Two bariatric surgeries however, are more than sufficient for the current patient to gradually and safely lose weight; and allowing the third surgery to proceed would also be akin to enabling her dependence. I could sense that her demeanour and attitude about the surgeries were based on the concept that the surgeries can be easily availed of and it was her right to demand said services. I felt that her dependence on bariatric surgeries must be stopped and the services to be offered to her must be based on her health maintenance – not on more bariatric surgeries. In a study by Kushner (2000, p. 126), the authors emphasized the importance fulfilling the essential caloric intake from the limited food intake allowable after gastric banding. This should be focused on by the patient – not the need for more surgeries.What was good about the experience was that I learned to detect signs of dependence in patients. I was able to assess the patient’s behaviour and attitude about the surgery and to determine whether these symptoms were indicative of dependence. The experience also taught me how to deal with patients and their dependence. Normally, I would have given in to a patient’s requests; and, this experience taught me to how to therapeutically refuse a patient’s requests or demands. Therapeutically refusing a patient is not simply about refusing a patient’s requests, but it is also about making oneself available to respond to the patient’s emotional needs (Austin, 2010, p.What was bad about the experience was that we had limited options for the patient in terms of psychological or mental health assistance. We knew that she was going through some mental health issues which affected her determination to lose weight. As health professionals, we could have provided more counselling for her in order to ensure that she would be able to deal with the emotional challenges of her obesity and to eventually maintain her weight without requiring further bariatric surgery. A study by Kalarchian, et., (2007, p. 328) was able to point out that for patients with previous mental health issues before their bariatric surgeries, they need the most mental care and attention in order to ensure that the benefits of the surgery would be gained.The situation portrays one of the controversial and difficult health issues which people face – their weight. For the patient, I believe that she was encouraged by the results of her surgery and perhaps for
Austin (2010) Psychiatric and mental health nursing for Canadian practice, London: Lippincott Williams and Wilkins
Dixon, J., Pories, W., O’Brien, P., Schauer, P. & Zimmet, P. (2005) Surgery as an Effective Early Intervention for Diabesity. Why the reluctance? Diabetes Care, volume 28, number 2, pp. 472-474
Kalarchian, M., Marcus, M., Levine, M., Courcoulas, A., Pilkonis, P., Ringham, R., Soulakova, M., Weissfeld, L., & Rofey, D. (2007) Psychiatric Disorders Among Bariatric Surgery Candidates: Relationship to Obesity and Functional Health Status, American Journal of Psychiatry, volume 164, pp. 328-334
Kushner, R. (2000) Managing the obese patient after bariatric surgery: A case report of severe malnutrition and review of related literature, Journal of Paternal and Enteral Nutrition, volume 24, number 2, pp. 127-132.
Van Hout, G., Verschure, S., & van Heck, G. (2005) Psychosocial predictors of success following bariatric surgery, Obesity Surgery, volume 15, pp. 552-560
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