Developing Interpersonal Relationships with Adolescents with Anorexia Nervosa
Valentina Micevski
Terence McCann
Nursing Research, School of Nursing & Midwifery, Victoria University, Melbourne, VIC
PP: 102
Abstract
Anorexia nervosa is a complex eating disorder that usually develops during adolescence. This paper reports how paediatric nurses develop professional interpersonal relationships with adolescent patients with anorexia nervosa. The study used a grounded theory approach to data collection and analysis. Data were collected using in-depth interviews from ten registered nurses who worked on a paediatric ward.
The findings revealed two foci of care: interacting with nurses, and interacting with patients, and interrelated categories and strategies. A core category highlighted the importance of instigating an individual focus when developing professional interpersonal relationships with patients with anorexia. Contextual factors emphasises the broader influences that modified the way nurses developed relationships with these patients. The findings have implications for clinical practice, education, unit administration, and further research, and these are examined.
Nurses who use this approach are better positioned to gain understanding of individuals experiencing the disorder and to develop professional interpersonal relationships.
Keywords
anorexia nervosa, interpersonal relationships, paediatric nurses, grounded theory
Article Text
Anorexia nervosa (hereafter referred to as anorexia) is a complex but hazardous disorder during which young people, usually female adolescents, endeavour to starve themselves (Rosenblum and Forman 2002; Sloan 1999). Building trusting relationships can help adolescents with anorexia understand why they have difficulties with food, weight, and body image and may facilitate change in their behaviour (Thompson 2004). Developing professional interpersonal relationships with these patients can be difficult as they are often reluctant to trust others. This raises questions about how paediatric nurses can initiate professional interpersonal relationships with patients with anorexia.
Literature Review
Professional interpersonal relationships
Professional interpersonal relationships are collaborative working partnerships, where recurring difficulties of patients' lives can be identified and managed by nurses and other healthcare professionals through mutual respect and understanding (Peplau 1991). Interpersonal relationships are shaped by factors including the duration of contact, patients' needs and willingness to trust nurses, and the commitment of nurses (Morse 1991). Both nurses and patients consider the development of relationships as important, and that nurse-patient interactions determine the effectiveness of interpersonal relationships (Lotzkar and Bottorff 2001). Individuals in the relationship do not have to like each other; the interactions are goal directed (to meet patients' needs), and healthcare professionals are expected to be non-judgemental and empathetic (Arnold and Boggs 1995). Mutual trust is fundamental, as patients need to feel that they and their judgements are respected (McQueen 2000).
Benefits of establishing professional interpersonal relationships
The development of therapeutic alliances between nurses and patients is important when treating patients with anorexia (Sloan 1999). For this to occur, healthcare professionals must be warm, positive, honest, empathetic and courteous (Sloan 1999). Being understood and having supportive relationships are vital to recovery for patients (Tozzi et al 1997; McCann and Baker 2001). Individuals who develop an interpersonal relationship with an adult, including a therapist, are able to develop more differentiated relationships, and can better manage stress and the social and physical aspects of the disorder (Wechselblatt et al 2000; Tozzi et al 2003).
Patients with anorexia interact frequently with nurses during hospitalisation, and nurses are considered important in managing these patients (Lask and Bryant-Waugh 2000). Nurses have an extensive background in physical assessment and use a multidimensional approach to client care, giving them advantages in the treatment of eating disorders (Grothaus 1998). Therapeutic relationships between patients and nurses can provide a foundation for meeting patients' goals and facilitating behaviour change (Lask and Bryant-Waugh 2000). Nurses' behaviours and attitudes influence patients with anorexia to recover; therefore it is important for nurses to be positive, supportive and accepting (Gordon 2000; Lask and Bryant-Waugh 2000).
Difficulties in developing professional interpersonal relationships
Despite the benefits of establishing professional interpersonal relationships with patients with anorexia, it is a challenging process (Fairburn and Harrison 2003; King and Turner 2000; Ramjan 2004). Patients may be manipulative and have difficulties trusting others, using deceit and untruthfulness to gain power and control over their surroundings. They may not cooperate with treatments and they see healthcare professionals as enemies (King and Turner 2000; Ramjan 2004).
Healthcare professionals may, in turn, view individuals with anorexia as difficult (Gordon 2000) and these negative views can adversely impact on the care they provide (Cameron et al 1997; King and Turner 2000). Professionals have voiced feelings of fear and inadequacy when working with patients with anorexia, viewing them negatively and considering them to be responsible for their illness (Cameron et al 1997; King and Turner 2000; Lindsay 1997). Harsh treatment and judgemental attitudes delay the possibility of developing interpersonal relationships (Lindsay, 1997). The rigid protocols used in caring for these patients cause added frustration and disconnectedness between patients and nurses (Cameron et al 1997; King and Turner 2000; Muscuri 1998).
Although it is considered that establishing professional interpersonal relationships with patients with anorexia is important to their recovery, there is limited literature that outlines how to develop this type of relationship (Finfgeld 2002).
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