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Nursing people with eating disorder

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With its white façade and plush green lawns, The Priory Hospital in Roehampton is a far cry from your average psychiatric facility. More akin to a country mansion, the sumptuous reception area is bright and airy, and the atmosphere relaxed with people allowed to come and go through unlocked doors.

With its white façade and plush green lawns, The Priory Hospital in Roehampton is a far cry from your average psychiatric facility. More akin to a country mansion, the sumptuous reception area is bright and airy, and the atmosphere relaxed with people allowed to come and go through unlocked doors.

'It makes it feel less institutionalised,' says nurse Suzi O'Connor, day care coordinator at the hospital's eating disorders unit (EDU). Ms O'Connor has worked with people who have eating disorders for over two years, and has been at the unit for three months.

Having worked in forensics, A&E liaison and university lecturing, it was an agency shift at another EDU that aroused her interest in this field. 'It made me realise that treating eating disorders is not just about force feeding and the patients are not all emaciated ghosts.'

The Priory has been treating people with eating disorders for about 15 years, and a new purpose built EDU is due to open in September. This will double the number of inpatient beds to 20, and increase the number of day care patients to 10 to 15.

According to Ms O'Connor, incidence of eating disorders has increased, but so has an understanding of the conditions. 'There used to be a lot of ignorance, but there are more people wanting to learn about it now,' she says.

'There is a lot more awareness surrounding eating disorders, especially because they get so much attention in the media.' The publication in 2004 of NICE guidelines on eating disorders also helped to raise awareness and improve care. The guidelines recommend outpatient treatment, where possible, for those with anorexia or bulimia nervosa.

'As a result of NICE, we have been able to change the variety and flexibility of our programmes. We've got plans to suit various funding packages, depending on what the patient wants, and have been able to increase day care.'

This increase in outpatient programmes has led to the development of new nursing roles in eating disorders, such as Ms O'Connor's role of day care coordinator, and there are also increasing outreach opportunities for nurses based in the community or GP surgeries.

'There are also lots of opportunities for staff nurses on an inpatient ward,' she emphasises. 'There is lots of individual and psychodynamic work, and the role also involves family work and counselling.
The long-term nature also means that you can expand your skills above and beyond acute mental health work.'

Traditionally, there has been a psychodynamic approach to the treatment of eating disorders, but evidence-based NICE guidelines advocate cognitive behavioral therapy (CBT). 'NICE guidelines have heavily influenced our work in this way. But it is a good thing for nurses because nurses can be trained in CBT, rather then having to change their careers to become therapists. It's made us look at and revamp the way we work.'

Eating disorder nurses can also take clinically based courses, such as the two-day Assessment of Bulimia course, and Working with People with Anorexia, which runs over four weeks. And it is also possible to undertake a master's degree in eating disorders.

As day care coordinator, Ms O'Connor oversees a full group programme, Monday to Friday, nine to five. Therapies can include exposure therapy and meal support. 'This involves a whole spectrum of things to supervise a patient's eating and dieting habits, from eating with a patient on a one-to-one basis, to taking them out to a restaurant for a meal,' she says.

A primary nurse system is in operation ' the patients also have a weekly session with their individual key worker.

The majority of the patients in the unit are there voluntarily, but rarely some are under section and do have to be tube fed. The length time patients stay on the unit depends upon their diagnosis. One who has anorexia and is very low weight will have to gain weight before any psychological issues can be addressed, so the amount of weight they have to gain will determine their length of stay.

Similarly, one with bulimia who needs to break their binge/vomit cycle may stay for up to four weeks as an inpatient, and then go on to take part in an intensive outpatient programme.

Although most of the patients' treatment is funded privately, the unit does take NHS patients, who usually come from areas where there are no dedicated eating disorder services.

'You get to use your brain and really work with people on an emotional and psychological level. On the whole, you get to know your client and you don't have the frustration of just patching them up that you may have if you worked on an acute mental health ward.

'I've watched someone come in at five stone, refusing to eat, refusing to drink, and I've cajoled them, battled with them and had them scream at me. When three months later that person is at a normal weight, even though they're not fully recovered, the fact that they've done that is incredible.

'One of the nicest things is working with them and helping them to learn to like themselves, and the best thing is when a patient really listens to you and then comes up to you and says, 'You know what, it really works'.'

Becoming an eating disorders nurse

This could be for you if: you like working autonomously and as part of a team, and are interested in working with patients on an intense psychological level.

You need to be good at: being concrete and directive in your approach ' you cannot be afraid of being disliked. You also have
to be able to set boundaries and work as a team to convey the same message.

You need to have: an RMN qualification, and an interest and desire to work with people with eating disorders.

You do not need to have: prior knowledge of CBT or other types of therapy as training will be given.

Other similar jobs you could consider: substance abuse or addictions nursing or counselling.

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