Running head: OCCUPATIONAL PROFILE & INTERVENTION PLAN

Occupational Profile and Intervention Plan

Brandon M. Roberson
Touro University Nevada

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Occupational Profile
Client
Jon Snow in an 83 year-old (y/o) male residing in Progressive Hospital, a long term acute
care (LTAC) facility. He was admitted into Progressive Hospital due to infected wounds. Jon is
a retired police sergeant from Chicago. His past medical history consists of lower extremity
cellulitis, coccyx wound, sleep apnea, deep vein thrombosis (DVT), morbid obesity, acute renal
failure, seizure disorder, and chronic obstructive pulmonary disease (COPD). He has lives alone
in a single story apartment. He has never married and has no pets. Before admission he fell out
of his wheelchair and broke his left shoulder and was on floor in his home for two weeks and
survived only by drinking his urine. Before admission he was using a power wheelchair (W/C)
and could stand pivot as well as take a few steps. Not being able to ambulate has caused him to
become increasingly depressed.
Need for Service
Jons primary diagnosis while being treating at Progressive Hospital is for the care of
infected wounds, something he wishes to complete independently. Jon is also seeking services to
increase independence with functional mobility, increase active range of motion (AROM),
decrease weight, and increase social interaction.
Concerns of client. The client reported wanting to increase independence with functional
mobility, increase AROM, decrease weight, and increase social interaction in order to improve
self-efficacy and overall quality of life (QOL) within his daily life activities. He has expressed
concerns relating to being able to surpass his prior level of function (PLOF) in regards to the
distance he is able to independently ambulate without the use of durable medical equipment

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(DME). Jon also shows concern regarding being able to independently manage his wounds, as
well as getting out of bed while in the hospital to help combat the depression he is experiencing.
Overall Jon stated he would like to increase his independence with his activities of daily living
(ADLs) and instrumental activities of daily living (IADLs) past his PLOF, to help facilitate a
higher QOL.
Occupations
Successful areas. Prior to admission the client was successful and independent using his
power W/C for functional mobility however, encountered frequent obstacles concerning
successful completion of occupations.
Barriers. Currently Jons infected wounds, morbid obesity, decreased range of motion
(ROM) in his left shoulder, as well as depression are affecting his successful engagement with
ADLs and IADLs. At the moment his depression is arguably the largest barrier affecting his
success due to his perception of himself, as well as the outlook he has on the rest of his life.
Another barrier Jon encounters is the lack of social support during this rough time in his life due
to the absence of family members and shortage of friends to act as a support system.
Factors supporting engagement. Jons prior living situation in a single story, W/C
accessible apartment supports his engagement in several desired occupations in and around his
home. Besides certain aspects pertaining to the accessibility of his home, the other aspect
supporting his engagement would be directly related to the personal context involving good
medical insurance procured through his job as a police officer.

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Factors inhibiting engagement. The client expressed that although some aspects of his
home support occupational engagement, the physical environment limits his abilities. The lack
of adaptive equipment (AE) within his home has made ADLs more difficult and hinders his
success in independently completing them. Another aspect which could be inhibiting Jons
engagement in desired occupations could be the cultural/society belief that obese people are lazy.
By associating Jon with this false and negative stereotype, he is not being given a fair and equal
chance at success. These negative thoughts are impacting his success by having him believe he
does not deserve to get better and will not. Jon is aware of these aspects because he has been
quoted with saying, I am a fat piece of shit just leave me here to die. Until his personal views
of himself change, certain intervention strategies may be futile.
Occupational History
Jon is an 83 y/o retired police sergeant from Chicago. He was born and raised with his
older sister in Germany until he was 18 y/o. He then moved to the United States of America
where he acquired a Bachelors degree in criminal justice in California. From there Jon attended
the police academy in Chicago and fulfilled his life-long dream of become a police officer. Jon
has never been married and does not have any children. Jons parents and sister have passed
away, along with nearly all of his friends from the police force.
Life roles. Jons daily life roles are minimal, in that his roles as a son and brother are no
longer an active part of his life. On a daily basis Jon has to care for himself, as he acts as his
own primary caregiver and does not have a spouse, children, or pets to care for. With that said he
takes care of meal preparation, cooking, clean-up, and home maintenance, among many other
IADLs, all of which used to be easier to complete before his health started deteriorating.

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Values and interests. Jon reported enjoyment while being outdoors, watching police
dramas, going to church, and traveling. He has recently shown an interest in learning how to
golf. He is saddened by the fact that his lack of community mobility has caused him to be unable
to attend church.
Engagement Patterns
Prior to retirement the client lived an active lifestyle before being diagnosed with limiting
health conditions. Being on the police force kept him in good shape physically and kept him
sharp cognitively. Immediately after retiring from the police force Jon procured a part time job
at UPS to keep busy. Illnesses forced Jon to resign his position after a year, and since then his
health has steadily declined. Jon had a pet German Shepard in the past; because he was
heartbroken when it passed away he has no desire to have another pet.
Changes. After Jons retirement and the steady decline of his health, his patterns of
engagement with his prior occupations have changed. Jon has not been able to participate in
numerous occupations due to his need for a W/C and his obesity. Jons social interaction and
roles were dramatically altered when his parents and sister passed away. Jon has also
experienced a change with decreased success with his ADLs and IADLs. These changes have
caused Jon to become depressed and pessimistic about his future.
Clients Priorities and Targeted Outcomes
Due to Jons past medical history it takes longer to complete his ADLs and IADLs.
Another pattern of his occupations which have changed over time would be in relation to meal
preparation. Due to decreased ROM, strength, and endurance combined with not having

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environmental modifications to make cooking simpler. Jon has resorted to eating prepared frozen
food often, which has been negatively impacting his health. Jons priorities are to return home
as independent as possible. He would like to increase his independence with his ADLs and
IADLs, improve the quality of sleep he achieves, and increase participation in play, leisure, and
social activities. Jon would like to prevent further health complications that may arise due to the
sedentary lifestyle he has been accustomed to. By returning home as independent as possible,
along with educating Jon pertaining to safety and energy conservation, his role competence will
improve. As discussed previously, Jon would like lose weight which would directly improve not
only his health and wellness but also his well-being, and over-all QOL.
Occupational Analysis
Context or Setting
Jons occupational therapy (OT) session was observed taking place in the inpatient setting
of Progressive Hospital. While at the hospital, the single session observed, over the span of three
hours, took place 50 percent in the patients room and 50 percent elsewhere on the facility
grounds.
Observed Activity
Due to Jons accident he has been bed-ridden since, decreasing his self-efficacy. He has
become increasingly depressed and even observed denying therapeutic services. Knowing that
without addressing this psychosocial issue first, physical interventions would not have as large of
an impact on his goals. Jons physician recommended getting him out of bed to improve his selfefficacy. Although the OT was hesitant, she proceeded with the physicians orders. During Jons

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OT session, I observed the patient participating in in-bed and functional mobility. Due to his
decrease strength, mobility, and ROM of his left upper extremity (UE) and decreased weight
bearing (WB) status, he was unable to complete this independently. After educating the client on
how the transfer from his bed to the cardiac chair was going to occur, it took two healthcare
professionals and three students to successfully transfer Jon. Upon transferring him to the
cardiac chair he had to remain there for five minutes until he was stable in regards to his vital
signs. From there Jon was pushed in his cardiac chair and taken outside, where he was cotreated by physical and occupational therapy. The physical therapy assistant (PTA) started off
Jons co-treatment with lower extremity (LE) exercises to increase his ROM and prevent edema.
After three sets of ten alternating repetitions, the PTA was satisfied with the clients therapeutic
activities for the day. At this point an occupational therapy assistant student (OTAS) began.
While seated upright in a cardiac chair, Jon was instructed to move his UE in a punching motion
forcefully enough to make contact with the OTAS hand in front of him. After 30 repetitions,
half of which required him to cross midline, the client became fatigued as well as hot. His vital
signs remained within normal limits (WNL) during and after his therapeutic exercises, allowing
us to transport him back to his room and into bed without any further complications.
Observations
The key observation I took away from Jons bed and functional mobility was the selfesteem boost and pleasure it brought him, despite struggling with the tasks. Prior to getting out
of bed for his treatment session, Jon had been bed-ridden for about two weeks and was growing
extremely depressed. This activity was beneficial and showed me that he was determined on
returning home as soon as possible (ASAP). The other observations I made while watching Jon

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attempt bed mobility, transferring, and therapeutic exercises was his decreased endurance,
strength, and ROM, all of which will need to improve significantly in order to safely return
home.
OTPF Domains
Occupation is used to mean all the things people want, need, or have to do (AOTA,
2014, p. S5) and with the fact his client factors, performance skills, performance patterns, and
context and environment are all impacted. Jons spirituality, or lack thereof, has had a negative
influence on successful engagement in his occupations. Jon grew up in a very religious family
and due to his deteriorating health; he has not been able to attend church as much as he once
could. This factor negatively impacts his psychosocial health, especially as he ages and nears the
end of his life. In regards to his body functions, those most impacted would be
neuromusculoskeletal and movement-related functions, muscle functions, movement functions,
and cardiovascular/respiratory systems. Lastly, in regards to body structures, Jon is affected by
the structures related to movement. If he continues to be unable to get out of bed he may start to
experience bed sores and possibly other issues relating to his skin.
Performance skills are goal-directed actions that are observable as small units of
engagement in daily life occupations. They are learned and developed over time (AOTA,
2014 p. S7). Many of Jons motor skills were impacted due to current health complications but
the two that have had the most significant impact are inadequate endurance and inability to walk.
By not being able to complete tasks without showing obvious signs of fatigue, as well as
respiratory complications, makes completing desired activities a longer and more tedious
process. The inability to walk has severely impacted Jons engagement in occupations due to

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reliance on his motorized W/C to ambulate. The most recent example of this limitation is when
Jon feel out of his W/C, broke his shoulder, and was not able to receive medical attention for two
weeks due his inability to independently ambulate without his W/C. Jon did not show any
obvious deficits with his processing skills. There were also no setbacks with his social
interaction skills, other than his desire to increase opportunities to engage in these occupations.
In regards to performance patterns, Jon has acquired an unhealthy lifestyle, which has led to the
decline of his health and wellness. As a result of other health complications, Jon is unable to
prepare healthier food options as he once did, and instead has gotten into the bad habit of eating
frozen prepared food. This unhealthy eating habit has turned into a daily routine. A large
cultural context which is negatively impacting Jon is the beliefs and expectations that society has
regarding obesity. Unfortunately, in todays society the majority of the population views the
obese and W/C bound negatively this can negatively impact ones self-esteem and self-efficacy.
The physical environment of his home hinders his successful engagement in occupations by not
having modifications to support mobility of his W/C. The lack of accessible shelves for use of
everyday items inhibits energy conservation and impacts Jons safety. Jon is aware of the lack of
relationships with friends and family and the negative affect it has on his overall QOL.
Problem Statements
Problem Statement One
Jon is (D) wound care management 2 lack of knowledge.
Problem Statement Two
Jon is Max (A) transfers 2 limited awareness of technique & safety precautions.

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Problem Statement Three
Jon requires Max (A) to complete ADLs 2 limited AROM.
Problem Statement Four
Jon requires Max (A) while walking 2 muscular/cardiorespiratory endurance.
Problem Statement Five
Jon is (D) LE dressing 2 limited UE ROM.
Intervention Plan & Outcomes
Long Term Goal
Jon will be able to perform wound management care Mod (I) while standing at sink
within 4 wks.
Short-term Goal #1. Jon will verbally demonstrate exceptionable knowledge of wound
care techniques while sitting EOB by 1 wk.
Intervention. This intervention plan will focus on educating the client on proper
wound care management while working on static sitting balance EOB. The education
portion will consist of demonstration of proper wound cleaning techniques on the patient
as well as in front of the patient for a better visual representation. This will be crucial
practice for the client, for he will be progressing to dynamic sitting balance and up to
dynamic standing balance before discharge.

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This intervention is supported by the study completed by Chen, Wang, Chen,
Smith, Huang and Huang (2013). The objective of this study was to explore the
effectiveness of a wound care program for patients. The rationale of the researchers for
conducting this study is because one of the major issues for trauma patients at home is
wound care. Little is known about how healthcare education impacts patient care of
wounds after discharge. Chen et. al (2013) studied 178 participants and concluded the
wound care program increased the patients knowledge, skills of wound care, and the
satisfaction of health education for the experimental group. They also discovered in post
wound care training, the experimental groups wound infection rate of nine percent was
lower than the 20.2 percent experienced by the control group. They determined through
practical demonstration of teaching and self-practice was most effective for patients in
learning their wound care. Quality education for bariatric patients and care providers is
critical for injury prevention. Lack of training, poor staffing, and unsafe handling
techniques can result in iatrogenic tissue damage (Muir & Archer-Heese, 2009).
Approach. The approach for this intervention is establish and restore. With this
intervention the OT will help to establish proper cleaning techniques and an appropriate
cleaning schedule for Jon to follow in order to prevent further infection of his wounds.
Desired outcome. The type of outcome the OT would strive for with this
particular intervention would be to increase Jons independence and perceived wellbeing.
Precautions and contraindications. Precautions and contraindications for this
intervention would include Jons comprehension of the education process as well at the

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potential to fall while EOB. If Jon is not able to effectively comprehend how to properly
clean his wounds, he will increase his risk for developing additional infections as well as
potential decreasing his self-efficacy. The OT should always be cautious of patients
potentially falling, particularly in Jons case given his medical history and multiple
diagnoses. Due to being bed-ridden for the past two weeks along with spending a
substantial amount of time in his wheelchair over the course of his life, his trunk strength,
righting reflexes, and muscular endurance have all been impacted, increasing his risk of
another fall. The OT will want to make sure they are aware that Jon recently suffered a
traumatizing experience after his last fall and may be reluctant to sit EOB.
Graded up and down. Depending on Jons performance of the activity the OT
may want to grade the activity up or down. An example in which to grade the activity up
sitting EOB, while being educated on wound care management, could be graded up could
involve having Jon sitting EOB but with a soft surface, or Bosu Ball under his feet
(opposed to being firmly planted on the ground). This will force Jon to be continuously
engaging his core muscles to right himself and keep from losing balance and potential
falling over. An example for grading the activity down could involve the OT doing the
demonstration and education portion while he is supine in bed followed by working on
sitting EOB. What this will allow is for Jon to focus his attention only on sitting EOB
and keeping his balance and decrease the possible distraction of comprehending vital
wound care instructions.
Short-term Goal #2. Jon will be able to perform changing wound bandages Min (A)
bariatric walker at sink by 3 wks.

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Intervention. This intervention plan will focus on having Jon changing his own
bandages while standing at a sink with the use of a bariatric walker. This will not only be
useful practice for Jon when he is discharged but also allow him to work on LE strength
and endurance, while the OT supervises and provides feedback about bandage changing
techniques for safety purposes.
This intervention focusing on the importance of proper wound care management
is supported by Dr. Janice Beitz (2014). Dr. Beitz (2014) discussed how obesity has a
profound impact on the health and integrity of the patients integumentary system and
how these bariatric patients are at risk for multiple skin disorders and delayed wound
healing. This article stresses the importance of skin care and proper wound management
care and how failure to address these issues, recognize impending breakdown, treat extant
damage, and meet nutritional demands can result in severe consequences for the bariatric
patient. Supported by numerous research articles with evidence emphasizing the
importance of wound care management it strengthens the argument to teach Jon how to
properly care for his wounds by changing the bandages when necessary to prevent further
complications.
Approach. The approach for this particular intervention is establish and restore.
By having Jon establish a skill that he has not yet developed, managing his wound care,
the OT would hope to restore part of his independence along with his health and
wellness.
Desired outcome. The desired outcome for this intervention would be to increase
Jons skills pertaining to his wound care. By doing this he may not feel as reliant on

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others and may even feel a sense of self accomplishment. The other intended outcome
would be to improve his dynamic standing balance and WB through his LE. By
accomplishing this Jon will be able to increase his duration of LE WB and eventually
ambulate longer distance without his power W/C.
Precautions and contraindications. Precautions and contraindications the OT
would have to be aware of would apply to proper changing technique of his bandages. If
the OT is not aware of Jons safe completion of the activity and does not catch errors, Jon
could unknowingly cause himself harm while trying to change them elsewhere. Another
precaution and contraindication to be aware of would pertain to the risk of falling while
standing at the sink. It would be crucial to monitor Jons vitals closely and at the first
sign of distress have him sit in a bariatric W/C which should be place right behind him
against the back of his knees.
Grading up and down. One way to grade up this activity of standing and
changing wound bandages, would be to have Jon complete the activity of standing at the
sink without the aid of the bariatric walker. Before attempting this, the OT should ensure
that Jon is physically as well as mentally capable to participate in this activity. It would
also be of utmost importance for the OT to have a bariatric W/C behind Jon in case he
fatigues quickly so he does not fall to the floor. A way to grade this activity down while
reducing the fall risk would be to stand and perform wound care management with the
aid of an EZ Way Smart Stand 800 lb. Bariatric Sit-to-Stand. This DME will still enable
Jon to safely perfect his bandage changing techniques while still WB through his LE (EZ
Way, 2014).

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Long-term Goal
Jon will be able to transfer Mod (I) using various bariatric AE & DME by 4 wks.
Short-term Goal #1. Jon will be able to transfer Mod (A) supine EOB using log
rolling & proper bed mobility techniques by the end of 3 wks.
Intervention. The purpose of this intervention would be to improve Jons bed
mobility in order to decrease the risk of pressure sores and other skin related
complications. This intervention would also provide Jon with knowledge of proper
transfer techniques while having him participate. By having Jon actively participate, he
may feel a sense of pride by physically contributing to his health and wellness; he is also
unknowingly helping the OT with the transfer by limiting their risk for injury.
This article by Muir and Archer-Heese (2009) realized that many bariatric
patients, due to their size and difficulty with mobility, require assistance with numerous
ADLs. This study has also found that the more mobility-dependent the patient is, the
more vulnerable they become for health complications during their hospital stay. By
making patients as mobile as possible, their risk of obese related complications will
decrease and with that their self-esteem increase. The study also showed that mobility
challenges increase with age for bariatric patients. Evidence-based research shows that
bariatric patients should be working on bed mobility in order to decrease the risk of
chronic illnesses including: cardiac disease, hypertension, respiratory disease, diabetes,
skin conditions, osteoarthritis, stress incontinence, hyperlipidemia, depression, decreased
self-esteem, certain types of cancers, and gallbladder disease.

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Approach. By taking a modify approach to this intervention, it will be directed at
finding ways to revise the current context or activity demands to support performance in
the natural setting (AOTA, 2014 p. S33) and allowing Jon to be as mobile as possible
in bed.
Desired outcome. By practicing bed mobility the OT will hope to improve
occupational performance and health and wellness but also prevent occurrence of other
complications associated with a lack of bed mobility.
Precautions and contraindications. While completing this intervention it would
be important for the OT to me mindfully of Jons surroundings. The OT should make
sure that environment is conducive and free of cords/wires in order for Jon to
successfully log roll and transfer. Obvious signs of fatigue and an unsafe drop in Jons
vitals should call for an immediate halt to the activity. Jon has been bed-ridden for a
couple of weeks and sitting up quickly or strenuous activity could cause his blood
pressure to drop and cause him to experience syncope.
Grading up and down. The OT could grade this activity up and make it more
difficult by offering Min (A) instead of Mod (A) and have Jon expend more of his own
energy to transfer from supine to EOB. The OT could also make this activity simpler for
Jon by beginning the activity with him on his side side-lying and have him transfer EOB
from this position rather than being in supine.
Short-term Goal #2. Jon will transfer bariatric W/C bariatric shower chair Mod (A)
using a stand-pivot transfer by the end of 3 wks.

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Intervention. The main focus of this intervention would be to familiarize Jon with
the bariatric shower chair while working on increasing his transfer proficiency. These
will be valuable skills for the client when he is ready to leave the facility. This
intervention will also teach Jon how to pick out and size appropriate DME according to
his size and weight. This will allow him to conserve energy as well as increasing his
safety.
The Washington Department of Labor and Industries, Safety and Health
Investment Projects (2014) stressed the importance of addressing weight concerns
directly with sensitivity and honesty. It also discussed how to focus on the patient as an
individual, and not a population, and to praise efforts and accomplishments while
reinforcing goals and goal-directed behavior. It is important to educate the clients on
how to select appropriate equipment while making sure patients can adjust it to fit their
individual needs. Multiple risk factors can be reduced by selecting proper equipment and
knowing how to safely use it. Once the correct equipment is selected it is crucial to
encourage as much participation as possible. By having the clients assist as much as
possible they are able to prevent learned helplessness, while increasing their overall
independence.
Approach. The main focus of this intervention will be to restore (establish). It
was noted that Jon was able to independently complete a stand-pivot transfer before
admission, which has since then become impaired.
Desired outcome. The desired outcome for this intervention would be to improve
his occupational performance in regards to transfers. By accomplishing this, the

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intervention will also seek to increase his participation in the desired activity of bathing.
And lastly the successful completion of both previous outcomes will directly improve his
well-being by increasing his self-esteem and independence.
Precautions and contraindications. Precautions and contraindications while Jon
is transferring would mostly be associated with muscular fatigue, loss of breath, chest
pains, and monitoring his vitals to ensure they are within WNL. All of these things
would need to be closely monitored, along with the risk of falling. As previously
discussed, Jon suffered a bad fall recently and may be skeptical and fearful when
attempting these activities.
Grading up and down. This activity of transferring could be graded up by having
the client participate in multiple transfers. By having Jon transfer EOB to W/C and then
from W/C to bariatric shower chair, his muscular endurance would undergo more stress.
An option for the OT to grade this activity down could be to offer a longer rest break
between transfers. This would give Jon extra time to catch his breath and focus on what
he needs to accomplish next to safely transfer to the bariatric shower chair.
Frequency and Duration
Jon will participate in OT treatment services five times a week for 60 minutes a day. He
will receive skilled OT services for a total of four weeks.
Framework
The model likely to be most beneficial for Jon would be the Person Environment
Occupation Performance (PEOP). This top down approach to Jons intervention would take into

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account his psychological status, being depressed, and aim to improve that before solving
environmental issues. The PEOP utilizes the clients perceptions of their own occupational
performance issues as the cornerstone for the intervention. By looking at the interactions of his
intrinsic and extrinsic factors this will enhance the OTs ability to emphasize valued roles, tasks
and activities that are personal to Jon and his performance of them. This model would allow Jon
to have more influence in his treatment compared to other models because the PEOP takes the
clients view of the problem and makes that the primary concern (Crepeau, Cohn, & Boyt, 2009).
Client or Caregiver Training and Education
Not only will Jon receive specific education before he is discharged, but continuously
throughout therapy. Typically the family would be educated on appropriate DME/AE usage, and
environmental modifications to make the clients life simpler, however Jon has limited family
support. Moreover, the goal for educating Jon is that he will remember proper wound care
management techniques, bed mobility, and transfer techniques upon discharge well enough to
safely complete the tasks. In addition, the OT will want to make sure Jon is able to explain the
instructions in vivid details to a caregiver, if he were to need one in the futures. Educating the
client will allow him to remain safe while making him an advocate for himself.
Clients Response
The OT will monitor Jons progress in reaching his goals through observation, and his
daily progress notes. Upon being admitted to Progressive Hospital Jon underwent an in-depth
initial evaluation. This evaluation contained information such as his previous and current level
of functioning. His level of functioning will be informally observed on a daily basis and halfway
through his stay at Progressive he will be formally reevaluated on his progress and response to

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current interventions. The OT will make sure he is making adequate progress towards his goals
and may change intervention strategies if need be. Progressive Hospital does their initial
evaluations differently from other healthcare facilities so his progress towards his goals would
reflect with his improvement of independence levels.

References
American Occupational Therapy Association. (2014). Occupational therapy practice framework:
Domain and process (3rd ed.). American Journal of Occupational Therapy, 68(Suppl. 1),
S1-S48. http://dx .doi .org/10 .5014/ajot .2014 .682006
Chen, Y.-C., Wang, Y.-C., Chen, W.-K., Smith, M., Huang, H.-M. and Huang, L.-C. (2013), The
effectiveness of a health education intervention on self-care of traumatic wounds. Journal
of Clinical Nursing, 22: 24992508. doi: 10.1111/j.1365-2702.2012.04295.x

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Crepeau, E., Cohn, E., Boyt Schell, B. (2009). Willard & Spackmans occupational therapy (11th
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Muir, M., Archer-Heese, G., (January 31, 2009) "Essentials of a Bariatric Patient Handling
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EZ Way Smart Stand 800 lb. Bariatric Sit-to-Stand. (n.d.). EZ Way. Retrieved September 7,
2014, from http://ezlifts.com/products/product_details.cfm?ProductID=29
http://ezlifts.com/products/product_details.cfm?ProductID=29
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Hahler, B. (2002, April 1). Morbid obesity: a nursing care challenge. (Clinical
Practice).. MedSurg Nursing, 60, 12-21.
Beitz, J. (2014). Providing Quality Skin and Wound Care for the Bariatric Patient: An
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