Nurses' Reactions to Patient Weight: Effects on Clinical Decisions

Abstract

In previous research, a variety of health care providers have expressed some degree of negative attitudes toward caring for obese patients. However, little is known about whether these negative attitudes lead to differential care. This study focused on the clinical decision-making of nurses, who are under-represented in this type of research despite their central and sustained role in patients’ care experiences. In an anonymous online survey, 256 nurses responded to clinical vignettes about a hypothetical patient depicted in a photograph. The patient’s appearance was altered to appear normal-weight or obese, for each of two different models per sex, utilizing a 2x2x2 experimental design. Participants indicated their clinical decisions related to walk assistance, timing of visits, pain management, and patient-centered communication. Participants also rated their attitudes toward the patient and provided relevant job and demographic information. Results revealed that although patient weight did have a significant negative influence upon nurses’ attitudes, nurses still held far more positive than negative attitudes toward patients of both weights. Furthermore, patient weight did not significantly impact nurses’ care decisions. Providing walk assistance to obese patients was perceived to be more physically demanding, a greater injury risk, and more likely to require additional assistance from a second staff member compared to normal-weight patients. However, neither the patient’s weight nor the nurse’s attitudes toward the patient influenced anticipated number of walk assists. Across all patients, the strongest predictor of walk assistance was the likelihood that a second staff member would be immediately available to help if needed. Findings suggest that although patients’ weight may influence nurses’ attitudes toward them, it is not likely to impact the quality of care they receive. Future research could examine the impact of resource availability (e.g., full staffing, specialized weight-appropriate equipment) on nurses’ care for patients of all weights.