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Vivian Hanson Meehan, DSC, RN, never planned on becoming
an expert in eating disorders. She first encountered
the illness in the 1970s, the day her daughter came
home from college.
Meehan's nursing background was little help at the
time because "eating disorders used to be a one-liner
in a medical textbook," Meehan remembers.
She quickly discovered that nobody in the medical community
could answer pressing questions about her daughter's
problem.
Meehan decided to send her 19-year-old daughter to
a therapist, but despite the sessions, the problems
persisted. Five therapists and seven years later, her
daughter cascaded into a pattern of bulimia and alcoholism,
and finally was arrested for drunken driving.
The incident turned out to be the motivation her daughter
needed to finally put an end to her destructive eating
patterns.
For Meehan, the experience with her daughter drove
her to found an advocacy group in 1976-the National
Association of Anorexia Nervosa and Associated Disorders.
Nurses like Meehan are among the medical professionals
who are on the frontlines, working with the growing
number of people who suffer from eating disorders.
Although nurses say these patients can sometimes be
among the most difficult to treat, they also agree that
the victories they witness can be some of the most intensely
rewarding moments in nursing.
Since Meehan was thrust into the world of eating disorders
in the 1970s, the illness has become more widespread,
she said. Patients no longer are primarily >>
Caucasian upper middle-class adolescents-eating disorders
now plague all ethnic groups, Meehan said.
Between 1 percent and 2 percent of American women suffer
from anorexia nervosa, according to the National Eating
Disorders Association. Bulimia nervosa affects 1 percent
to 3 percent of middle and high school girls and 1 percent
to 4 percent of college-aged women.
According to the National Eating Disorders Association,
anorexia is characterized by a refusal to maintain body
weight at or above a minimally normal weight and an
intense fear of being fat. People with bulimia also
are extremely concerned with body weight and shape,
but they eat large quantities of food and follow this
with some form of purging, such as self-induced vomiting,
laxative or diuretic abuse, fasting or compulsive exercise.
For Jill Shea, MSN, ARNP, eating disorder patients
are some of her most challenging cases at the University
of Washington's Hall Health Center.
She said these patients usually are hesitant to give
up their eating patterns because the disorder serves
an important purpose in their lives: It provides a sense
of control.
"Trust of the therapist is critical, but it's
really hard to build trust with an eating disorder patient,"
Shea said. "They are holding so tightly to the
eating disorder and so afraid to let go, so anyone who
is trying to take it away is a threat."
She explains to patients that her role is not to force
them to give up their pattern of eating, but rather
to help them determine how and when they are ready to
give it up.
But Shea also admits that even though many patients
will recover from their eating disorders, they often
are at risk of relapsing during times of stress. Shea
recently discovered just how chronic the disorder can
be when she read an obituary of a former patient in
the newspaper.
The woman had started struggling with anorexic and
bulimic symptoms at age 16. As an adolescent, the girl
had grown to be much taller than her peers, and she
started dieting as a way to cope with her body image
concerns.
At times, she'd only eat as much as a pear for an entire
day.
She was 5 feet 10 inches tall and weighed about 100
pounds. The woman finally died at the age of 34 from
heart failure because her body was so malnourished.
Shea acknowledges that patients like this woman challenge
health professionals' own issues with control. "You
think you can fix something, but with eating disorder
patients you have to give that up," she said. "Otherwise,
you get into a power struggle with the client and you
will lose. I see people make wrong choices, and I can't
let it affect me."
Tammy Taylor, RN, a charge nurse at Texas Children's
Hospital in Houston, also has learned the importance
of keeping a safe emotional distance. Taylor explains
that patients will sometimes try to distract her to
avoid eating their meals.
One time, a patient was not in her room when Taylor
came in to check on her. When the patient returned to
the room, Taylor asked where she had been and the girl
said she had been in the restroom. The patient's mother
believed the story, but Taylor was suspicious.
"It had me second-guessing myself," Taylor
explained. "She was probably walking up and down
the hallway exercising to lose weight."
Twana McVicker, MSN, RN, is intimately familiar with
patterns like this between parents and their anorexic
or bulimic children. As an outpatient nurse practitioner
at Children's Medical Center of Dallas, one of her tasks
is teaching parents how to handle their children's disorders.
McVicker says that parents will try to explain to their
children that they won't get fat, and may even scream
at them in an effort to persuade them to eat. She teaches
parents instead to let their children pick what they
want to eat, and not to argue about food.
"It's not important what they are eating,"
she said. "Just the fact that they are eating is
good, and it's hard for parents to understand that.
I teach them not to get into a food argument, because
anorexics already have a lot of guilt, and it perpetuates
the low self-esteem cycle."
McVicker also is in charge of evaluating new patients
and determining where they should go for help. Her hospital
has three different levels: an inpatient treatment program,
partial hospitalization in which the patients sleep
at home and spend their waking hours in the hospital,
and a day treatment program in which patients come in
from 8 a.m. to 4:30 p.m.
McVicker said she's seen patients as young as 9 or
10 go through the treatment program and that most patients
enter feeling lonely and disconnected from their parents.
For McVicker, the highlight of her job is seeing these
feelings change over time.
"It's neat to see withdrawn, malnourished kids
with disruptive thought patterns actually smile and
connect with parents," McVicker said. "They
can enjoy life again, and seeing that process is incredible."
Contact
Heather Stringer at heathers@nurseweek.com.
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