An eating disorder is the serious mental illness that can cause the severe disturbance in eating habits of a person such as obsessed with the food & body weight and eating too much or too less (National Institute of Mental Disorder, 2016). The eating disorder has become the serious issue for society and affecting the people severely. It is estimated that in Australia one million people have this disorder, and these figures are increasing per year. The eating disorder is of different types such as Anorexia nervosa, Bulimia nervosa, and Binge-eating disorder. In the United States nearly thirty million people of all ages and genders affected with an eating disorder and every 62 minutes, one person dies due to this disorder. It has been found that nearly eating disorder have the maximum mortality rate of any other mental illness and close to 13 % of women engaged in eating order (ANAD, 2018). Symptoms of this disorder include mood changes, having strictly followed dietary habit, eating very less food, and avoiding socialization where food is involved, feeling tired and cold, digestive problems, and missed or ceased periods in women (NHS, 2018). The patient in the given case study suffers from an eating disorder and developed this health issues due to different biological, psychological and social factors. The biopsychosocial factors, nursing interventions or management, and the ethical implication for the patient will be discussed in this essay.
Biopsychosocial factors of the eating disorder are the biological, psychological and social aspects that contribute to developing the disorder in a patient. The biological factors of the eating disorder include genetic factors, history of dieting, burning more calories than usual, and type-1 diabetes. The person who has a close relative with the eating disorder may develop this health issue. Various studies of families have found that a person having a parent or sibling with this disorder is more likely to be affected by it. A study conducted by Butcher, Mineka, and Hooley (2017) reported that the risk of developing anorexia nervosa for the family members of the person with anorexia nervosa is nearly 11.4 times higher than the healthy relatives. Having the history of dieting and other different weight control may also cause Binge eating disorder. People who burn calories more than they take in may also lead to a state of disturbed energy balance. Most of the people with eating disorder report that their disorder starts developing when they restrict the daily calorie intake in their diet. As discusses in Charlie’s case she eats very little for a whole day which results in her weight loss.
One of the most common psychological factors of the eating disorder is perfectionism where the people highly expected for themselves to be as perfect as others. The patient in the given case scenario may also develop eating disorder due to these factors as she reported that she always wanted to be perfect like her father and brother. She also revealed that she thinks that her parent does not care for her because she is not as perfect as her sibling. Next factor associated with this disorder is body image dissatisfaction in which a person might be unsatisfied with their body weight. They usually compare their body Weight with other and develop negativity about them; this may also contribute to causing the eating disorder. Charlie was disappointed and dissatisfied with her body weight, she expressed about her body and mentioned that she is too fat and wants to lose more weight. She has already reduced her weight by 10 kg and this caused various health issues such as constipation and ceased periods. Another common psychological factor is behavioural inflexibility.
Social factors associated with this mental disorder are weight stigma, acculturation, teasing or bullying for weight, appearance ideal internalization, limited socialization, and historical trauma. When the person exposed to the messages like being thinner is healthy everywhere, he or she can develop body dissatisfaction, which ultimately results in an eating disorder. Weight stigma is basically the stereotyping or discrimination based on an individual’s weight. Bullying or teasing a person for their weight also becomes one of the main aspects of the eating disorder. Most of the person diagnosed with eating disorder report that teasing is associated with the development of their disordered. In the given case study the patient was not bullied but she developed a thought that people do not like her because she is fat. Charlie is the only daughter of her parents, and they are unable to spend enough time with her because of a busy schedule, but the patient thinks that her mother and father do not like her because she is fat. And the diseased person starts ignoring public places and reduces socialization. This also contributed to her mental illness and she started ignoring the places where food is involved. Various studies revealed that having fewer friends and a limited social network and social activities are associated with the eating disorder (Ltzer & Stein, 2016).
A nurse has various roles in way to treat a person with eating disorder. He or she plays major roles throughout the treatment such as structure provider, role model, and support system. A newly diagnosed person with eating disorder in early stages looks to nurses to provide them with the highly structured environment. This sometimes includes taking behavioural decision on the patient’s behalf; the nurses offer such advice with the clear message that helps the patient to make their decision themselves. As the treatment progresses the patient eventually appreciates the nurse to help them and see them as role model. At the end of the treatment the nurses become a support system for the patient, they encourages the person to move forward and guiding them on where to seek for helps if necessary. With various skills like active listening, empathy, communication and adaptability the nurses can assist in identifying individual at risk and helps to optimise the delivery of a multidisciplinary and a holistic approach to patient care. Nurses having the knowledge and understanding enable them to manage food intake and examine the potential eating disorder. The treatment of this disorder depends on the type of symptoms of an individual.. In the given case scenario the patients have various symptoms such as weight loss, lack of socialization, eating less, disturbed digestion, ceased periods, pale appearance, cold and dissatisfaction with her body image. Nurses can assess motivation for body perception, changes, impact on functioning and family influences contributing to disturbance. The patient should be allowed to express how she feels about her and fear she has, to release the anxiety. It helps the patient to feel light. This can be done by developing a therapeutic relationship with the patient so that she can express her feeling to the nurse easily.
The nurse should develop trust in the patient to get the actual observation about her psychological problem. To manage the disturbed digestion a nurse can help the patient by encouraging her to consume more liquid (University of Toledo Medical Center, 2017), assessing the contributing factors such as medication, discussion about the elimination pattern and characteristics of stool, administrating the gut agents as prescribed and educating the patient about the importance of diet and fluid consumption for normal bowel function (Davies, 2017). Make a well nutritious diet plan for the patient and help her to follow it. To manage nutrition imbalance associated with the loss of healthy weight a nurse should help the patient by managing daily calorie intake.
The patient suffers from the low self-esteem and low self-motivation; in this case, a nurse can help the person to identify the contributing factors and the favourable and unfavourable self-attributes. Encouraging the patient to involve in the decision-making process for their treatment might help the patient to gain the lost self-esteem. It also increases the patient’s interest in socialization. The patient has also developed self-harm urges which can also develop suicidal ideation. Charlie has been spending most of her time being alone and a therapeutic communication build by nurses may help the patient to show these feeling (Wright, 2010). Nurses should spend time with the person and assess the self-harm thoughts, her eating habits, and body image by asking directly to the patient (Townsend & Morgan, 2017)). The environment should be safe and noiseless.
The nurses should be well trained to develop hope and positivity in the patient. The girl has also developed the self-dissatisfaction issues as she thinks her parents do not like her compared to her brother. This can be resolved by involving the family moment in the treatment of the patient. Various studies have suggested that including the relatives or friends in the treatment of a patient helps to improve the patient’s condition (Hay, 2013). Ask the parents to have a healthy conversation with the patient and to make her realize that they care for her; this might develop hope in the patient. A study conducted by Couturier, Isserlin, and Lock (2010) shows that this approach is effective for the people with Anorexia nervosa. As the patient is complaining about being fat, a nurse practitioner can encourage her for daily exercises or physical activities to change the body image (Campbell & Hausenblas, 2009), and educating the patient about that eating less is not the only method to control the body weight, there are various approaches that can help to maintain the healthy weight.
During the treatment of the patient, various ethical issues can be raised including denying the treatment. The severely ill person often refuses the treatment and the tension may occur between the patient’s choice and the need for the treatment (Royal Australian and New Zealand College of Psychiatrists, 2014). Conflicts related to the confidentiality may occur while treating a patient with this disorder. The medical practitioners should take precaution to protect the patient’s confidential information (American Psychological, 2018).
As mentioned in the given case scenario the patient has reduced her diet, so enforced feeding might be programmed for the person to fulfil the nutrient requirement of the body. This may also create ethical issues it depends on how this imperative part of the treatment is implemented. The consequences can be enacted if the diseased person denied feedings may help to clarify whether the ethical principles are broken. In this case, the patient is only nineteen years old so the decision making related to the treatment or intervention should involve her parents instead of her own choice (NSW, 2014). This is because many teenagers are not comfortable or it is difficult to make decisions for their treatment as they do not have that much of experience. The patient has the right to choose the health provider for her treatment and she has to be asked before involving health practitioners in the treatment of the patient. In some case, the patient is not comfortable with the person of the opposite sex, and ethical issues may be raised if the patient is not comfortable with the person providing treatment. Removing the contrabands is the routine practice in psychiatric units to treat many mental illnesses. The main purpose of this is to deliver a safe and favourable environment for the patient; however, this may become another ethical issue related to the patient’s rights and liberties (Bohon & McCurdy, 2014). This practice is well understood and accepted universally to be the safety measure for all diseased people. But in some cases, the patient is not comfortable with giving up their access to things like diet pills. In Charlie’s case, she has been taking laxatives for a long time and she might refuse to leave the habit forever. This should be dealt with politely and empathetically. The nurses should educate the person about why it is necessary.
Eating disorder is the serious psychological illness in which the patient developed severely disturbed eating habits like eating very less or too much, being obsessed with body weight. This mental disorder is affecting many people across the globe. One million people are diagnosed with this disorder in Australia. The Patient in the case study was 19 years old girl living with the other two girls. She developed this disorder and there are various bio-psychosocial factors are associated with eating disorder such as genetic factors and restriction on calorie intake. The psychological factors include perfectionism, body image dissatisfaction, and behavioural inflexibility. Social factors are weight stigma, acculturation, bullying and teasing, limited socialization and historical trauma. The nursing interventions that can be helpful in this case are assessing the patient, encouraging the patient for consuming more liquid diet to deal with digestion related problems. The nurse should develop a therapeutic relationship with the patient and allow them to express their feeling and thoughts. Making a diet plan is a part of nursing intervention manages the nutrition. The patient and her family should be included in the treatment for the better recovery results as the patient feel detached from her family and develop negative thoughts about self-harm. During the treatment, the health providers should be aware of the ethical implication such as refusing the treatment by the patient, conflicts related to the confidentiality, forced feeding, issues related to not including the person and her family in decision making and removing the laxatives.
References
American Psychological Association (2018). Ethical principles of Psychologists and code of conduct. Retrieved from: https://www.apa.org/ethics/code/index.aspx
ANAD (2018). Eating disorder statistics. Retrieved from: https://www.anad.org/education-and-awareness/about-eating-disorders/eating-disorders-statistics/
Bohon, C., & McCurdy, D. (2014). Ethical considerations in the treatment of eating disorders. Retrieved from: https://static1.squarespace.com/static/55403a31e4b0c2b9f03cb120/t/580aa23a725e25c5282c5c06/1477091899640/ED_ethics_Bohon_2014.pdf
Butcher, J. N., Mineka, S., & Hooley, J. M. (2017). Abnormal psychology. (16th ed.). India: Pearson Education India.
Campbell, A., & Hausenblas, H. A. (2009). Effects of exercise interventions on body image: A meta-analysis. Journal of health psychology, 14(6), 780-793.
Couturier, J., Isserlin, L., & Lock, J. (2010). Family-based treatment for adolescents with anorexia nervosa: A dissemination study. Eating Disorders, 18(3), 199-209.
Davies, N. (2017). The role of the nurses in eating disorder recovery. Retrieved from: https://www.independentnurse.co.uk/clinical-article/the-role-of-the-nurse-in-eating-disorder-recovery/152976/
Hay, P. J. (2013). Assessment and management of eating disorders: An update. Australian Prescriber, 36(5), 154-7.
Latzer, Y., & Stein, D. (2016). Bio-psycho-social contributors to understanding the eating disorder. Switzerland: Springer.
National Institute of Mental Disorder (2016). Eating disorders. Retrieved from: https://www.nimh.nih.gov/health/topics/eating-disorders/index.shtml
NHS (2018). Eating disorder. Retrieved from: https://www.nhs.uk/conditions/eating-disorders/#what-causes-eating-disorders
NSW (2014).Guidelines for the inpatient management of adult eating disorder in general medical and psychiatric setting in NSW. Retrieved from: https://cedd.org.au/wordpress/wp-content/uploads/2014/09/Guidelines-for-the-Inpatient-Management-of-Adult-Eating-Disorders-in-General-Medical-and-Psyciatric-Settings-in-NSW-Developed-by-Centre-for-Eating-Dieting-Disorders-2014.pdf
Royal Australian and New Zealand College of Psychiatrists (2014). Australian and New Zealand clinical practice guideline for the treatment of Anoxia nervosa. Retrieved from: https://www.alabmed.com/uploadfile/2014/0515/20140515070241491.pdf
The University of Toledo medical center (2017). Eating disorder. Retrieved from: https://www.utoledo.edu/policies/utmc/nursing/guidelines/kobacker/pdfs/eating_disorders_guidelines.pdf
Townsend, M. C., & Morgan, K. I. (2017). Psychiatric mental health nursing: concept of care in evidence-based practice. (9th ed.). Philadelphia, PA: F. A. Davis.
Wright, K. M. (2010). Therapeutic relationship: Developing a new understanding for nurses and care workers within an eating disorder unit. International Journal of Mental Health Nursing, 19(3), 154-161.
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