Psychologically informed care of patients with anorexia nervosa on an acute medical ward.

Anorexia nervosa is a challenging and highly distressing illness associated with significant and often debilitating symptoms that affect the person's physical and mental well-being, as well as their wider social networks. Although some patients can make important steps in their recovery in the community, many will become significantly unwell and require medical stabilisation and refeeding in an acute medical ward as a result of significant weight loss. This article describes some of the challenges experienced by adult nurses when caring for patients with anorexia nervosa on acute medical wards and explores how the patient's distress may manifest and complicate the recovery process. The article also discusses the principles of psychologically informed care and therapeutic interactions that nurses can use to promote recovery and ensure optimal practice.

Psychometric properties of the Spanish version of the Experience of Caregiving Inventory (ECI) among caregivers of individuals with an eating disorder.

PURPOSE: The aim of this study was to examine the psychometric properties of the Spanish version of the Experience of Caregiving Inventory (ECI-S), which is designed to assess the caregiver's appraisal of the impact of caring for a relative with a serious mental illness. METHODS: A cross-sectional study was conducted among 320 caregivers of a relative with an eating disorder to examine: (a) descriptive statistics; (b) internal consistency reliability; (c) the fit of the original ten-factor structure of the ECI through exploratory factor analysis, using a semi-confirmatory approach, for each subscale individually, and (d) concurrent validity. A total of 307 caregivers completed the scale. RESULTS: Reliability of the ECI subscales scores was acceptable (α = 0.63-0.89). Results replicated the original ten-factor structure of the instrument. The concurrent validity was supported by correlations of the ECI-negative subscale with psychological distress (GHQ-12, 0.43), and with depression and anxiety (HADS, 0.48 and 0.49, respectively). CONCLUSIONS: The Spanish version of the ECI (ECI-S) demonstrated good psychometric properties in terms of validity and reliability that were similar to the original version. It is an acceptable and valid instrument for assessing the impact on family members of caring for a relative with an eating disorder and can be recommended for use in clinical settings in Spain. LEVEL OF EVIDENCE: Level V, cross-sectional descriptive study.

Anorexia nervosa in adolescents: An overview.

Anorexia nervosa (AN) is an eating disorder that is difficult to treat, and relapse is common. This article addresses management strategies and nursing interventions for adolescents diagnosed with AN.

Dynamics of nurses' authority in the inpatient care of adolescent consumers with anorexia nervosa: A qualitative study of nursing perspectives.

Nurses caring for adolescent consumers with anorexia nervosa in the inpatient setting are challenged in a unique way, in that they are caring for people with whom they do not have a mutually held concept of well-being. Their efforts to ensure weight gain are frequently against the wishes of the consumer. This dissonance results in challenging interactions, where nursing care and authority may be undermined. This study investigated the dynamics of nurses' authority within this context. Interviews with nurses (n = 10) were conducted and analysed through thematic analysis. Nurses reported that consumers, compelled by the psychopathology of anorexia nervosa, often sought to challenge or undermine their authority. Some nurses experienced the opposition and conflict as demoralizing, whereas others were able to maintain confidence in the therapeutic merit of their care. Younger, inexperienced nurses in this study were particularly vulnerable to interactions that mitigated their authority, due to their tendency to engage in friend-like relationships. Nurses caring for adolescents with anorexia nervosa should be prepared to be confronted by interactions that overtly and surreptitiously undermine their capacity to exercise professional authority. It is important that nurses recognize the importance of maintaining their authority, and how it can be threatened in subtle and unexpected ways.

Task-sharing interventions for patients with anorexia nervosa or their carers: a systematic evaluation of the literature and meta-analysis of outcomes.

The eating disorder clinical and scientific community advocates for the use of a shared approach to healthcare that actively involves patients and carers. A systematic review of the literature on guided self-help or self-help in anorexia nervosa (targeting either the individual affected by the illness or their carers) and meta-analyses of studies using randomised controlled designs for the evaluation of the outcomes: (1) drop-out from end-of-treatment assessment, (2) body mass index (BMI), (3) anxiety, (4) depression and (5) quality of life, were undertaken. Guided self-help was directed to patients in 15 studies and to carers in seven studies. The interventions were based on a variety of theoretical models, used different formats (books and digital materials), and were delivered by individuals with a range of experiences and expertise (e.g. individuals with lived experience of the illness, graduate students, or clinically trained professionals). Guided self-help was associated with significantly lower drop-out from the completion of end-of-treatment assessments compared to a control condition. There was an improvement in carers' wellbeing from skill-sharing interventions. Guided self-help may facilitate patients' treatment engagement and also improve carers' wellbeing.

Living with someone with an eating disorder: factors affecting the caregivers' burden.

We focused on carers of subjects suffering from eating disorders (ED), and studied the characteristics that mostly expose them to high levels of stress, anxiety, depression and expressed emotion, favoring the accommodation of the family system to the cared person. We administered the accommodation and enabling scale for eating disorders (AESED) questionnaire, the family questionnaire (FQ) and the depression, anxiety and stress scale (DASS-21) questionnaire to 97 carers of 62 ED patients, and investigated the carer's characteristics associated with the scores in the three questionnaires. A personal history of ED, being the primary carer, and caring for a person with a diagnosis of anorexia nervosa are the characteristics that contribute most to aggravate the carers' burden in terms of stress, anxiety, depression, accommodation and enabling. Our findings may help doctors to provide effective support to caregivers and eventually improve the treatment of subjects with ED.

[Occupational therapy and eating disorders, a care case study]. / Ergothérapie et troubles du comportement alimentaire, récit d'une prise en charge.

Occupational therapy offers support through actuation via a suggested activity. It opens up a differentiated space, a space of experiences where patients can contemplate themselves through play. The therapeutic relationship, assured by the occupational therapist, offers flexibility and malleability to welcome, contain and support the person with an eating disorder. It aims to be compassionate without judgement to favour the experience of movement. 'Making do with oneself' to 'be with oneself' while respecting the temporality of the patient's possibilities.

The nature of the therapeutic alliance between nurses and consumers with Anorexia Nervosa in the inpatient setting: A mixed-methods study.

AIMS AND OBJECTIVES: To develop a greater understanding of the nature of the inpatient therapeutic alliance between nurses and consumers with Anorexia Nervosa (AN). BACKGROUND: Consumers with AN value interpersonal relationships with nurses, finding these relationships meaningful and therapeutic. It is established that the therapeutic alliance enhances outcomes for consumers with AN. However, establishing the therapeutic alliance in the inpatient setting is considered challenging. DESIGN: This study employed a two-phase mixed-method explanatory sequential design. An initial quantitative survey, phase one, was followed by the collection and analysis of qualitative data, phase two. METHODS: Phase one employed validated survey instruments, measuring the perceived degree of therapeutic alliance and elements of ward milieu. Phase two involved semi-structured interviews that focused on therapeutic relationships between nurses and consumers, with specific exploration of the results from phase one. Data collection commenced May 2014 and concluded February 2015. RESULTS: The therapeutic alliance involved interpersonal engagement and a balanced application of authority. In a therapeutic alliance, nurses cared for consumers with interpersonal finesse, whilst maintaining clear distinction between the consumer as an individual and AN as an illness. Nurses also developed a therapeutic alliance by occupying their position of power with consistent yet individualised expectations and by maintaining appropriate professional boundaries. CONCLUSIONS: The therapeutic alliance between nurses and consumers with AN is not developed through negotiation of equal partners. Rather, the therapeutic alliance is dependent on nurses' capacity to maintain their position of power, whilst demonstrating their trustworthiness to the consumer. In trusting nurses, consumers felt safer in investing in a new concept of well-being. RELEVANCE TO CLINICAL PRACTICE: By understanding the nature of the therapeutic alliance as it is described in this study, nurses have an enhanced capacity to develop effective therapeutic alliances with consumers. A maternalistic nursing style emerged as a viable approach.

Therapeutic alliance, anorexia nervosa and the inpatient setting: A mixed methods study.

AIMS: The aim of this study was to understand the context of the inpatient setting for the treatment of anorexia nervosa and the implications for the therapeutic alliance between nurses and consumers. BACKGROUND: The nature of the therapeutic alliance is dependent on the contextual factors that influence interactions. The inpatient setting for the treatment of anorexia nervosa is one such setting where the therapeutic alliance is operative, yet challenging and poorly understood. DESIGN: A two-phase explanatory sequential design was employed. Descriptive statistics from phase one informed phase two interviews. Phase two data were analysed through thematic analysis. METHODS: A convenience sample of nurses and consumers were recruited from six wards, in five hospitals. Phase one involved the completion of a survey (N = 128) that measured the strength of the therapeutic alliance, as well as other elements of ward context. Phase two interviews (N = 54) were focused on the therapeutic alliance between nurses and consumers and the implications of the inpatient setting. Data collection occurred between May 2014 - February 2015. RESULTS: Anorexia nervosa as an illness carries destructive implications for the quality of the therapeutic alliance. Nurses' intimate position in the inpatient setting and interpersonal capacity is influential in overcoming the obstacles that impede the therapeutic alliance. CONCLUSION: Nurses' capacity for developing therapeutic alliances is in part dependent on a supportive ward organization and the adequacy of resources to permit meaningful interactions with consumers with anorexia nervosa. Understanding the contextual factors specific to the inpatient setting enhances nurses' ability to develop therapeutic alliances.

Procedures and Protocols for Weight Assessment During Acute Illness in Individuals With Anorexia Nervosa: A National Survey.

BACKGROUND: Weight assessment is a key component of nursing care for individuals with the acute illness of anorexia nervosa (AN). However, there is little data to guide protocols and procedures regarding weight assessment. OBJECTIVE: To describe institutional practices regarding weight assessment of individuals during acute illness of AN. DESIGN: Treatment facilities ( N = 24) completed a survey about written protocols and procedures regarding weight assessment and disclosure of weight to patients. RESULTS: The majority of facilities ( n = 22; 92%) have written protocols for weight assessment. Weight assessments occurred mostly in the morning ( n = 23; 95.8%), in hospital gowns ( n = 21; 87.5%), and after voiding ( n = 14; 58.3%). Respondents described mixed practices for disclosing weight to patients. CONCLUSION: Results indicate widespread variability in weight assessment and disclosure of weight. Further research is necessary to help develop evidence-based guidelines about weighing practices during acute illness for individuals with AN.

The Roy Adaptation Model: A Theoretical Framework for Nurses Providing Care to Individuals With Anorexia Nervosa.

Using a nursing theoretical framework to understand, elucidate, and propose nursing research is fundamental to knowledge development. This article presents the Roy Adaptation Model as a theoretical framework to better understand individuals with anorexia nervosa during acute treatment, and the role of nursing assessments and interventions in the promotion of weight restoration. Nursing assessments and interventions situated within the Roy Adaptation Model take into consideration how weight restoration does not occur in isolation but rather reflects an adaptive process within external and internal environments, and has the potential for more holistic care.

[Influence of the internet on eating disorders in teenagers]. / Influence d'Internet sur les TCA chez les adolescents.

Thanks to new technologies, young people can keep themselves informed, communicate, socialise and perform a host of other activities more easily, online. Adolescence is also a period of vulnerability for the development of eating disorders. This expansion of digital media in the daily lives of adolescents raises questions regarding the long-term implications and the possible impacts of the internet on the evolution and treatment of people with eating disorders.

[A mobile application for people with anorexia and bulimia]. / Une application mobile pour les personnes souffrant d'anorexie et de boulimie.

The development of new technologies in the field of eating disorders should help to improve access to care and serve to complement traditional treatments, notably after hospitalisations, to prevent early relapses. Mobile applications considered appropriate by experts, all Anglo-Saxon, do not necessarily offer the expected features. A French application has been developed at Sainte-Anne general hospital in Paris. It comprises a logbook, therapeutic tools and cognitive remediation games which favour better adaptability and improve psychological functioning.

[All the bodies of anorexia]. / Tous les corps de l'anorexie.

Anorexia is an active struggle against hunger. In this fight, the body is a real battlefield where the therapies used aim to re-establish peace. Hence the importance of an integrative 'body to body' approach between patient and caregiver.

[Anorexia and borderline personality disorder : bonds pathology]. / Anorexie mentale et trouble borderline : une pathologie du lien.

Comorbidity with a borderline personality disorder is far from rare in patients suffering from eating disorders. Clinically, this presents as chronic instability in many areas: interpersonal relationships, self-image, emotions, mood and acting out. Treatment is mainly based on a containing and reassuring therapeutic framework. A care plan may be put in place that incorporates reducing impulsive harmful, eating and self-harming behaviours. Dialectical behaviour therapy is intended in particular to prevent suicide risk in borderline personality disorder patients.

[Anorexia in males]. / L'anorexie au masculin.

Anorexia nervosa is often considered as a women disease, whereas 10% of the cases are men. There are much more researches in this field for a couple of decades. "Bigorexia", which combines food control and need for muscles, seems to be more frequent above men.

[Towards a transcultural approach to eating disorders]. / Pour une approche transculturelle des troubles du comportement alimentaire.

Anorexia must not be considered as a syndrome specific to a culture but as being linked to fast-moving sociocultural changes. Its occurrence can be favoured by certain transcultural phenomena, such as globalisation and the process of acculturation. The analysis of a clinical case of a young migrant with anorexia illustrates the complexity and need for complementary transcultural psychotherapy, to improve understanding and the future.

[My stomach, the monster under my bed]. / Mon ventre, ce monstre caché sous mon lit.

Care for patients with eating disorders is complex and plurimodal. Care plans need to be adapted in order to take into account the body in crisis. A series of hospital admissions combined with specific psychomotor approaches, can contribute to the patient being reappropriated with their own body.

[Care pathway for teenagers with anorexia]. / Trajectoires de soins de l'anorexie à l'adolescence.

Identifying a care pathway for a teenager with anorexia enables the therapeutic stages to be put into perspective. From prevention to full hospitalisation, from the general practitioner to the paediatrician or child psychiatrist, this harmonisation aims to help the patient feel safe at every level of the care pathway.