Physical Labour, Dignity Preservation, and Weight Stigma in Nurses' Care for Larger-Bodied Patients in Acute Care Settings: A Qualitative Evidence Synthesis.

BACKGROUND: Acute care systems serve patients across a wide range of body sizes. For some larger-bodied patients, nursing care may become more physically demanding when body size and mobility needs interact with limitations in equipment, staffing, space, and workflows. These conditions may also challenge dignity preservation and contribute to weight stigma. AIM: To synthesize qualitative evidence on nurses' experiences of caring for larger-bodied adults described in the source literature using obesity-related classifications in acute care settings, and to examine how physical labour, dignity preservation, and weight stigma intersect in practice. METHODS: PubMed, Web of Science, Ovid, and the Cochrane Library were searched from inception to 15 April 2026. Eligible qualitative studies were appraised using the Joanna Briggs Institute Critical Appraisal Checklist for Qualitative Research. Data were synthesized using Thomas and Harden's three-stage thematic synthesis. RESULTS: Eleven reports representing 10 independent studies were included. Four analytical themes and 12 subthemes were generated: amplified physical labour; the non-standard body within standardized systems; fragile dignity preservation; and the clinicalisation of weight stigma. Care became more physically intensive, safety-sensitive, and team-dependent when body size and mobility needs exceeded the capacity of standard equipment, staffing arrangements, space, and workflows. These system-level mismatches could also increase exposure, constrain dignity-preserving care, and contribute to blame, othering, and implicit weight stigma. Nurses also described efforts to resist stigma through respectful communication, collaboration, perspective taking, and adaptive care. CONCLUSION: Physical labour, dignity preservation, and weight stigma are interrelated dimensions of acute nursing care for larger-bodied patients. Safer and more equitable care requires size-inclusive systems, appropriate equipment, adequate staffing, flexible workflows, and respectful body-size-sensitive communication. NO PATIENT OR PUBLIC CONTRIBUTION: This study is a meta-synthesis and does not require relevant contributions from patients or the public.