z, Mann Whitney U-test.

It was found that the mean score of the attitude toward obesity and obese patients scale showed a significant difference according to the positions of the nurses (p < 0.05). It was determined that the nurses with the most negative point of view on obese patients worked as a clinical training nurse, and the most positive nurses were the ones working as an intensive care nurse. It was found that the mean scores of attitude toward obesity and obese patients scale showed significant differences according to the working shift of the nurses (p = 0.015 < 0.05). While the nurses working the day shift were negative, it was seen that the nurses working the night shift had a positive perspective (Table 2).

It was found that the mean scores of the NATOOPS showed a significant difference in terms of weekly working hours (p < 0.05). It was determined that nurses working less than 40 h a week had the most negative perception of obesity and obese patients, while nurses working between 50 and 59 h had the most positive perception. It was determined that the increase in the number of obese individuals cared for by nurses affected the mean score of attitude toward obesity and obese individuals scale (p < 0.05). It was seen that the nurses who cared for three or more obese patients per day were more negative in comparison to the perspective of the nurses who did not care for obese patients and cared for 1–2 obese patients per day (Table 2).

In the study, a weak negative correlation was found between age and obesity and attitude scores toward obese patients (r = −0.148). It was found that there was no relationship at 95% confidence level between the nurses working time in their clinic and their attitude scores toward obesity and obese patients (p = 0.211 > 0.05) (Table 3).

Table 3.

The Relationship Between Some Characteristics and the Mean Scores of the Nurses' Attitude Scale Toward Obesity and Obese Patients (N = 204)

Characteristics	n	%	Mean ± SD	Test
Age	204	100	29.50 ± 6.984	r = −0.148 p = 0.034
Total working time as a nurse
Less than a year	34	16.7	100.58 ± 22.08	X² = 11.112 p = 0.025
1–5 years	69	33.8	111.76 ± 20.51
6–10 years	46	22.5	107.19 ± 18.41
11–15 years	27	13.2	103.37 ± 24.37
16 years and above	28	13.7	96.60 ± 23.64
Total working time in the clinic (years)	204	100	4.68 ± 5.538	r = −0.088 p = 0.211
Weekly working time
Less than 40 h	6	2.9	91.83 ± 20.45	X² = 8.789 p = 0.032
40–49 h	153	75.0	104.16 ± 20.75
50–59 h	43	21.1	113.27 ± 24.18
60 h and over	2	1.0	100.00 ± 18.38

Bold values indicate p < 0.05.

r, Spearman correlation test; X², Kruskal–Wallis test.

Discussion

There are studies in the literature examining the attitudes of health care professionals toward obese patients.^14,22–25 The surgical nurse has an active role in ensuring that the patients perform the activities they cannot do in the process until they gain independence in the postoperative period. In the postoperative period, nurses may be reluctant to care for obese patients in proportion to the increasing number of obese patients because of reasons like difficulty in moving the patient, care itself being difficult and tiring, and the high risk of injury, which may degrade the quality of care provided.^10,26 In studies conducted with obese patients, it was stated that health care professionals showed negative attitudes toward obese patients and were reluctant to care for obese patients.^{10,13,14,17,27–30} Bucher Della Torre et al.³¹ and Sikorski et al.²³ in the studies in which they examined health care professionals' attitudes toward obese female patients, they found that nurses had the most positive attitude toward obese individuals among other health care professionals. Similarly, in this study, it was seen that the nurses working in surgical services had moderately positive score from the attitude toward obesity and obese patients scale. This result may be an indication that serious and increasingly widespread obesity is accepted by nurses and that nurses have a positive attitude toward managing obesity.

It is important to know the attitudes of health care professionals toward obese patients and the factors affecting these attitudes for obese patients to benefit from quality health care.¹⁴ It was determined in the study that variables such as age, gender, the total working year, position, type of work, duration of work, and the number of obese patients who were given daily care affected nurses' attitudes toward obesity and obese patients. In the studies conducted by Brown et al.,²⁶ Poon and Tarrant,¹³ and Usta and Akyolcu,¹⁰ it was seen that female nurses had more positive attitudes toward obese patients, while Isık et al.¹⁴ found that gender did not affect attitude toward obese patients. In this study, it was seen that female nurses had a more negative perspective. This may be related to the fact that the majority of the nurses in the study did not receive any training on obesity and that they lacked knowledge about the approach to obese patients. In the study of Sikorski et al.,²³ it was determined that the attitude toward obese individuals became more negative as the age increased, while Darling and Atav³² and Soto et al.³³ showed that attitudes toward obesity and obese patients were more negative at a young age. Similarly, Brown et al.,²⁶ in the study in which they examined the nurses' attitudes toward obese patients, they found that their attitudes toward obese patients were more positive as the age of the nurses increased. In this study, a weak negative correlation was found between age and obesity and attitude scores toward obese patients. It was seen that the nurses older than 50 who cared for obesity and obese patients had the most positive perspective. This situation may be related to the increase in age and tolerance depending on maturity as age increases.

In the study of Zuzelo and Seminara,¹⁸ there was no significant relationship between the nurses' working year, education level, and attitude scores, while Sikorski et al.²³ and Bucher Della Torre et al.³¹ showed that health workers with more years of work experience had less negative attitudes toward obese individuals. Contrary to the literature, the attitudes of nurses with more years of work experience were found to be more negative toward obese patients in this study. It was found that there is an inverse relationship between age and years of work in the study. Nurses with more working years are expected to have a more positive attitude toward obese patients, as the age increases, so it is observed that they have a more negative attitude. This situation can be explained by the fact that nurses show a positive attitude toward obese individuals as their maturity levels increase as the age increases, but they cannot reflect this to patient care due to burnout in the profession.

Conclusion

As a result, in the study, it was determined that nurses had a positive perspective toward obesity and obese patients and that nurses' attitudes toward obese patients were affected by variables such as age, gender, year of work, type of work, duration of work, and number of obese patients who were given daily care. In line with the results obtained, organizing training programs targeting obesity to further improve nurses' attitudes may help to increase the quality of care given to obese patients and to ensure job satisfaction of nurses.

Measuring nursing attitudes toward obesity and obese patients is very important considering the prevalence of obesity in society. It may be suggested to plan well-designed, randomized controlled studies regarding the effect of nurses' attitudes on the nurse–patient relationship and patient outcomes.

Footnotes

Acknowledgments

The authors express their sincere thanks to all of the nurses who voluntarily participated in this study.

Authors' Contributions

We confirm that all listed authors meet the authorship criteria, and all authors are in agreement with the content of the article. E.S.A., A.T., A.O., and U.Y.F. designed the present study. E.S.A. and A.T. collected, analyzed, and interpreted the data. E.S.A. wrote the first draft of the article. E.S.A., A.T., A.O., and U.Y.F. revised the article. All authors read and approved the final article to be published.

Author Disclosure Statement

No competing financial interests exist.

Funding Information

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

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