Perceptions of Caring for Adolescents With Eating Disorders Hospitalized on a General Pediatric Unit

Harken, Whitney; Maxwell, Joan P.; Hainline, Margaret; Pollack, Lauren O.; Roberts, Cristine

doi:10.1016/j.pedn.2017.02.008

Cited by 9 publications

(45 citation statements)

References 24 publications

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“…In 13 studies, the necessity of close observation of service users – particularly in inpatient environments (Akgül et al, ) – and a sense of being observed in turn, resulted in interpersonal mistrust amid a culture of surveillance. Participants described feeling awkward about intently monitoring service users to prevent ED behaviors: “They have to have somebody sitting in their room all day long with them….I feel uncomfortable for them” (nurse; Harken et al, , p. e38). Some noted that this entailed a lot of work: “General psychiatric is easier…there's [fewer things] to look out for…Compared to the ED is how you eat, what you eat, what you drink, how much you drink, where are you, what you doing…everything” (nurse; Seah et al, , p. 141).…”

Section: Resultsmentioning

confidence: 99%

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The lived experience of working with people with eating disorders: A meta‐ethnography

Graham

Tierney

Chisholm

et al. 2020

Intl J Eating Disorders

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Objective Working with people with eating disorders (EDs) is known to elicit strong emotional reactions, and the therapeutic alliance has been shown to affect outcomes with this clinical population. As a consequence, it is important to understand healthcare professionals' (HCPs') experiences of working with this client group. Method A meta‐synthesis was conducted of qualitative research on HCPs' lived experiences of working with people with EDs. The results from the identified studies were analyzed using Noblit and Hare's meta‐ethnographic method. Data were synthesized using reciprocal translation, and a line of argument was developed. Results Thirty‐seven studies met the inclusion criteria. Reciprocal translation resulted in a key concept: “Coping with caring without curing.” This was underpinned by the following third‐order concepts: (a) “The dissonance and discomfort of being a helper struggling to help,” (b) “Defending against the dissonance,” and (c) “Accepting the dissonance to provide safe and compassionate care.” These concepts were used to develop a line‐of‐argument synthesis, which was expressed as a new model for understanding HCPs' experiences of working with people who have an ED. Discussion Although the conflict associated with being a helper struggling to help led some HCPs to avoid and blame people with EDs, others adopted a compassionate stance characterized by humanity, humility, balance, and awareness.

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Section: Resultsmentioning

confidence: 99%

“…Interactions with service users' families could be stressful if, for example, they were in denial about the ED (Harken et al, ). Difficulties with colleagues were also reported to add to the emotional demands: “We are forcing kids to do things that we do not understand.…”

Section: Resultsmentioning

confidence: 99%

The lived experience of working with people with eating disorders: A meta‐ethnography

Graham

Tierney

Chisholm

et al. 2020

Intl J Eating Disorders

View full text Add to dashboard Cite

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“…Although a few previous studies on adolescent care -generally in oncology or mental health -have included staff perspectives, these have mainly been limited to staff opinions on what is important to adolescents rather than the implications for the staff themselves [19,[21][22]. The impact on staff, both in practical and emotional terms, was a prominent theme in our study despite featuring minimally in our interview topic guide (Appendix A).…”

Section: Discussionmentioning

confidence: 99%

Where Should Critically Ill Adolescents Receive Care? A Qualitative Interview-Based Study of Perspectives of Staff Working in Adult and Pediatric Intensive Care Units

Wood

Geoghegan

Ramnarayan

et al. 2019

J Intensive Care Med

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Purpose: In the UK, critically ill adolescents are treated in either adult or paediatric intensive care units (AICUs or PICUs). This study explores staff perspectives on where and how best to care for this distinct group. Materials and Methods:Semi-structured interviews were conducted with 12 members of staff (3 medical, 6 nursing and 3 allied-health professionals) working in 4 ICUs; 2 general hospital AICUs and 2 tertiary centre-based PICUs in England. Interviews were audio-recorded, transcribed and analysed using Framework Analysis.Findings: One overarching theme was identified, reflecting staff understanding of the term "adolescent", and this was linked to two further themes, each of which had several subthemes. "Needs of the critically ill adolescent" included medical needs, dignity and privacy; issues around consent; and the impact of intensive care admission."Implications for staff" included managing parental presence, and lack of familiarity with, and emotional impact of, dealing with this patient group. Some of these factors are currently better accommodated in adult settings. Conclusions:Decision-making about place of care should take into account the individual circumstances of the patient (e.g. nature of their medical condition and previous experiences, maturity, family preference) and not be based only on age at admission. We should work across disciplines to ensure we can discover, and consistently deliver, best practice to meet the needs of critically ill adolescents.

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“…Although fewer studies have been conducted in the pediatric ED realm with respect to burnout, clinician attitudes toward adolescents with ED have been documented [12,13]. One study involving 120 clinicians treating adolescents with ED reported six patterns of reactions including angry/frustrated, warm/competent, aggressive/sexual, failing/incompetent, bored/angry at parents and overinvested/worried [13].…”

Section: Introductionmentioning

confidence: 99%

“…One study involving 120 clinicians treating adolescents with ED reported six patterns of reactions including angry/frustrated, warm/competent, aggressive/sexual, failing/incompetent, bored/angry at parents and overinvested/worried [13]. An additional qualitative study examining attitudes and perceptions of physicians, registered nurses, and care assistants treating adolescents with ED on a general pediatric unit found several themes including awkwardness and uncertainties of care, navigating family dynamics, and establishing therapeutic boundaries, as challenging [12].…”

Section: Introductionmentioning

confidence: 99%

A mixed methods exploratory evaluation of burnout in frontline staff implementing dialectical behavior therapy on a pediatric eating disorders unit

Couturier

Rahman

et al. 2021

J Eat Disord

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Background Eating disorders are life-threatening illnesses that commonly affect adolescents. The treatment of individuals with eating disorders can involve slow treatment progression and addressing comorbidities which can contribute to staff burnout. Dialectical behavior therapy (DBT) has emerged as a viable treatment option and has reduced staff burnout in several other settings. Our aim was to describe frontline staff burnout using mixed methodology on a DBT-trained combined inpatient/day hospital unit for pediatric eating disorders. Method Frontline staff were trained to provide DBT skills for adolescents with eating disorders. Twelve months following the training and implementation, they completed the Copenhagen Burnout Inventory (CBI) and a qualitative interview. Directed and summative content analyses were used. Results Eleven frontline staff including nurses, child life specialists and child and youth workers participated. The CBI revealed that only one staff member experienced high personal burnout, while another experienced high client-related burnout. Qualitative data indicated that all frontline staff felt DBT had the potential to reduce burnout. Conclusion Qualitative data indicate that staff believe that DBT may hold promise in reducing burnout for pediatric frontline staff who treat children and adolescents with eating disorders. Further study is needed. Plain English summary Understanding burnout is particularly important for nursing staff in inpatient and day hospital settings for eating disorders, as nursing staff generally have the most frequent patient contact; thought to be a risk factor for burnout. The reduction of burnout can prevent detrimental effects on job performance, personal well-being, and patient outcomes. Our exploratory study shows that frontline staff believe that DBT may have the potential to reduce burnout in staff treating children and adolescents with eating disorders in a combined inpatient/day hospital setting. Further study is needed in this area.

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Perceptions of Caring for Adolescents With Eating Disorders Hospitalized on a General Pediatric Unit

Cited by 9 publications

References 24 publications

The lived experience of working with people with eating disorders: A meta‐ethnography

The lived experience of working with people with eating disorders: A meta‐ethnography

Where Should Critically Ill Adolescents Receive Care? A Qualitative Interview-Based Study of Perspectives of Staff Working in Adult and Pediatric Intensive Care Units

A mixed methods exploratory evaluation of burnout in frontline staff implementing dialectical behavior therapy on a pediatric eating disorders unit

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