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1.
Nursing ; 49(10): 24-30, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31568077

RESUMO

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.


Assuntos
Anorexia Nervosa/enfermagem , Adolescente , Anorexia Nervosa/complicações , Anorexia Nervosa/epidemiologia , Anorexia Nervosa/fisiopatologia , Comorbidade , Humanos , Transtornos Mentais/epidemiologia , Diagnóstico de Enfermagem , Fatores de Risco
2.
Int J Ment Health Nurs ; 28(4): 940-949, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30931550

RESUMO

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.


Assuntos
Anorexia Nervosa/enfermagem , Relações Enfermeiro-Paciente , Enfermagem Psiquiátrica/métodos , Adolescente , Anorexia Nervosa/terapia , Feminino , Hospitalização , Humanos , Poder Psicológico , Pesquisa Qualitativa
3.
Int Rev Psychiatry ; 31(4): 367-381, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30950660

RESUMO

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.


Assuntos
Anorexia Nervosa/psicologia , Anorexia Nervosa/terapia , Cuidadores , Psicoterapia , Autogestão , Anorexia Nervosa/enfermagem , Humanos
4.
Eat Weight Disord ; 24(6): 1209-1214, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-29368292

RESUMO

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.


Assuntos
Ansiedade/psicologia , Cuidadores/psicologia , Depressão/psicologia , Transtornos da Alimentação e da Ingestão de Alimentos/enfermagem , Estresse Psicológico/psicologia , Adolescente , Anorexia Nervosa/enfermagem , Emoções Manifestas , Relações Familiares/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pais/psicologia
6.
Soins Psychiatr ; 39(316): 31-33, 2018.
Artigo em Francês | MEDLINE | ID: mdl-29753436

RESUMO

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.


Assuntos
Transtornos da Alimentação e da Ingestão de Alimentos/enfermagem , Transtornos da Alimentação e da Ingestão de Alimentos/reabilitação , Terapia Ocupacional/enfermagem , Adolescente , Anorexia Nervosa/enfermagem , Anorexia Nervosa/reabilitação , Criatividade , Feminino , Humanos , Relações Enfermeiro-Paciente , Terapia Ocupacional/métodos , Autoimagem
7.
J Am Psychiatr Nurses Assoc ; 24(3): 241-246, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-28754062

RESUMO

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.


Assuntos
Anorexia Nervosa/enfermagem , Revelação/estatística & dados numéricos , Exame Físico/métodos , Guias de Prática Clínica como Assunto , Enfermagem Psiquiátrica/métodos , Inquéritos e Questionários/estatística & dados numéricos , Doença Aguda , Peso Corporal , Humanos , Estados Unidos
8.
J Adv Nurs ; 74(2): 443-453, 2018 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-28792604

RESUMO

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.


Assuntos
Anorexia Nervosa/enfermagem , Anorexia Nervosa/psicologia , Pacientes Internados/psicologia , Relações Enfermeiro-Paciente , Recursos Humanos de Enfermagem no Hospital/psicologia , Equipe de Assistência ao Paciente/organização & administração , Enfermagem Psiquiátrica/métodos , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente , Resultado do Tratamento
9.
J Clin Nurs ; 27(1-2): 416-426, 2018 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-28677200

RESUMO

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.


Assuntos
Anorexia Nervosa/enfermagem , Anorexia Nervosa/psicologia , Pacientes Internados/psicologia , Relações Interpessoais , Relações Enfermeiro-Paciente , Recursos Humanos de Enfermagem no Hospital/psicologia , Enfermagem Psiquiátrica/métodos , Adolescente , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , New South Wales , Inquéritos e Questionários , Adulto Jovem
10.
ANS Adv Nurs Sci ; 40(4): 370-383, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28825933

RESUMO

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.


Assuntos
Adaptação Psicológica , Anorexia Nervosa/enfermagem , Anorexia Nervosa/psicologia , Atitude Frente a Saúde , Relações Enfermeiro-Paciente , Recursos Humanos de Enfermagem no Hospital/psicologia , Pacientes/psicologia , Adulto , Atitude do Pessoal de Saúde , Feminino , Humanos , Modelos de Enfermagem , Resultado do Tratamento , Adulto Jovem
11.
Soins Psychiatr ; 38(311): 21-24, 2017.
Artigo em Francês | MEDLINE | ID: mdl-28683881

RESUMO

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.


Assuntos
Anorexia Nervosa/enfermagem , Anorexia Nervosa/psicologia , Bulimia Nervosa/enfermagem , Bulimia Nervosa/psicologia , Internet , Smartphone , Apoio Social , Adolescente , Feminino , Troca de Informação em Saúde , Humanos , Fatores de Risco
12.
Soins Psychiatr ; 38(311): 40-43, 2017.
Artigo em Francês | MEDLINE | ID: mdl-28683886

RESUMO

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.


Assuntos
Anorexia Nervosa/enfermagem , Anorexia Nervosa/psicologia , Bulimia Nervosa/enfermagem , Bulimia Nervosa/psicologia , Smartphone , Terapia Assistida por Computador , Adolescente , Adulto , Criança , Terapia Cognitivo-Comportamental , Terapia Combinada , Feminino , França , Acesso aos Serviços de Saúde , Hospitalização , Humanos , Masculino , Educação de Pacientes como Assunto , Prevenção Secundária , Adulto Jovem
13.
Rev. Rol enferm ; 39(11/12): 759-764, nov.-dic. 2016.
Artigo em Espanhol | IBECS | ID: ibc-157990

RESUMO

La incidencia de los trastornos de la conducta alimentaria (TCA) es ahora más alta que nunca. La edad promedio de inicio de la anorexia nerviosa está en los 17 años. La prevalencia encontrada es preocupante. En las chicas escolarizadas de 12 a 21 años, parece que el 4-5 % padece algún TCA (diagnosticado por psiquiatra). En este trabajo se pretende reflejar, mediante un caso clínico, los cuidados de enfermería que se realizan en una unidad de psiquiatría infanto-juvenil a los usuarios que ingresan con diagnóstico de anorexia nerviosa. Se trata de una adolescente que ingresa en la unidad con diagnóstico de anorexia nerviosa. Inicialmente, se realiza una valoración mediante los patrones funcionales de Gordon, para posteriormente determinar las esferas sobre las que se va a actuar y enunciar los diagnósticos principales, con sus respectivos objetivos e intervenciones. La atención de enfermería en la Unidad de Psiquiatría Infanto-Juvenil es primordial. Las enfermeras son las que están en constante contacto con los pacientes y las que limitan las conductas de estos. También actúan como confesores y mantienen una relación estrecha con ellos (AU)


The incidence of eating disorder (ED) is now higher than ever. The average age of onset of anorexia nervosa is 17 years. The prevalence found is worrying. In the girls in school 12 to 21 years, it seems to suffer from a 4-5 % ED (diagnosed by a psychiatrist). This work intends to reflect, through a clinical case, the nursing care performed in a unit of child and adolescent psychiatry users admitted with diagnosis of anorexia nervosa. The teenager joined the unit with a diagnosis of anorexia nervosa. Initially, an evaluation is performed by the functional patterns of Gordon, later to identify areas on which it will act and state the principal diagnoses, with their respective objectives and interventions. The nursing care at the Adolescent Psychiatry Unit is paramount. Nurses are the ones that are in constant contact with patients and limiting these behaviors. They also act as confessors and maintain a close relationship with them (AU)


Assuntos
Humanos , Feminino , Criança , Adolescente , Anorexia Nervosa/enfermagem , Cuidados de Enfermagem , Comportamento do Adolescente/psicologia , Psicologia do Adolescente , Transtornos Nutricionais/complicações , Transtornos Nutricionais/enfermagem , Transtornos Nutricionais/psicologia , Comportamento Alimentar/fisiologia , Comportamento Alimentar/psicologia , Fenômenos Fisiológicos da Nutrição do Adolescente/fisiologia , Ansiedade/enfermagem , Estado Nutricional/fisiologia , Saúde Mental
14.
Soins Psychiatr ; 37(307): 10-12, 2016.
Artigo em Francês | MEDLINE | ID: mdl-27890267

RESUMO

Anorexia is a reflection of issues with the body in all its states. The social body and the representation of a model's body, mistreated in order to meet certain standards, the medical body shaken by the mystery of anorexia, and the subjective body and the reality of the flesh. The anorexic body is a testament to a past full of pain and neglect, a sign of emotional deficiency. Caring for the body of a person with anorexia, whatever the approach, means also and above all working with the future of a human being.


Assuntos
Anorexia Nervosa/enfermagem , Anorexia Nervosa/psicologia , Imagem Corporal , Adolescente , Criança , Abuso Sexual na Infância/psicologia , Fantasia , Feminino , Humanos , Imaginação , Acontecimentos que Mudam a Vida , Autoimagem , Conformidade Social , Valores Sociais , Magreza/enfermagem , Magreza/psicologia
15.
Soins Psychiatr ; 37(307): 13-14, 2016.
Artigo em Francês | MEDLINE | ID: mdl-27890268

RESUMO

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.


Assuntos
Anorexia Nervosa/enfermagem , Anorexia Nervosa/psicologia , Imagem Corporal , Fome , Comportamento Aditivo/enfermagem , Comportamento Aditivo/psicologia , Bulimia/enfermagem , Bulimia/psicologia , Feminino , Humanos , Peso Corporal Ideal , Desnutrição/enfermagem , Desnutrição/psicologia , Relações Enfermeiro-Paciente
16.
Soins Psychiatr ; 37(307): 15-19, 2016.
Artigo em Francês | MEDLINE | ID: mdl-27890269

RESUMO

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.


Assuntos
Anorexia Nervosa/enfermagem , Anorexia Nervosa/psicologia , Transtorno da Personalidade Borderline/enfermagem , Transtorno da Personalidade Borderline/psicologia , Apego ao Objeto , Transtorno Reativo de Vinculação na Infância/enfermagem , Transtorno Reativo de Vinculação na Infância/psicologia , Encenação , Anorexia Nervosa/diagnóstico , Anorexia Nervosa/epidemiologia , Comportamento Aditivo/diagnóstico , Comportamento Aditivo/epidemiologia , Comportamento Aditivo/enfermagem , Comportamento Aditivo/psicologia , Transtorno da Personalidade Borderline/diagnóstico , Transtorno da Personalidade Borderline/epidemiologia , Bulimia/diagnóstico , Bulimia/epidemiologia , Bulimia/enfermagem , Bulimia/psicologia , Terapia Combinada/enfermagem , Comorbidade , Feminino , Hospitalização , Humanos , Masculino , Terapia Ambiental , Relações Enfermeiro-Paciente , Prognóstico , Transtorno Reativo de Vinculação na Infância/diagnóstico , Transtorno Reativo de Vinculação na Infância/epidemiologia , Fatores de Risco
17.
Soins Psychiatr ; 37(307): 20-21, 2016.
Artigo em Francês | MEDLINE | ID: mdl-27890270

RESUMO

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.


Assuntos
Anorexia Nervosa/enfermagem , Anorexia Nervosa/psicologia , Adulto , Anorexia Nervosa/diagnóstico , Anorexia Nervosa/epidemiologia , Composição Corporal , Transtornos Dismórficos Corporais/diagnóstico , Transtornos Dismórficos Corporais/epidemiologia , Transtornos Dismórficos Corporais/enfermagem , Transtornos Dismórficos Corporais/psicologia , Imagem Corporal , Estudos Transversais , Humanos , Controle Interno-Externo , Masculino , Desenvolvimento Muscular , Somatotipos
18.
Soins Psychiatr ; 37(307): 22-24, 2016.
Artigo em Francês | MEDLINE | ID: mdl-27890271

RESUMO

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.


Assuntos
Aculturação , Anorexia Nervosa/etnologia , Anorexia Nervosa/enfermagem , Emigrantes e Imigrantes/psicologia , Enfermagem Transcultural/métodos , Adolescente , Anorexia Nervosa/psicologia , Anorexia Nervosa/terapia , Criança , China/etnologia , Feminino , França , Humanos , Relações entre Irmãos/etnologia , Mudança Social , Valores Sociais
19.
Soins Psychiatr ; 37(307): 25-30, 2016.
Artigo em Francês | MEDLINE | ID: mdl-27890272

RESUMO

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.


Assuntos
Anorexia Nervosa/enfermagem , Anorexia Nervosa/psicologia , Imagem Corporal , Bulimia/enfermagem , Bulimia/psicologia , Estômago , Adolescente , Terapia Combinada/enfermagem , Terapia Combinada/psicologia , Comorbidade , Intervenção na Crise , Hospital Dia , Transtorno Depressivo Maior/enfermagem , Transtorno Depressivo Maior/psicologia , Feminino , Humanos , Hipopotassemia/enfermagem , Hipopotassemia/psicologia , Tentativa de Suicídio/psicologia
20.
Soins Psychiatr ; 37(307): 31-33, 2016.
Artigo em Francês | MEDLINE | ID: mdl-27890273

RESUMO

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.


Assuntos
Anorexia Nervosa/enfermagem , Anorexia Nervosa/psicologia , Procedimentos Clínicos , Relações Enfermeiro-Paciente , Adolescente , Feminino , Hospitalização , Humanos , Comunicação Interdisciplinar , Colaboração Intersetorial
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