Designing space for the bariatric resident: providing ample space for larger residents isn't just a matter of comfort--quality of care and staff safety depend on it.Obesity has dramatically increased in the United States United States, officially United States of America, republic (2005 est. pop. 295,734,000), 3,539,227 sq mi (9,166,598 sq km), North America. The United States is the world's third largest country in population and the fourth largest country in area. during the last decade, and there are indications that it is beginning to increase significantly in other developed nations, as well. This increase is occurring in all states, in both sexes, and across age groups, races, and educational levels. (1,2) The impact of this trend is being felt by virtually every segment of our society, including long-term care facilities long-term care facility
See skilled nursing facility. , which are starting to see an increased demand for accepting and accommodating bariatric Bariatric
Pertaining to the study, prevention, or treatment of overweight.
Mentioned in: Malnutrition residents.
Long-term care facilities need to rethink re·think
tr. & intr.v. re·thought , re·think·ing, re·thinks
To reconsider (something) or to involve oneself in reconsideration.
re the space required to provide quality care for bariatric residents because of the high risk of injury to both residents and staff during these residents' care. Most existing architectural designs This article or section may contain original research or unverified claims.
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This article has been tagged since September 2007. , furnishings furnishings
the extra type or quantity of hair on the head, tail, ears or legs, specified for a particular breed. For example, the feathers in setters, the beard in Bearded collies, the eyebrows in Schnauzers. , and equipment can accommodate residents weighing as much as 350 pounds, but for larger residents, as well as for the staff who care for them, standardsize resident rooms are a barrier to care and safety. This article focuses on the space and equipment requirements for providing care to residents weighing 350 to 1,000 pounds.
Process mapping is an effective care-planning tool for facilities providing care for bariatric residents. By mapping a resident's care needs from admission through discharge or death, and by considering each part of the facility that might be used during the resident's stay, the planner can identify space and capacity problems that may be encountered.
Potential problems include insufficient door widths to allow the bariatric resident access into the building, inadequate space for turning a stretcher stretcher /stretch·er/ (strech´er) a contrivance for carrying the sick or wounded.
n. (if needed) in the halls, and lack of access to or inadequate space within the resident room and bathroom, the shower/bathing room, the activities room or lounge, elevators, the facility van, etc.
Staff will need written protocols for handling the bariatric resident through each phase of the process. In addition, the facility will need to coordinate with the local hospital to ensure that it can provide care for the facility's bariatric residents requiring hospitalization hospitalization /hos·pi·tal·iza·tion/ (hos?pi-t'l-i-za´shun)
1. the placing of a patient in a hospital for treatment.
2. the term of confinement in a hospital. .
Planning to ensure adequate space for bariatric residents can have a positive effect on their care. The following cascade of events occurs when residents have enough space in which to be properly cared for and mobilized:
* Heart/lung capacity and blood circulation increase when residents are up and moving; their hearts beat faster, increasing the amount of oxygen that reaches their tissues and organs. [right arrow]
* The risk of pneumonia, thrombosis thrombosis (thrŏmbō`sĭs), obstruction of an artery or vein by a blood clot (thrombus). Arterial thrombosis is generally more serious because the supply of oxygen and nutrition to an area of the body is halted. , and other illnesses is reduced as a result of the increased heart/lung capacity and blood circulation. [right arrow]
* Residents' quality of life is improved.
For providing care to bariatric residents, having adequate space and equipment means:
* Reduced need to assist residents;
* Fewer strain-related injuries and increased staff productivity;
* Lower staff turnover rates;
* Reduced costs of delivering care; and
* Enhanced quality of nursing care.
If room furnishings are not large enough or if caregivers cannot get appropriately sized equipment into the resident's room and/or gain adequate access to the resident's bed, then care suffers. The facility may also be in jeopardy of regulatory noncompliance noncompliance
failure of the owner to follow instructions, particularly in administering medication as prescribed; a cause of a less than expected response to treatment.
Care needs. Care may be provided to residents:
* Within the confines con·fine
v. con·fined, con·fin·ing, con·fines
1. To keep within bounds; restrict: Please confine your remarks to the issues at hand. See Synonyms at limit. of bed (for those with virtually no mobility). This includes lifting, turning, boosting, and feeding them, as well as applying dressings and assisting with hygiene.
* Around the bed and beyond, into other areas of the facility (for residents who are mobile with assistance and who range from being only somewhat independent to somewhat dependent). In bariatric resident rooms, there needs to be enough space to accommodate several pieces of equipment and up to six healthcare workers simultaneously for resident handling and various care tasks.
Care may also include assisting the resident with mobility tasks such as:
* Transfers from bed to chair/wheelchair/commode/stretcher and back;
* Transfers from bed to shower chair or stretcher and back;
* Transfers from bed to toilet and back; and
* Ambulation am·bu·late
intr.v. am·bu·lat·ed, am·bu·lat·ing, am·bu·lates
To walk from place to place; move about.
[Latin ambul assistance--i.e., helping with sitting, standing, or walking.
The appropriate equipment and methods used for transfers depend upon:
* Resident's weight and height;
* Resident's ability to bear weight and assist;
* Resident's trunk and upper-extremity strength;
* Whether resident has an infectious disease Infectious disease
A pathological condition spread among biological species. Infectious diseases, although varied in their effects, are always associated with viruses, bacteria, fungi, protozoa, multicellular parasites and aberrant proteins known as prions. that might require isolation;
* Resident's cognition cognition
Act or process of knowing. Cognition includes every mental process that may be described as an experience of knowing (including perceiving, recognizing, conceiving, and reasoning), as distinguished from an experience of feeling or of willing. level or presence of dementia;
* Resident's cooperativeness; and
* Medical complications that might affect resident's mobility--e.g., the presence of various tubes, the existence of pressure ulcers Pressure ulcer
Also known as a decubitus ulcer, pressure ulcers are open wounds that form whenever prolonged pressure is applied to skin covering bony outcrops of the body. Patients who are bedridden are at risk of developing pressure ulcers. , whether the resident has undergone amputations, etc.
Furniture needs. The type of furniture needed in the resident's room is the basic facility-provided or resident-owned furniture, albeit larger and with an increased weight capacity. The absolute minimum space designed to meet these needs adds an additional 5 feet to the width of the standard room. Additional space may be needed depending upon the resident's personal effects personal effects n. an expression often found in wills ("I leave my personal effects to my niece, Susannah") personal effects (things) include clothes, cosmetics, and items of adornment. and furniture.
Bariatric chairs have expanded widths--up to 36 inches--as do other pieces of bariatric furniture and equipment. The beds available for bariatric residents range up to 54 inches wide and 88 inches long when overhead bars are included (because the bars are attached to the outside surface of the headboard). Obviously, adequate space must be allowed to accommodate these items.
The minimum width for doors should be 60 inches, because the doorway into the room must accommodate the bed width and the widest piece of equipment. A split door that can be expanded to that width should be considered.
Equipment needs. The table on page 28 provides a list of equipment/furnishings that are needed for the bariatric resident.
Essential equipment for mobility includes an extra-capacity ceiling lift and/or a floor lift, in addition to an extra-capacity SARA Sara or Sarah, in the Bible, wife of Abraham and mother of Isaac. With Rebekah, Rachel, and Leah, she was one of the four Hebrew matriarchs. Her name was originally Sarai [Heb.,=princess]. , depending upon the resident's mobility.
There is increasing interest in ceiling-track systems that can save space and increase safety for both bariatric residents and their caregivers. All facilities being newly constructed or with resident rooms that are being significantly renovated should seriously consider ceiling lifts, because the expense of installing tracks in the ceiling is often less during construction than when retrofitting a room after construction is complete.
Some facilities have beds that convert to chairs. These may reduce the amount of space required, by eliminating the task of transferring a resident from the bed to a separate chair. Physical loads for caregivers transporting residents to a chair or to the bathroom are sometimes prohibitive pro·hib·i·tive also pro·hib·i·to·ry
1. Prohibiting; forbidding: took prohibitive measures.
2. , but a powered commode commode
Piece of furniture resembling the English chest of drawers, used in France from the late 17th century. Most had marble tops, and some were fitted with pairs of doors. chair or a powered mobile lift (the latter is in development) could make this activity possible in the future.
Space needs. Most residents of long-term care facilities need some type of assistance. From the caregiver's perspective, the space provided in resident rooms designed for bariatric residents must allow for proper ergonomic ergonomic - Concerning ergonomics or exhibitting good ergonimics. postures during nursing care activities to minimize musculoskeletal musculoskeletal /mus·cu·lo·skel·e·tal/ (-skel´e-t'l) pertaining to or comprising the skeleton and muscles.
Relating to or involving the muscles and the skeleton. injuries. Therefore, the room should be at least 13 feet, 3 inches wide by 15 feet long.
Mobility tasks for the bariatric resident, with varying space requirements, will usually be performed with equipment and three to four caregivers, depending on the resident's ability to assist. Options for transferring bariatric residents are:
* Independent transfer with or without aids, such as a mobile walking device, cane, or other device;
* Transfer with limited assistance from one healthcare provider and a mobile walking device, cane, or other device; or
* Transfer with three or more caregivers, using a mechanical transfer device such as a standing and raising aid (SARA), a sling sling (sling) a bandage or suspensory for supporting a part.
mandibular sling a structure suspending the mandible, formed by the medial pterygoid and masseter muscles and aiding in or ceiling lift, or a bed/stretcher that converts to a chair or repositioning repositioning Laparoscopic surgery The changing of a Pt's position during a procedure to improve access or visualization of the operative field, which may be linked to complications, as it changes anatomic planes of operation. Cf Laparoscopic surgery. aid.
Example of space needs. The care plan for a 600-pound, non-weight-bearing resident includes the need to perform a lateral transfer from the bed to a stretcher for showering, either with a ceiling lift and three caregivers or with a friction-reducing sheet and six caregivers. To turn lift equipment 360 degrees requires a 5-foot radius of floor space between the equipment and the walls. Ideally, there should also be 5 feet of space on either side of the bed, although a minimum of 39 inches is required to allow nurses to position their stance and move safely and ergonomically during resident-handling maneuvers.
Toileting space and equipment in standard bathrooms are not designed to manage residents weighing more than 350 pounds or those with wider bodies. Designers need to take into consideration the bathroom space needs not only of the bariatric resident, but also for special equipment and at least two caregivers. The activities that may take place in the bathroom include:
* Transporting a resident to the bathroom by wheelchair;
* Transporting the resident to the bathroom by commode chair;
* Residents ambulating by pushing or using an assistive walking device;
* Transporting residents with a sit/stand, ceiling, or floor lift; or
* Transferring residents to the toilet from a wheelchair using a walker, sit/stand aid, or lift device.
Which method should be used depends upon the resident's ability to assist and ambulate am·bu·late
intr.v. am·bu·lat·ed, am·bu·lat·ing, am·bu·lates
To walk from place to place; move about.
[Latin ambul . If it is determined that caregivers can safely transport the resident (with assistance), then the resident will be able to access the bathroom facility. If the resident cannot assist or the caregivers cannot safely transport the resident without risk of injury to the resident or themselves, then the resident may be toileted at the bedside using a commode chair.
Most toilets are not designed to accommodate the bariatric resident. Toilets that are floor mounted are preferable to those that are wall mounted, because they are more sturdy, but even they have their limits. If an oversized o·ver·size
1. A size that is larger than usual.
2. An oversize article or object.
adj. o·ver·size also o·ver·sized
Larger in size than usual or necessary. toilet is available then it should be purchased. However, if the toilet cannot accommodate the resident's size and weight, then an extra-capacity commode chair will need to be used over the toilet or at the bedside.
There also must be space for folding support handles used to assist the resident in standing, without impeding im·pede
tr.v. im·ped·ed, im·ped·ing, im·pedes
To retard or obstruct the progress of. See Synonyms at hinder1.
[Latin imped the access of mobility equipment. Additional space is also needed so that the caregiver care·giv·er
1. An individual, such as a physician, nurse, or social worker, who assists in the identification, prevention, or treatment of an illness or disability.
2. can assist the resident with hygiene care after the resident uses the toilet. The space we recommend is 31 inches on either side of a floor-mounted toilet. This will allow enough space from the walls to accommodate an oversize o·ver·size
1. A size that is larger than usual.
2. An oversize article or object.
adj. o·ver·size also o·ver·sized
Larger in size than usual or necessary.
Adj. 1. commode chair.
The toilet should be placed 8 inches from the wall. Since hygiene care in this small area is difficult, a built-in shower hose and wet area built into the design would be extremely helpful for those residents who are able to stand. This design currently needs to be studied and problems identified before being adopted, but it appears promising.
The ideal room configuration has a bathroom attached to the bedroom area.
Bariatric residents often find hygiene tasks difficult because they cannot reach all of the areas requiring care. Therefore, they usually need assistance. Caregivers also find it difficult to provide good hygiene for bariatric residents because of body folds and corresponding skin-integrity issues. In long-term care facilities, hygiene assistance is sometimes provided in private bathrooms, but usually it takes place in private or all-facility shower/tub rooms.
Depending on the size and weight of bariatric residents and their general health and mobility, it is possible that, for some, bathing in a tub would be unsafe or inappropriate. Currently available tubs are not designed to accommodate a resident who weighs more than 500 pounds; therefore, showering may be a safer and more acceptable practice. Shower chairs are currently being designed to accommodate the bariatric resident and should be available soon. An ideal design would allow the resident to recline re·cline
v. re·clined, re·clin·ing, re·clines
To cause to assume a leaning or prone position.
To lie back or down. in a comfortable position and be safely transported to the shower area by two caregivers.
For residents who do not meet the weight-limit criteria of shower chairs, reclining bariatric shower stretchers or plastic-covered bariatric transport stretchers should be considered. These residents cannot tolerate lying on their backs, so the reclining feature is important. Otherwise, they should only be showered while lying on one side with their head slightly propped up, if this position can be tolerated. Residents showered while lying on their side should not be turned during this procedure, because of the narrow width of most stretchers.
The shower stretcher is managed in the shower room Noun 1. shower room - a room with several showers
room - an area within a building enclosed by walls and floor and ceiling; "the rooms were very small but they had a nice view"
shower bath, shower stall - booth for washing yourself, usually in a bathroom by two to three caregivers. The shower area must be large enough to allow the caregivers to circulate cir·cu·late
v. cir·cu·lat·ed, cir·cu·lat·ing, cir·cu·lates
1. To move in or flow through a circle or circuit: blood circulating through the body.
2. around the entire stretcher while using the shower hose.
Our recommendation for the combined bathroom and shower area is 106 inches by 177 inches, and the length of the shower hose should be at least 98 inches. This type of bathing, with two or three caregivers, allows access to most body creases and difficult-to-reach areas. The shower door must be wide enough to allow the stretcher to pass through along with the caregivers.
In addition to space requirements for resident rooms and care areas, other issues must be considered by facilities planning to care for bariatric residents. For example, elevators must have the appropriate space and weight capacities. Also, planning what to do in the event of a bariatric resident's death is important in facilities that will need to transport and temporarily house the body.
Because of the dramatic rise in obesity, it is likely that the demand for care of bariatric residents in long-term care facilities will likewise increase. These facilities must consider the extra care, equipment, furniture, and space needs of these residents in order to properly provide that care and prevent injury, both to residents and caregivers. Caregivers who have worked with bariatric residents should be involved in the design of these facilities. The recommendations outlined in this article are meant to be used as a guide for designers and space planners and to provide administrators with important information on the relationship between space, equipment, and furnishings for quality care of bariatric residents. The space guidelines guidelines,
n.pl a set of standards, criteria, or specifications to be used or followed in the performance of certain tasks. described are based on current practices and currently available equipment. Future designs for bariatric equipment may alter space requirements.
Table. Typical equipment needs for bariatric residents * Extra-capacity floor and/or ceiling lift * Appropriately designed and sized slings (1X, 2X, 3X) * Wheelchairs in various widths (26", 28", and larger) * Extra-wide stretcher with 1,000 lb (455 kg) capacity * Extra-capacity and extra-width walkers * Armchair or stretcher-chair up to 32" (105 cm) wide * Step stool with extra size and weight capacity * Commode up to 42" (105 cm) wide * Extra-wide bedpans * Extra-capacity shower chair or shower stretcher * Extra-capacity standing and raising aids (SARAs) * Beds expandable up to 54" (135 cm) wide * Bariatric-size pressure-reduction mattresses * Trapeze bar system for over the bed * Powered "tug" for pushing bed, stretcher, or wheelchair * Bariatric-size friction-reducing devices (air-powered or slide sheets) * Extra-capacity clothing, slippers, and incontinence pads/briefs * Appropriately scaled tape measures for measuring special medical supplies--e.g., longer needles, larger blood pressure cuffs, etc.
1. Mokdad AH, Serdula MK, Dietz WH, et al. The spread of the obesity epidemic in the United States. 1991-1998. JAMA JAMA
Journal of the American Medical Association 1999;282:1519-22.
2. Mokdad AH, Bowman BA, Ford ES, et al. The continuing epidemics of obesity and diabetes in the United States. JAMA 2001;286:1195-1200.
3. World Health Organization. Global strategy on diet, physical activity and health. Accessible at www.who.int/dietphysicalactivity/en.
4. World Health Organization. Controlling the global obesity epidemic. Accessible at www.who.int/nut/obs.htm.
RELATED ARTICLE: Bariatric: Definition of Terms
The word bariatrics bariatrics /bar·i·at·rics/ (-e-a´triks) a field of medicine encompassing the study of overweight and its causes, prevention, and treatment.
n. is derived from the Greek word baros, meaning "weight." Whether someone is simply overweight or falls into the bariatric category is determined by the individual's body mass index (BMI BMI body mass index.
body mass index
Body mass index (BMI)
A measurement that has replaced weight as the preferred determinant of obesity. ), which is a calculation of body weight adjusted for height. The BMI can be calculated with a basic formula, using either pounds and feet/inches, or kilograms and meters/centimeters. A simple, government-sponsored BMI calculator calculator or calculating machine, device for performing numerical computations; it may be mechanical, electromechanical, or electronic. The electronic computer is also a calculator but performs other functions as well. , along with other useful information, is available at www.consumer.gov/weightloss/(click on the "BMI Chart" button and go to the bottom of the page to find the calculator).
An individual is considered to meet the bariatric criteria if he or she is overweight by more than 100 pounds, has a BMI of 40 or greater, or weighs more than 300 pounds (137 kg). (3,4)
BY MARYLOU MUIR, RN, OHN OHN Our Healthier Nation
OHN Occupational Health Nurse
OHN Often Heard News
OHN Olthoi Hoarde Nest
OHN Optical Hub Node ; AND LINDA L. HANEY, RN, MPH, COHN-S, CSP (1) (Certified Systems Professional) An earlier award for successful completion of an ICCP examination in systems development. See ICCP.
(2) (Commerce Service P
Marylou Muir, RN, OHN, has a certificate in Occupational Health Nursing. She is the Coordinator of Injury Prevention and Disability Management for the Winnipeg Regional Health Authority The Winnipeg Regional Health Authority (WRHA) is the governing body for healthcare regulation in an area of the Canadian province of Manitoba. Established in December 1999, the WRHA is one of 12 Regional Health Authorities in Manitoba responsible for coordinating health services in , Winnipeg, Manitoba, Canada, and has extensive involvement in nursing management for bariatric patients. Linda L. Haney, RN, MPH, COHN-S, CSP, is the Clinical Director for Diligent Services, a company that focuses on the reduction of injuries in healthcare workers. She develops and provides on-site clinical counseling in healthcare ergonomics ergonomics, the engineering science concerned with the physical and psychological relationship between machines and the people who use them. The ergonomicist takes an empirical approach to the study of human-machine interactions. to acute and long-term care facilities. For more information, contact her at (715) 842-3563. To comment on this article, please send e-mail to email@example.com. For reprints in quantities of 100 or more, phone (866) 377-6454.