The integration of a specialized eating disorders nurse on a general inpatient pediatric unit

Nurse experiences of partnership nursing when caring for children with long-term conditions and their families: A qualitative systematic review

AIM

To explore the experiences of partnership nursing among nurses when caring for children and young people with long-term conditions, and their families.

BACKGROUND

Partnership nursing is promoted as a positive model of care among paediatric nurses, where shared roles and decision-making, parental participation, mutual trust and respect, communication and negotiation are valued to create positive care experiences and enhance patient outcomes. Little is known about how nurses use partnership with both the patient and the parents in this triad to deliver partnership nursing.

DESIGN

A qualitative systematic review followed Joanna Briggs Institute meta-aggregation approach and has been reported according to PRISMA guidelines.

METHODS

A comprehensive systematic search was conducted in seven electronic databases. Studies were assessed according to a pre-determined inclusion criteria. Qualitative findings with illustrative participant quotes were extracted from included studies and grouped into categories to inform overall synthesised findings. Methodological quality assessment was conducted.

FINDINGS

A total of 5837 publications were screened, and 41 qualitative studies were included. Three overarching synthesised findings were identified: (1) Using education to promote feelings of safety and support, (2) Partnering to develop a strong therapeutic relationship and (3) Optimising communication underpinned by shared decision-making principles to deliver individualised care.

CONCLUSION

Nurses demonstrated successful partnership in their practice, but focused on developing dyadic nurse-parent and dyadic nurse-child partnerships. Future practice development that creates a three-way triadic partnership may aid therapeutic relationships and shared decision-making.

IMPLICATIONS FOR CLINICAL PRACTICE

Clinicians can reflect on how dyadic partnerships (focusing on the child or the parent) may exclude opportunities for coherent care. Further exploration in practice, policy and research as to how nurses determine child competency and child and parent level of engagement in triadic partnership may improve the potential of meaningful shared decision-making.

Nurses' perceptions on and experiences in conflict situations when caring for adolescents with anorexia nervosa: A qualitative study

Anorexia nervosa (AN), which primarily affects adolescent girls and young women, is characterized by excessive dieting, leading to severe weight loss and a pathological fear of becoming overweight, or unhealthy behaviours that hinder weight gain. Caring for patients who have AN is particularly challenging for nursing staff, who are on the front line and have the closest contact with patients. However, little is known about how nursing staff care for adolescent patients with AN in Taiwan. This study aimed to explore nurses' perceptions on and experiences in conflict situations in caring for adolescents with AN. A qualitative study approach was conducted. Through semi-structured interviews, ten nursing staff from the paediatric ward at a university-affiliated medical centre in central Taiwan shared their experiences. Recorded interviews were transcribed and analysed by content analysis. This analysis identified three themes with eight subthemes: (i) struggling to develop therapeutic relationships, (ii) selective focusing, and (iii) difficulty changing minds. The findings of this study indicated a need for ongoing support for nursing staff, the development of therapeutic relationships with adolescent patients with AN, extensive nursing staff preparation, and the development of in-service training programs to enable nursing staff to care for these patients with greater understanding.

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

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.

Recurrent hyponatremia in a young adult woman with anorexia nervosa and the effects of insufficient communication

This is the case of an 18-year-old young adult woman with anorexia nervosa (AN) who presented to the emergency department with complications from AN and was found to be hyponatremic. The hyponatremia was prioritized and corrected with fluids on hospital day one. The consulting adolescent medicine team recommended the primary inpatient medical team initiate the malnutrition protocol. Nephrology recommended fluid restriction. Despite initiation of this protocol and emphasis on protocol adherence with the primary team, patient, and family, the hyponatremia recurred. Retrospectively, there were three factors that led to her recurrent hyponatremia: inconsistencies in protocol adherence across medical clinical providers, lack of knowledge regarding the importance of adherence to the malnutrition protocol, and suboptimal communication between medical clinical providers. A multidisciplinary team experienced in the care of patients with AN may enhance inpatient treatment of this condition. A multidisciplinary team experienced in AN will have a better understanding of the complexities of AN, skill in protocol implementation, understand the importance of protocol adherence, and be more likely to clearly communicate the plan of care to the patient/family. These skills can lead to improved care quality, decreased risk of adverse outcomes, and likely decreased medical costs.

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

PURPOSE

To describe the perceptions of inpatient pediatric hospitalist physicians (HPs), registered nurses (RNs), and care assistants (CAs) at a tertiary pediatric hospital regarding caring for children with eating disorders (EDs) who are hospitalized for medical stabilization.

DESIGN AND METHODS

A qualitative descriptive study was conducted using semi-structured individual interviews with aforementioned health care workers (HCWs) to explore their perspectives on caring for children/adolescents with EDs in relation to recent initiatives to transform their care. These initiatives focused on admitting patients to a designated "ED Unit", development of an ED consult team, providing ED education to staff, and development of ED standardized order sets (SOSs).

RESULTS

Twenty HCWs representing the three disciplines completed individual interviews. Most participants reported that the system changes led to more consistent care of patients with ED. Content analysis of the interviews revealed the following themes: awkwardness and uncertainties of care, navigating family dynamics, establishing therapeutic boundaries, and finding rewards in ED care.

CONCLUSIONS

Education, structure, and support for staff improved care for adolescents with EDs as perceived by HCWs. HCWs found satisfaction in providing care during the medical stabilization process. Study findings were positive for staff and future studies should include perceptions of patients/families to further design a therapeutic environment.

PRACTICE IMPLICATIONS

Providing a standardized order set, expert consult team, and ongoing staff training can strengthen the therapeutic hospital environment for adolescents with EDs. Pediatric hospitals can provide excellent care for children with EDs while supporting their staff to provide a therapeutic environment.