Materiały źródłowe

• #1 Nurse’s Guide To Caring For Patients With Eating Disorders | NurseJournal.org

  https://nursejournal.org/resources/caring-for-patients-with-eating-disorders/

  Nurses play an essential role in identifying destructive eating patterns and providing physical and emotional care for patients from detection to recovery. The goal is to have a manageable multidisciplinary, holistic approach to care. […] Monitoring nutritional status, electrolyte balance, weight, and activity, while keeping watch over diuretic/laxative use, make up important aspects of a nurses role. […] Patients also need emotional support, as they face deep pain and traumatic thoughts. Nurses can gain trust through active listening, empathy, and positive reinforcement. They can foster independence and educate patients and loved ones. […] Establishing goals to ensure the patient maintains awareness, practices healthy coping techniques, and adopts a positive body image and sense of self-worth is a priority.

• #2 13.4 Applying the Nursing Process to Eating Disorders – Nursing: Mental Health and Community Concepts

  https://wtcs.pressbooks.pub/nursingmhcc/chapter/13-4-applying-the-nursing-process-to-eating-disorders/

  People with eating disorders may appear healthy even when they are very ill. Additionally, individuals with anorexia nervosa often do not view their behavior as a problem. They are typically only seen in health care settings due to concerned family or friends who encourage them to seek treatment. Conversely, individuals with bulimia nervosa or binge eating disorder may feel shame and sensitivity to the perceptions of others regarding their illness. Therefore, it is vital for the nurse to build a therapeutic nurse-patient relationship with clients with eating disorders and empathize with possible feelings of low self-esteem and lack of control over eating. […] When assessing an individual with a potential or diagnosed eating disorder, it is vital to obtain their perception of the problem while assessing for signs and symptoms. Care planning that does not address their perspective will not be effective. As previously mentioned, clients with anorexia nervosa often do not perceive their behaviors as a problem, so specialized therapeutic techniques may be required.

• #3 How to Become an Eating Disorder Nurse? | Salary & Career | Maryville Nursing

  https://nursing.maryville.edu/blog/eating-disorder-nurse.html

  When patients seek treatment for eating disorders, nurses are often among the first caregivers they encounter. Consequently, its important for registered nurses (RNs) interested in working with this patient population to develop the advanced knowledge and skills to identify and treat the psychological and behavioral symptoms of these disorders. […] RNs interested in working with patients with eating disorders are employed in various settings, such as intensive outpatient treatment centers, residential treatment centers, hospitals, doctors offices, and psychiatric clinics. […] An eating disorder nurse is an advanced practice registered nurse (APRN) whos received additional training in how to treat patients struggling with psychiatric and mental health disorders, such as anorexia nervosa, bulimia nervosa, and binge eating disorder.

• #4 The rise in eating disorders: How can nurses help? | Nursing in Practice

  https://www.nursinginpractice.com/clinical/the-rise-in-eating-disorders-how-can-nurses-help/

  The past few years have seen a significant rise in the numbers of people with eating disorders across the UK. Hospital admissions have risen by 84% since 2017, with an 82% rise in young people admitted since 2021 alone, according to the Royal College of Psychiatrists (RCPsych). Its estimated that an even larger number of people with eating disorders are going undiagnosed and untreated due to signs of their illness being missed. […] At the eating disorder charity Beat, we know nurses play a vital role in ensuring eating disorders are better recognised, understood and treated. But nurses across the field need the right support and guidance in order to help their patients get the care they deserve. […] Some common challenges faced by nursing staff when identifying symptoms that may indicate an eating disorder stem from a lack of screening tools, training or knowledge.

• #5 13.4 Applying the Nursing Process to Eating Disorders – Nursing: Mental Health and Community Concepts

  https://wtcs.pressbooks.pub/nursingmhcc/chapter/13-4-applying-the-nursing-process-to-eating-disorders/

  People with eating disorders may appear healthy even when they are very ill. Additionally, individuals with anorexia nervosa often do not view their behavior as a problem. They are typically only seen in health care settings due to concerned family or friends who encourage them to seek treatment. Conversely, individuals with bulimia nervosa or binge eating disorder may feel shame and sensitivity to the perceptions of others regarding their illness. Therefore, it is vital for the nurse to build a therapeutic nurse-patient relationship with clients with eating disorders and empathize with possible feelings of low self-esteem and lack of control over eating. […] When assessing an individual with a potential or diagnosed eating disorder, it is vital to obtain their perception of the problem while assessing for signs and symptoms. Care planning that does not address their perspective will not be effective. As previously mentioned, clients with anorexia nervosa often do not perceive their behaviors as a problem, so specialized therapeutic techniques may be required.

• #6 8 Eating Disorders: Anorexia & Bulimia Nervosa Nursing Care Plans – Nurseslabs

  https://nurseslabs.com/eating-disorders-anorexia-bulimia-nervosa-nursing-care-plans/

  Anorexia nervosa is an illness of starvation, brought on by severe disturbance of body image and a morbid fear of obesity. People with anorexia nervosa attempt to maintain a weight that’s far below normal for their age and height. To prevent weight gain or to continue losing weight, people with anorexia nervosa may starve themselves or exercise excessively. […] Bulimia nervosa is an eating disorder (binge-purge syndrome) characterized by extreme overeating followed by self-induced vomiting, trying to get rid of the extra calories in an unhealthy way. It may include abuse of laxatives and diuretics. […] Nursing care planning for patients with eating disorders: anorexia nervosa and bulimia nervosa include establishing adequate nutritional intake, correcting fluid and electrolyte imbalance, assisting the patient to develop realistic body images, and improving self-esteem.

• #7 The rise in eating disorders: How can nurses help? | Nursing in Practice

  https://www.nursinginpractice.com/clinical/the-rise-in-eating-disorders-how-can-nurses-help/

  If an eating disorder is suspected, a history and physical examination of the person should be undertaken, including establishing capacity and consent. […] Following this process and discussion with the patient, the next step is to refer to a community-based, age-appropriate eating disorder service for further assessment or treatment as soon as possible. […] The warning signs of eating disorders are not always obvious, and the person can appear physically healthy. NICE guidelines recommend being alert to the following potential signs: Unusually low or high BMI or body weight for their age. Dieting or restrictive eating behaviours that are worrying the person, their carers or professionals. […] You may also identify that the person: Has rituals around food. Has low confidence and self-esteem. Has anxiety/distress. Avoids activities involving food or eating with others.

• #8 Resources for Nursing Students Coping with Eating Disorders

  https://www.edumed.org/resources/eating-disorders-in-nursing-school/

  I think the most apparent signs of eating disorders are changes in energy level and mood, as well as severe weight loss. […] Other signs include frequent talk about diet and exercise, or trying to control their body. […] The first thing Id say to nursing students in recovery is to prioritize their self-care. This includes scheduling meals and sleep, advocating for their needs at school and work, finding time for alternative coping skills such as meditation, and reaching out for support from a therapist and dietitian. […] I recognize that this is far easier said than done, but in all my work with nursing and other graduate students, the conversation has always come back to self-care. […] I think we can reduce stigma and encourage recovery by making eating disorders a more commonly understood idea. The more we talk to each other, the more people will understand how disordered eating is a coping mechanism for things like anxiety and stress.

• #9 Anorexia: Nursing Diagnoses, Care Plans, Assessment & Interventions | NurseTogether

  https://www.nursetogether.com/anorexia-nursing-diagnosis-care-plan/

  Patients with anorexia nervosa who are severely malnourished or psychologically at risk require treatment in an inpatient facility. The following are indications for hospital admission: Significant weight loss, Lack of any weight gain, Significant edema, Vital sign alterations, Severe electrolyte imbalance, Cardiac disturbances, Acute medical disorders, Altered mental status, Psychosis, High risk of suicide, Lack of a support system, Limited access to outpatient treatment, Nonadherence or continued purging behaviors. […] The nurse should use active listening and empathy when communicating with the patient and family. The nurse must not make comments, good or bad, about the patients weight or appearance and should instead focus on other qualities. […] Anorexia can cause complications that may affect every body system. Some signs of anorexia include: Thinning, brittle hair and nails, Lanugo (fine hair covering the body), Edema, Stomach pain or bloating, Cold hands and feet, Breast atrophy, Loss of muscle mass, Arrhythmias.

• #9 Anorexia: Nursing Diagnoses, Care Plans, Assessment & Interventions | NurseTogether

  https://www.nursetogether.com/anorexia-nursing-diagnosis-care-plan/

  Anorexia nervosa shares similarities with other eating disorders. Avoidant/Restrictive food intake disorder, for example, can occur in children and causes extreme pickiness or disinterest in eating, which could worsen into anorexia. Other eating disorders may include: Bulimia nervosa, Binge eating disorder, Pica, Rumination disorder. […] The nurse must obtain a current height and weight to evaluate treatment effectiveness. Patients with anorexia often display a very low BMI. […] The nurse can take the patients blood pressure lying, sitting, and standing, to assess for a drop in blood pressure of 20 mm Hg or more systolic or 10 mm Hg or more diastolic. […] The nurse should document how they see themselves and how they think others see them will help in determining the extent of their body image distortion.

• #10 Anorexia: Nursing Diagnoses, Care Plans, Assessment & Interventions | NurseTogether

  https://www.nursetogether.com/anorexia-nursing-diagnosis-care-plan/

  Anorexia nervosa shares similarities with other eating disorders. Avoidant/Restrictive food intake disorder, for example, can occur in children and causes extreme pickiness or disinterest in eating, which could worsen into anorexia. Other eating disorders may include: Bulimia nervosa, Binge eating disorder, Pica, Rumination disorder. […] The nurse must obtain a current height and weight to evaluate treatment effectiveness. Patients with anorexia often display a very low BMI. […] The nurse can take the patients blood pressure lying, sitting, and standing, to assess for a drop in blood pressure of 20 mm Hg or more systolic or 10 mm Hg or more diastolic. […] The nurse should document how they see themselves and how they think others see them will help in determining the extent of their body image distortion.

• #11 Anorexia: Nursing Diagnoses, Care Plans, Assessment & Interventions | NurseTogether

  https://www.nursetogether.com/anorexia-nursing-diagnosis-care-plan/

  Patients may report symptoms of headache, dizziness, fatigue, and difficulty concentrating, which can alert the nurse to hypovolemia. […] Patients with anorexia are often very self-critical and need to feel in control. They may withdraw from friends and family. The nurse should assess for thoughts of suicide as this is the second leading cause of death for patients with anorexia. […] The nurse should collaborate closely with the dietician. Oral feedings are recommended, though tube feedings are necessary for severely underweight patients. […] Patients may attempt to reduce weight through: Fasting or extreme calorie restriction, Excessive exercise, Self-inflicted vomiting (purging), Use of laxatives, enemas, diet supplements, appetite suppressants, or herbal remedies. […] Patients with anorexia may form habits around food and may obsessively count calories, hoard or conceal food, or refuse to eat certain foods or food groups. Family members or friends may notice behaviors like spending time in the bathroom immediately after eating, lying about how much or when they’ve eaten, or finding laxatives or diuretics in their possession.

• #12 13.4 Applying the Nursing Process to Eating Disorders – Nursing: Mental Health and Community Concepts

  https://wtcs.pressbooks.pub/nursingmhcc/chapter/13-4-applying-the-nursing-process-to-eating-disorders/

  Common nursing diagnoses for individuals diagnosed with anorexia nervosa or bulimia nervosa include these diagnoses: Imbalanced Nutrition: Less Than Body Requirements, Risk for Electrolyte Imbalance, Risk for Imbalanced Fluid Volume, Impaired Body Image, Ineffective Coping, Interrupted Family Processes, Chronic Low Self-Esteem, Powerlessness, Risk for Spiritual Distress. […] Planning depends on the acuity of the clients situation. As previously discussed, clients are hospitalized for stabilization. Common criteria for hospitalization include extreme electrolyte imbalance, weight below 75% of healthy body weight, arrhythmias, hypotension, temperature less than 98 degrees Fahrenheit, or risk for suicide. After a client is medically stable, the treatment plan includes a combination of psychotherapy, medications, and nutritional counseling.

• #13 8 Eating Disorders: Anorexia & Bulimia Nervosa Nursing Care Plans – Nurseslabs

  https://nurseslabs.com/eating-disorders-anorexia-bulimia-nervosa-nursing-care-plans/

  The following are the nursing priorities for patients with eating disorders: Provide nutritional support and guidance to restore healthy eating patterns. Offer individual therapy to address underlying psychological factors contributing to the eating disorder. Implement cognitive-behavioral therapy (CBT) or other evidence-based therapies to modify unhealthy thoughts and behaviors. Monitor and manage co-occurring mental health conditions, such as depression or anxiety. Involve family members or support systems in the treatment process, if appropriate. Educate patients and caregivers about the dangers and consequences of disordered eating behaviors. […] Following a thorough assessment, a nursing diagnosis is formulated to specifically address the challenges associated with eating disorders based on the nurses clinical judgement and understanding of the patients unique health condition.

• #14 13.4 Applying the Nursing Process to Eating Disorders – Nursing: Mental Health and Community Concepts

  https://wtcs.pressbooks.pub/nursingmhcc/chapter/13-4-applying-the-nursing-process-to-eating-disorders/

  Nurses individualize interventions based on the clients current clinical status and their phase of treatment. Interventions can be categorized based on the American Psychiatric Nursing Association (APNA) standard for Implementation that includes the Coordination of Care; Health Teaching and Health Promotion; Pharmacological, Biological, and Integrative Therapies; Milieu Therapy; and Therapeutic Relationship and Counseling. […] If the client is exhibiting risk for suicide, a safety plan should be immediately implemented. […] Severely malnourished clients may require therapeutic enteral nutrition. Any client with negligible food intake for more than five days is at risk of developing a potentially fatal complication called refeeding syndrome. […] After resolving acute symptoms, clients with anorexia begin a weight restoration program for incremental weight gain with a treatment goal set for 90% of ideal body weight. Specially trained dieticians assist in developing daily meal plans and caloric intake, and clients are generally weighed two or three times a week to gauge progress.

• #15 Bulimia, Anorexia Nervosa, and Binge Eating Disorder – Mental Health

  https://leveluprn.com/blogs/psychiatric-mental-health/37-disorders-eating?srsltid=AfmBOopBvtEHPfYbmQttQ665gqgoIbpFW-ae7y-Lny74kYUKOpgHuP8m

  Nursing care you need to know for bulimia and anorexia nervosa include: Maintaining strict inputs outputs, Weighing procedures, Mealtime monitoring, Privileges, Activity restriction, Refeeding syndrome monitoring. […] Refeeding syndrome can occur if nutrition is introduced too rapidly after prolonged starvation. […] Binge eating disorder is the most common eating disorder in the United States, and it’s characterized by recurrent episodes of eating large amounts of food (bingeing). […] Treatment of binge eating disorder includes cognitive behavioral therapy (CBT), as well as dialectical behavioral therapy (DBT). […] Nursing care of a patient with binge eating disorder includes encouraging the patient to keep a food diary, working with the patient to establish realistic weight goals, and providing referrals to support groups.

• #16 Nurse’s Guide To Caring For Patients With Eating Disorders | NurseJournal.org

  https://nursejournal.org/resources/caring-for-patients-with-eating-disorders/

  Nurses collaborating with patients with ED should be cognizant that patients can certainly enter recovery from an ED. However, it is something that nurses should be monitoring on an ongoing basis. […] Nurses must be conscientious when communicating with patients with ED. Refrain from commenting about their weight, appearance, and food/intake. […] Nurses provide a safe environment with active listening, open communication, and empathy. As an advocate, nurses ensure a multidisciplinary and holistic team approach. They can provide referral options to patients and loved ones, such as information on support groups and other eating disorder resources. […] The goals of treatment for a patient with an eating disorder need to be patient-centered or patient-driven, meaning that the patient and the nurse work to formulate shared goals for recovery.

• #17 Episode 80: The Role of an Eating Disorder Nurse

  https://emilyprogram.com/blog/episode-80-the-role-of-an-eating-disorder-nurse-with-stacey-brown/

  Stacey Brown, RN, joins us in this episode of Peace Meal to reflect on the role of nursing in eating disorder care. […] Stacey’s experiences have set her on a mission to speak to nurses at all levels about best practices when caring for patients with eating disorders, including developing strong emotional intelligence. […] She highlights the importance of every care team member and multidisciplinary collaboration to meet a patient’s full range of needs. […] How eating disorder nurses help at all levels of care to ensure patients get the medical and emotional care they need. […] On the nurse’s role in collaborative eating disorder care: “In our setting, one of the most important things that we learn [is] how to validate and also to redirect the client to the appropriate caregiver. It’s not my role to be their therapist. It’s not my role to overstep and try to be their dietitian. My role is to be their nurse, to address their medical needs, to be validating and listening and compassionate, but also know when to redirect back to other care providers.”

• #18 13.4 Applying the Nursing Process to Eating Disorders – Nursing: Mental Health and Community Concepts

  https://wtcs.pressbooks.pub/nursingmhcc/chapter/13-4-applying-the-nursing-process-to-eating-disorders/

  A significant part of the recovery process includes rebuilding relationships with family. Family members or significant others often feel frustrated, powerless, and hopeless because the strategies they previously attempted, such as forcing the client to eat or begging the client to eat, were not successful. The nurse helps with this recovery process by providing education to the client and their loved ones about the illness, treatment, and meal planning. Adaptive coping skills to address disordered thoughts should be reinforced.

• #19 8 Eating Disorders: Anorexia & Bulimia Nervosa Nursing Care Plans – Nurseslabs

  https://nurseslabs.com/eating-disorders-anorexia-bulimia-nervosa-nursing-care-plans/

  Goals and expected outcomes may include: The client will verbalize understanding of nutritional needs. The client will establish a dietary pattern with caloric intake adequate to regain/maintain an appropriate weight. The client will demonstrate weight gain toward the individually expected range. The client will maintain/demonstrate improved fluid balance, as evidenced by adequate urine output, stable vital signs, moist mucous membranes, and good skin turgor. The client will verbalize understanding of causative factors and behaviors necessary to correct the fluid deficit. The client will establish a more realistic body image. […] Therapeutic interventions and nursing actions for patients with eating disorders may include: Patients with anorexia and bulimia nervosa may use laxatives to control their weight, leading to inadequate nutrient absorption and less than body requirements. Inadequate food intake in anorexia nervosa can also result in nutrient deficiencies and imbalanced nutrition.

• #20 Types of Eating Disorder Treatment | Levels of Care | The Alliance

  https://www.allianceforeatingdisorders.com/types-of-eating-disorder-treatment-levels-of-care/

  Eating disorder treatment can be delivered in a variety of settings and approaches and is generally categorized into different levels of care. This continuum of care exists on a spectrum and is meant to slowly provide more autonomy for patients as they progress on their recovery journey. There are several different treatment options available at each level of care, which generally involve a multidisciplinary team, including therapists, dietitians, psychiatrists and more. Eating disorder treatment is very individualized and there is no one size fits all. Certain treatment approaches may work for some, but not for others. […] Inpatient or residential eating disorder treatment occurs within a facility where the patient receives 24-hour care. This level of care provides constant supervision and higher levels of support for the patient.

• #21 Bulimia, Anorexia Nervosa, and Binge Eating Disorder – Mental Health

  https://leveluprn.com/blogs/psychiatric-mental-health/37-disorders-eating?srsltid=AfmBOopBvtEHPfYbmQttQ665gqgoIbpFW-ae7y-Lny74kYUKOpgHuP8m

  Anorexia nervosa is an eating disorder characterized by restriction of calorie intake that results in a dangerously low body weight. […] Signs and symptoms of anorexia nervosa include: Extreme thinness, Amenorrhea, Lanugo, Cold intolerance, Brittle hair and nails, Severe constipation, Lethargy, Decreased heart rate, Decreased blood pressure, Decreased respiratory rate. […] The criteria for hospitalizing a patient with anorexia nervosa includes: Inadequate response to outpatient therapy, Electrolyte abnormalities, Daytime heart rate under 50 bpm, Systolic blood pressure under 90 mmHg, Arrhythmias, Body temperature under 96, Body weight under 75% of ideal, Body fat under 10%, Refusal to eat. […] Treatment for bulimia and anorexia nervosa can include: Individual, group, or family talk therapy, Cognitive behavioral therapy, Nutritional counseling, Medications for comorbid psychiatric conditions.

• #22 Types of Eating Disorder Treatment | Levels of Care | The Alliance

  https://www.allianceforeatingdisorders.com/types-of-eating-disorder-treatment-levels-of-care/

  Residential treatment provides 24-hour care/supervision for individuals who are medically stable but still engaging in eating disorder behaviors. Intensive supervision and support are required to help the individual reduce, and ultimately stop, self-destructive eating disorder behaviors (i.e. purging, restrictive eating, bingeing, compulsive exercise, etc.). Services include multiple weekly sessions of individual therapy, nutrition counseling, group therapy, family therapy, and psychiatric care. All meals and snacks are supervised and provided in a supportive environment. Residential programs may be held in medical hospital settings or on home-like grounds or estates. […] Inpatient treatment is most appropriate for individuals whose eating disorder is either not responding to treatment in a less intensive setting or clinical evidence strongly indicates that the individual requires a higher level of care. The individual may also be at risk of harm to self and/or others that requires treatment in a structured 24-hour medical or psychiatric inpatient unit. Services include medical management and intensive treatment of physically harmful eating disorder behaviors, medical complications, and co-occurring disorders, along with a focus on weight restoration, if needed.

• #23 Models of care for eating disorders: findings from a rapid review | Journal of Eating Disorders | Full Text

  https://jeatdisord.biomedcentral.com/articles/10.1186/s40337-022-00671-1

  Additionally, to tackle ongoing resource issues and ensure timely detection and treatment of EDs, further research into novel alternatives, such as active waiting lists or a greater role for primary care clinicians is needed. […] Similar to other complex conditions, those with EDs benefit from clearly defined referral pathways and comprehensive care provided by multidisciplinary teams (MDTs). […] Specialist ED services are comprised by a MDT of medical and non-medical staff (e.g., psychologists) with expertise in treating EDs and the recommended treatments, who work together to set holistic treatment goals for the individual in care. […] Community or outpatient services are a step-down in intensity from day programs, typically consisting of a MDT which provides assessment and treatment, with referral to higher level care (e.g., inpatient) if needed.

• #24 Models of care for eating disorders: findings from a rapid review | Journal of Eating Disorders | Full Text

  https://jeatdisord.biomedcentral.com/articles/10.1186/s40337-022-00671-1

  These lower intensity alternatives (e.g., outpatient services, day programs) may allow individuals to practice their newly learned skills in their home settings, increasing generalisation of skills obtained in treatment. […] Evidence suggests that EDs can be effectively treated in the community, achieving outcomes on par with inpatient services. […] Outpatient or community care for EDs is recommended for most mild-to-moderate presentations, with the vast majority of evidence-based psychological therapies primarily provided in such settings. […] Evidence suggests the presence of specialist ED services in the system may help optimise patient outcomes by aiding in ED detection and referral, and reducing mortality rates. […] Further, evidence suggests ED patients may be effectively treated in both inpatient and outpatient/community settings with MDTs.

• #25 Virtual Eating Disorder Treatment & Therapy | Within Health

  https://withinhealth.com/

  Studies have shown that online therapy can be just as or even more effective than in-person care for certain conditions […] After completing Within’s remote program, 86% of patients saw reduced eating disorder symptoms […] 77% reported reduced feelings of depression and anxiety […] 86% said they experienced an improved quality of life […] Intensive outpatient treatment (IOP) is a pivotal middle-ground of eating disorder recovery […] Our program is a minimum of 3 hours a day 3 days a week, but can increase to significantly more than that […] Clients also have high frequency individual sessions with many different members of the care team […] We’re a team of diverse, inclusive, multilingual experts who strongly believe in equality and offering supportive, affirming care for all people who need it.

• #26 UPMC Center for Eating Disorders | Treatment and Therapy Options

  https://www.upmc.com/services/behavioral-health/programs/eating-disorders

  Our licensed psychiatric inpatient unit at UPMC Western serves patients 12 years old and up who need help because of: Anorexia nervosa, Bulimia nervosa, Binge eating disorder, Other eating disorders. […] Our partial hospitalization program (PHP) is for individuals ages 14 and older, who don’t need to be in the hospital for treatment but still need serious support. […] Daily group programming includes opportunities to: Eat breakfast and lunch together and have a snack in the afternoon with trained staff. […] Our intensive outpatient program (IOP) requires a nine-hour per week commitment. […] The outpatient clinic serves adults who need help with eating disorders but not at a level that requires treatment daily or multiple times each week. […] The CED Services for Kids and Youths with Eating Disorders (SKYE) program specializes in serving the unique needs of children and adolescents with eating disorders.

• #27 Models of care for eating disorders: findings from a rapid review | Journal of Eating Disorders | Full Text

  https://jeatdisord.biomedcentral.com/articles/10.1186/s40337-022-00671-1

  In particular, outpatient services are ideal for medically stable patients as they are less burdensome to the individual and family, and may allow for greater generalisation of skills learnt in therapy to everyday settings. […] Day programs may constitute a promising middle ground between outpatient and inpatient care, providing all the daytime support of inpatient care, but allowing the patient to stay connected to their community. […] This RR has identified key gaps in our care for EDs, including the integration of different healthcare services and the limited role of primary care clinicians in ED services.

• #28 Eating Disorders Program – UChicago Medicine

  https://www.uchicagomedicine.org/conditions-services/psychiatry-and-psychology/eating-disorders-program

  Our comprehensive outpatient program provides state-of-the-art assessment and treatment services with a broad range of eating- and weight-related problems. […] Treating eating disorders requires an interdisciplinary approach to care and treatment. Our team includes therapists, psychiatrists and medical staff who work together to provide individualized patient care that is informed by the latest advances in eating disorders research. […] Our care program provides comprehensive outpatient services to children, adolescents and adults with eating disorders, including: Diagnostic evaluations, Individual and/or family therapy, Parent participation in the treatment of children and adolescents, Medical evaluations and follow-up, Medication consultations and management. […] Because eating disorders can have serious medical consequences, we need to ensure that symptoms can be managed safely on an outpatient basis. All patients complete a thorough diagnostic assessment and medical evaluation before starting treatment. In some cases, ongoing medical monitoring during treatment may be needed.

• #28 Eating Disorders Program – UChicago Medicine

  https://www.uchicagomedicine.org/conditions-services/psychiatry-and-psychology/eating-disorders-program

  The goals and length of outpatient eating disorders treatment depend on the needs of each patient. […] Adults typically are treated using cognitive-behavioral therapy (CBT), which focuses on normalizing eating behavior, eliminating unhealthy methods of weight control such as excessive exercise, self-induced vomiting, laxative misuse and decreasing the degree to which concerns about eating, weight and body shape affect the way patients feel about themselves. […] Our program focuses on self-monitoring of eating behavior, as well as thoughts and feelings related to eating, weight and body shape. Treatment also includes re-introduction of avoided foods, techniques designed to challenge negative beliefs about eating, weight and body shape, and regular weighing. […] For patients with bulimia nervosa and binge eating disorder, treatment typically is short term, approximately 20 sessions. For underweight patients, treatment lasts longer, approximately 40 sessions.

• #29 The Care Team

  https://nedc.com.au/eating-disorders/treatment-and-recovery/the-care

  A treatment team’s capacity to work collaboratively in assessment, treatment planning, and treatment review is essential for safe and effective treatment. […] When working with a person experiencing an eating disorder, the treatment team should be respectful of and respond to the specific needs, preferences, and values of the person throughout the co-development of a treatment plan. […] At a minimum, a treatment team in the community (as opposed to those in a hospital setting), should be made up of a medical practitioner and a mental health professional. […] A medical practitioner could be a GP, paediatrician, physician, psychiatrist, or other qualified medical practitioner that is able to provide treatment and management of the physical symptoms of the eating disorder. […] A mental health professional is an umbrella term for those professions that can provide psychological support and evidence-based psychological treatment for people experiencing an eating disorder.

• #30 The Care Team

  https://nedc.com.au/eating-disorders/treatment-and-recovery/the-care

  A mental health professional is an essential part of the treatment team and will work collaboratively with a medical practitioner to provide holistic treatment and support for the person living with an eating disorder and their family and supports. […] The inclusion of these professions in the treatment team will be determined by the needs of the person experiencing an eating disorder. […] GPs are often the first point of contact for a person experiencing disordered eating or living with an eating disorder and their families and supports. […] Dietitians often play a significant role in the treatment of eating disorders through providing specialised nutrition advice and support. […] Psychiatrists are medical professionals who specialise in diagnosis and treatment of mental, emotional, and behavioural disorders.

• #31 The Care Team

  https://nedc.com.au/eating-disorders/treatment-and-recovery/the-care

  Paediatricians are medical professionals specialising in the physical, mental, and behavioural development of children and adolescents. […] Psychologists are tertiary qualified mental health professionals and are commonly involved in the treatment of eating disorders and co-occurring mental health disorders. […] Social workers focus on a person’s social systems and the way these systems can be supported and changed to meet their needs. […] Occupational therapists assess the impact of an eating disorder on a person’s daily life, which includes their ability to engage in meaningful and important activities such as self-care, school, work, leisure, and social interactions. […] Nurses form an important part of the multidisciplinary treatment team as a provider of medical and/or mental health care.

• #32 Chapter 13 Eating Disorders – Nursing: Mental Health and Community Concepts – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK590029/

  Treatment plans are tailored to individual needs and may include one or more of the following: Individual, group, and/or family psychotherapy; Medications; Nutritional counseling; Medical care and monitoring. […] Cognitive behavioral therapy (CBT) is used to reduce or eliminate binge eating and purging behaviors. […] Family-based therapy is a type of psychotherapy where parents of adolescents with anorexia nervosa assume responsibility for feeding their child. […] Standard treatment for clients with anorexia nervosa includes nutritional rehabilitation and psychotherapy. […] Nurses should keep in mind that low weight clients are at increased risk for side effects. […] Medical treatments for eating disorders can be delivered in a variety of settings. […] Planning depends on the acuity of the clients situation. […] Evaluation is a continuous process of reviewing a clients progress towards their individualized goals and SMART outcomes.

• #33 Eating Disorders in Primary Care: Diagnosis and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2021/0101/p22.html

  Goals should include the identification of trends in nutrition, menstruation, height, weight, and BMI; the establishment of motivation for change; determination of medical and mental health sequelae; and the provision of unified, evidence-based care by team members and caregivers. […] Cognitive behavior therapy (CBT), which can be applied in person or by self-help or guided self-help, is an evidence-based treatment for adults that has also demonstrated effectiveness for youth. […] Anorexia Nervosa. Family-based therapy is recommended as a first-line treatment for youth and some young adults. […] Bulimia Nervosa. Among adolescents, guidelines recommend family-based therapy and, alternatively, CBT as appropriate treatments. […] Binge-Eating Disorder. Meta-analytic data support treatment with CBT and self-guided therapy.

• #34 Eating Disorders Program – UChicago Medicine

  https://www.uchicagomedicine.org/conditions-services/psychiatry-and-psychology/eating-disorders-program

  Children and adolescents typically are treated using family-based treatment (FBT), an evidence-based psychotherapy that puts parent(s) temporarily in charge of helping to reduce the control that an eating disorder has over their child’s life. […] The first stage of FBT focuses on weight restoration and reducing eating disorder symptoms. As treatment progresses, parent(s) return control over eating back to their child and help him or her with normal developmental tasks. This program typically addresses eating disorder issues in 20-25 sessions over the course of 10-12 months.

• #35 Eating Disorders in Primary Care: Diagnosis and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2021/0101/p22.html

  Pharmacotherapy should not be pursued as a monotherapy for eating disorders, but it may be a worthwhile adjunctive therapy, specifically in the presence of co-occurring mental health conditions. […] Weight restoration in patients with anorexia nervosa resolves most associated medical complications. […] Caregivers should be empowered to monitor social media use and restrict access to pro-anorexia (proana) and pro-bulimia (pro-mia) websites. […] Restoring the patient’s healthy relationship with food involves fostering cognitive flexibility around eating, eliminating harmful behaviors, and reducing body dissatisfaction and overvaluation of shape and weight. […] For patients of all weight strata, caregivers and clinicians should support healthy, sustainable lifestyle choices such as optimizing family meals, physical activity, and consumption of fruits, vegetables, whole grains, legumes, and water, while limiting sweetened beverages, refined carbohydrates, and entertainment-based screen time.

• #36 Anorexia Nervosa | Peter O’Donnell Jr. Brain Institute | Condition | UT Southwestern Medical Center

  https://utswmed.org/conditions-treatments/anorexia-nervosa/

  At UT Southwestern, our team approach brings together specialists from several fields of medicine for comprehensive care. Based on our evaluation, the team tailors a treatment plan based on each patients specific symptoms and overall health. […] For people with anorexia nervosa, we provide outpatient treatment that includes: Medications to treat medical and psychiatric symptoms common in anorexia nervosa, Individual psychotherapy, which can include cognitive behavioral therapy for eating disorders, dialectical behavioral therapy, interpersonal psychotherapy, and supportive therapy, Group psychotherapy, Psychoeducation sessions, Referral and coordination for nutritional counseling with a registered dietitian for nutrition education and meal planning, Coordinated care with primary care providers and specialists, as needed, for physical health related to other conditions.

• #37 Treatment – Anorexia nervosa – NHS

  https://www.nhs.uk/mental-health/conditions/anorexia/treatment/

  Family therapy involves you and your family talking to a therapist, exploring how anorexia has affected you and how your family can support you to get better. […] If you have anorexia, you may not be getting all the vitamins and energy that your body needs to grow and develop properly, which is especially important as you reach puberty. […] Anorexia can make your bones weaker, which can make you more likely to develop a condition called osteoporosis. […] Antidepressants are not used to treat anorexia. But you may be offered an antidepressant, such as fluoxetine (Prozac), in combination with therapy, to help you manage other mental health conditions. […] Most people with anorexia will be able to stay at home during their treatment. […] Your doctors will keep a careful eye on your weight and health. They’ll help you to reach a healthy weight gradually, and either start or continue any therapy. […] It’s important that you receive ongoing support after your treatment is finished.

• #38 Gynecologic Care for Adolescents and Young Women With Eating Disorders | ACOG

  https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2018/06/gynecologic-care-for-adolescents-and-young-women-with-eating-disorders

  Weight restoration is the best treatment for low bone mineral density (BMD) caused by disordered eating. […] Further research is needed to define best practices, including management of low BMD, menstrual irregularities, and pregnancy prevention. […] The American College of Obstetricians and Gynecologists recommends against the use of combined oral contraceptive pills (OCPs) solely for the treatment of amenorrhea associated with eating disorders.

• #39 Caring for Adults With Eating Disorders in Primary Care

  https://www.psychiatrist.com/pcc/caring-adults-eating-disorders-primary-care/

  Full weight restoration to a healthy weight range improves physical and psychological well-being; this target weight range is specific to each patient. […] Weight restoration is an important first step in allowing low-weight patients with eating disorders to regain cognitive flexibility, feel more comfortable with their bodies, and minimize eating disorder behaviors. […] Eating disorders are mental illnesses with life-threatening physical consequences. […] Many adult patients may decline recommended treatment. A patient can be sent to an emergency department for evaluation via an involuntary order if failure to hospitalize would create a likelihood of serious harm by reason of mental illness, but the threat would need to be significant/life-threatening. […] Eating disorders are common, and most PCPs will care for many patients with these illnesses during their careers. […] Primary care can play an integral role in promoting recovery for adults with eating disorders through screening, monitoring for medical complications, and connecting to evidenced-based treatments.

• #40 Resources for Nursing Students Coping with Eating Disorders

  https://www.edumed.org/resources/eating-disorders-in-nursing-school/

  Nursing students are at risk for eating disorders just like anyone else. Yet there are unique features about their training and profession that may increase the chances of eating disorders. Lets take a look at some of these risks and how they relate to students in nursing school. […] Nursing students with eating disorders often report struggles with maintaining a focus on their recovery. This can be because taking the time to schedule meals and other self-care can be difficult with their high-demand schedules. […] Their motivation to recover can also cycle back and forth, as they are often surrounded by conversations with classmates and coworkers about health, wellness, dieting, exercise, and so on. […] People with restrictive eating disorders typically need to recover by eating more; but adding more food to their daily intake can create feelings of shame.

• #41 Resources for Nursing Students Coping with Eating Disorders

  https://www.edumed.org/resources/eating-disorders-in-nursing-school/

  Fatphobia is also highly present in nursing and medical fields. […] When eating disorders are severe enough, higher levels of treatment such as residential care may be indicated, meaning that some students need to take time away from school. […] Academic performance can certainly be negatively affected by eating disorder symptoms. […] The consequences of eating disorders can be brutal. People who engage in recovery often feel an internal dilemma every day, either questioning their choice to recover or struggling to find alternative ways of coping with stress. […] As eating disorders progress, students can experience physical symptoms such as GI distress, inability to concentrate, fainting spells, or worse all of which can create serious problems, especially while they are working in hospital settings.

• #42 The rise in eating disorders: How can nurses help? | Nursing in Practice

  https://www.nursinginpractice.com/clinical/the-rise-in-eating-disorders-how-can-nurses-help/

  When we asked UK nurses about specific training in eating disorders, many told us they had received little or none. […] Identifying eating disorders quickly reduces costs to the NHS and the wider economy, as people are less likely to need intensive treatment if they can access timely care. Most importantly though, early intervention results in better recovery rates and treatment outcomes, and less risk of hospitalisation and relapse. […] Your role may also include: Evaluating and monitoring eating disorder-related risks. Helping to prevent the progression of the illness. Being the first point of contact for a person with an eating disorder. Making a referral for specialist treatment. Signposting to support services. Supporting service transitions and shared care. […] Beat, NHS England and the RCPsych recently launched free eating disorder training for nurses and healthcare staff. This training is designed to help nurses at every stage of the process, including managing medical risk, communicating sensitively with patients and creating care plan pathways.

• #43 Caring for Adults With Eating Disorders in Primary Care

  https://www.psychiatrist.com/pcc/caring-adults-eating-disorders-primary-care/

  PCPs are most often on the front lines of screening and detecting eating disorders. As severity and treatment resistance increase with illness duration, timely intervention is key. However, recovery from eating disorders is possible and common even 20 years after initial diagnosis. […] This review includes up-to-date screening and treatment guidelines and relevant studies concerning the care of adult patients with eating disorders and provides concise guidance for PCPs regarding the outpatient management of these patients in primary care. […] Patients with eating disorders may be hesitant to accept the diagnosis and the need for treatment. […] Recovery is possible, even after patients have been ill for many years. PCPs can use motivational interviewing to identify reasons that a patient might want to recover.

• #44 Caring for Adults With Eating Disorders in Primary Care

  https://www.psychiatrist.com/pcc/caring-adults-eating-disorders-primary-care/

  The management of the adult primary care patient with an eating disorder depends on the severity and chronicity of the illness. While some patients may be medically unstable to the point of requiring hospitalization, others are medically stable but suffer from ongoing active eating disorder symptoms. […] Patients with eating disorders who are medically unstable may need hospitalization. […] Refeeding syndrome defines the clinical and metabolic abnormalities that can occur during refeeding of a severely malnourished patient and is another indication for hospitalization. […] Patients who are medically stable may still require a higher level of psychiatric and nutritional support and may pursue a higher level of eating disorder care (such as a residential or partial hospitalization treatment program), or they may remain with an outpatient team.

• #45

  https://www.fideliscare.org/Member/Helpful-Tools/Health-Resources/Eating-Disorders

  Eating disorders can be deadly due to various medical complications and the high risk of associated suicide. […] Recovery from an eating disorder is an ongoing process. It is possible with professional treatment and support. Continued therapy, nutritional monitoring, and access to support networks is needed to prevent and treat relapses. The support of family and friends is also important during the recovery journey. […] Acute eating disorder treatment can occur in various settings, depending on the severity of the individual’s condition: inpatient hospital units, Residential treatment centers (individuals live temporarily at a medical facility), Partial hospitalization programs (also called day programs), Intensive outpatient programs (IOP). […] Treatment typically involves a multidisciplinary approach, including psychotherapy, nutritional counseling, medical monitoring, and sometimes medication.

• #46 How to Become an Eating Disorder Nurse? | Salary & Career | Maryville Nursing

  https://nursing.maryville.edu/blog/eating-disorder-nurse.html

  Licensed RNs interested in learning how to provide care for patients with eating disorders are likely to find that completing an advanced degree, such as an MSN nursing online program, with a concentration in psychiatric mental health, can prepare them with the skills and knowledge to provide compassionate, holistic care to patients struggling with eating disorders. […] Many online resources offer future eating disorder RNs up-to-date information and data about how to treat patients of all ages, genders, and gender identities who struggle with body dysmorphia and eating disorders. […] ANAD estimates that roughly 30 million Americans struggle with an eating disorder. Consequently, the need for knowledgeable and compassionate nurses who are passionate about helping patients toward recovery remains strong.

• #47 Models of care for eating disorders: findings from a rapid review | Journal of Eating Disorders | Full Text

  https://jeatdisord.biomedcentral.com/articles/10.1186/s40337-022-00671-1

  Delayed diagnosis, gaps in services and subsequent delays in specialist care and treatment lead to poorer health outcomes for individuals with eating disorders (EDs) and drive significant government healthcare expenditure. […] This review aimed to provide an updated synthesis on models of care for EDs in developed healthcare systems. […] Across EDs, specialist care was found to improve patient outcomes, with many patients effectively being treated in outpatient or day programs with multi-disciplinary teams, without the need for lengthy inpatient hospitalisation. […] Issues surrounding low treatment uptake, underdiagnosis, long waiting lists and limited hospital beds were also evident across services. […] Findings suggested further research into alternatives to traditional inpatient care is needed, with partial and shorter hospitalisations emerging as promising avenues.

• #48 Caring for individuals with eating disorders–how to improve care while reducing unnecessary spending? | PLOS Mental Health

  https://journals.plos.org/mentalhealth/article?id=10.1371/journal.pmen.0000160

  Moreover, anorexia nervosa has the highest mortality rate of any psychiatric disorder. […] Due to the high costs of care in this population, well-organised efforts directed toward early intervention and active management of these individuals physical and mental health are warranted. […] Many jurisdictions have implemented strategies, such as high-risk care management, to reduce costs and improve the quality of care among patients with high health care needs. […] The idea behind these types of strategies/interventions is that the implementation of high-quality outpatient care may help reduce unnecessary acute care for these patients. […] However, it is unclear whether any costs can be reduced, and if so which, especially among patients who require costly care. […] Overall, these findings suggest that providing better diabetes care, which could support individuals in normalizing eating patterns and improving diabetes control, could potentially help reduce diabetes-related hospitalisations.

• #49 Caring for individuals with eating disorders–how to improve care while reducing unnecessary spending? | PLOS Mental Health

  https://journals.plos.org/mentalhealth/article?id=10.1371/journal.pmen.0000160

  Moreover, it is likely that care coordination between health care providers and improved access to primary care and disease prevention, particularly related to diabetes, may help prevent the occurrence of some emergency department visits. […] Cost-savings resulting from the reduction of unnecessary acute care could provide further economic justification for increased investment in outpatient care for individuals with eating disorders.

• #50 The Care Team

  https://nedc.com.au/eating-disorders/treatment-and-recovery/the-care

  Eating disorders are complex and multifaceted. While the minimum treatment team is a medical practitioner and a mental health professional, input from practitioners from a range of disciplines is often necessary for comprehensive care. Family and supports are integral to the care team. […] The care team consists of the person experiencing an eating disorder and all people who will be involved in providing care, support, and/or treatment. The treatment team consists of the professionals within the care team who are providing treatment for a person experiencing an eating disorder. […] Treatment plans should always be developed within a person-centred, family and culture-sensitive and recovery-oriented framework (NEDC, 2018) and thus information and decision making is shared between all members of the care team, including the person experiencing an eating disorder, their families, and supports.

• #51 Care for Eating Disorders | Albany Med Health System

  https://www.albanymed.org/specialty/eating-disorders/

  The Comprehensive Care Center is a collaboration between the Albany Med Health System and HPA Livewell. The Center coordinates treatment services throughout 23 counties in northeastern New York to provide a seamless continuum of care. Our mission is to ensure that patients affected by the complex issues associated with eating disorders receive timely, quality care. […] Eating disorders are serious conditions characterized by extreme emotions, attitudes and behaviors related to weight and food issues. They can have life-threatening consequences. […] All eating disorders require professional help.

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