Anorexia 10 people seeks treatment. Additionally, 80% of the

Anorexia nervosa is and increasing
psychiatric disorder prevalent in adolescents that can encounter many medical
complications. Many of these complications such as death can be avoided if the
patient is undergoing an effective recovery. Nurses work with patients on a
daily basis, making it is essential to establish a relationship and motivate
the adolescent affected by it. Additionally, it is necessary to provide
culturally competent care. Nurses must understand all of the variables that
affect adolescence, and be able to use a multi-disciplinary approach to address

Keywords: anorexia
nervosa, adolescent, mental illness, nursing, family-centered care, effective
care, recovery

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Anorexia Nervosa

Anorexia nervosa is a prominent chronic psychiatric eating disorder defined
by an abnormally low body weight, starvation, intense fear of gaining weight,
and a distorted perception of body weight and their appearance. To obtain
weight loss people affected by anorexia use extreme methods that can affect
activities in their lives and lead to death. This disorder is alarming because
it is among the psychiatric conditions with the highest mortality and patients
affected by it can have significant medical complications and psychological
distress This disorder affects both males and females of all ages. However, it
is more common to develop anorexia during adolescence (National Association of
Anorexia Nervosa). Although a generic cause behind anorexia cannot be
identified, there are several factors that can increase the likelihood of it to
occur. Some suggest that sociocultural, biological, and environmental factors
come together to spark an eating disorder such as anorexia. (Zuguai, 2013)

According to eating disorder
statistics reported by the National Eating Disorder Association, approximately
30 million people in the United States suffer from an eating disorder such as
anorexia nervosa, bulimia nervosa, or binge eating disorder. However, only 1 in
10 people seeks treatment. Additionally, 80% of the patients that accessed care
do not get the intensity of treatment needed. (National Eating Disorder Association)
Anorexia nervosa is the third most common chronic illness among adolescents. It
affects about 1% of female adolescents in the United States. That means that
about one out of 100 young women between 10 and 20 years old are starving
themselves to death. Anorexia has the highest mortality rate among females
between 15 and 24 years of age. Without treatment, up to 20% of people with a serious
eating disorder, such as anorexia, will die. However, with treatment the
mortality rate falls to 2-3% (National Association of Anorexia Nervosa).

Given this data it is evident that
eating disorders have to be taken seriously, because if inadequately treated
they can lead to death. It is necessary to have an effective nursing care for
the patients affected to increase their chances of getting better. One study presented
the Roy Adaption Model as a “theoretical framework to better understand individuals
with anorexia nervosa during acute treatment, and the role of nursing
assessments and interventions in the promotion of weight restoration” (Jennings,
2017). The Roy Adaptation Model is based on philosophic, scientific, and
cultural assumptions derived from systems theory, adaptation-level theory, and
cultural challenges of the 21st century (Jennings, 2017). Furthermore, it denoted
how it is important not to focus primarily on the weight restoration of the
patient but helping them in changing habits and restore all areas of
functioning (Jennings, 2017). 

Studies indicated that when
children hospitalized with malnutrition caused by illnesses such as cancer or
cystic fibrosis, nurses engage in active, reciprocal, therapeutic relationship
that are extremely beneficial to patients and their families. Whereas, in the
case of a malnourished adolescent diagnosed with anorexia, nurses demonstrate a
less engaged relationship resulting in ineffective patient and family centered
care. (Silber et al.,2011). Furthermore, this study showed how often times
family are not included in helping their loved ones to recover without
realizing how essential it is to implement a family-centered approach to care
for the teenage patient affected by mental illnesses such as anorexia nervosa
(Silber et al., 2011).

Another research acknowledged the
consumer’s perspective on an effective nursing care for adolescents with
anorexia nervosa. Three major themes were identified. The first theme analyzed was
the “ways a nurse ensured weight gain” (Zugai, 2013). Patients recognized the
importance of implementing strict rules and make them understand the consequences
for breaking them in order to make them adhere to the prescribed eating and
exercise. The second theme focused on the nurse’s approach on nutritional
rehabilitation emphasizing the importance of a caring, open minded and
thoughtful nursing care. The third theme looked at the relationship between the
adolescent patient and the nurse. The clients emphasized the importance of
certain qualities that the nurses taking care of them should have such as being
friendly, caring, open minded and thoughtful.

Being affected by Anorexia Nervosa

By searching the browse, I was able
to find many stories of people affected by anorexia. In their stories, what
seemed most important to people affected by an eating disorder was being able
make other people understand certain misconceptions about this disorder. Now a
days people assume that eating disorders are a choice or just a set of
behaviors. They think that the person affected by the anorexia is deliberately
choosing to restrict their food choices in order to lose weight. Instead, anorexia
is a mental illness and the physical aspect is just a side effect of it. Many
of them describe anorexia as an addiction to drugs. They feel obliged to
perform fasting because it provide them a sense of pleasure. However, they are
not able to stop performing these behaviors, like drug addicts cannot stop
making use of drugs (Ross, 2016).  “You can’t ‘just eat.’ The world inside
your head is so twisted and controlling, a prison of black and white; it makes
you fear every aspect of your life outside of your ‘control'” (Sarah Schuster,
2015). This is just one example of how patients affected by anorexia nervosa
feel about their eating disorder. This quote is able to demonstrate the darkness
of anorexia and how it negatively affects the lives of people affected by it.

Recovery for people diagnosed with
anorexia nervosa is long and hard and cannot be summed up in one solid straight
line. Patients describe anorexia as easy to fall into but extremely challenging
to fall out of (Arnold, 2016). Jessica Ross, diagnosed with anorexia, described
how she has been in and out of treatment for the past 5 years and said,

“I have found
myself broken down into fetal position on cold hospital floors screaming and
crying out for mercy…Just like all of the others, my brain screams at me that I
am always the fattest one in the room. I did not choose this. However, what we
can ask for and what we can chose is help” (Ross, 2016)

Many of them like Jessica understand the darkness of
anorexia and are willing to seek treatment. However, a lot of times their mind,
committed to anorexia, has greater power over their will and a lot of times
will win. In fact, the most challenging moment is after hospitalization because
it is very easy to slip back into the undeserving and hateful mindset. Several
people affected by anorexia believe that they will never fully recover (Arnold,

Personal Perspective

I have been passionate about anorexia
since high school because it affected many of my close friends and myself. When
I first acknowledge the existence of this disorder, I did the mistake of developing
a stereotype about individuals affected. I thought the reason why people
developed it was because they were seeking attention or they were unable to
have control over their lives. However, as soon as I took time to understand
this problem and was affected by it myself I soon realized that there was much
more behind this disorder.   

Throughout childhood I have always
been very skinny and used to be able to eat whatever I wanted, whenever I
wanted without being scared of gaining weight. Up until puberty, I had never
though anything bad about my body. However, when puberty hit and I gained 25
pounds in 8 months. People started to comment about the changes that my body
was going through and rather than explaining to me that it was normal to gain
weight and see your body change, everyone seemed focused on giving me advice on
how not to gain weight and be aware of what I was eating. This started to make
me feel confused and somewhat embarrassed about the changes that my body was
going through. It also made me feel unhappy and anxious about my appearance. I
then started dieting and fasting because in Italy curves are not accepted and
everyone has to have a Victoria’s Secret model-type of body. I used to believe
that I could never achieve happiness without being skinny. Looking back to it,
I now realize how the people that attended my school all had the same mindset
where being skinny meant being perfect. Ethnocentrism, is defined as the
tendency to view one’s own culture as superior to others (Wilkinson et al.,
2016). My school is a perfect example of ethnocentrism because everyone that
did not adhere to their same beliefs would have been judged and many times
bullied. I myself felt victim to this mindset that made me develop a body image

Cultural Competence

I believe that because I was
affected myself by an eating disorder I would be able to care for my patient
under a more personal point of view. I would understand the mental and physical
distress that they are going through. Doing research for this paper helped me
to broaden my view on how to care effectively for a patient. Also, I believe
that it is fundamental to focus on the people caring for the patient. I saw how
much my parents were affected by it and would do everything in my power to help
them understand better what their loved one is going through.

I have been raised by an American
mother and an Italian father, so I have been exposed to two different cultures
throughout my life. This required me to constantly keep an open mind on the
differences that these cultures presented. I believe this will help me to
address patients with little to no judgment because I, myself understand how
sometimes it is difficult to deal with cultural differences. I firmly believe
that culturally competent care should include understanding the diversity among
patients who have different socio-economical, and cultural backgrounds.

I might not always understand their
point of view, however I will always try to take in consideration the Leininger’s
theory model (2006) which is based on the respect of other cultures. I will try
to preserve the most of patient’s relevant care values as much as possible.

(Leininger, 2006).  However, in a
situation where my patient presented traditional ways of handling eating
disorders that I considered harmful to their own health, I would try to
negotiate with them to find a better solution to the problem so we could
achieve the goal of obtaining his/her optimal health. Leininger described
negotiation as creative nursing actions that help patients of a different
culture to negotiate with the nurse and/or the healthcare community in order to
achieve optimal health (Leininger, 2006). If negotiation or preservation cannot
be taken into consideration because of the treatment required by the physician,
then I would try to repattern the patient’s point of view on the treatment but
always by respecting his/her culture. Repattering, refers to the nurse actions
that help a patient to modify their personal health behaviors to achieve
beneficial outcomes (Leininger, 2006).

Christian faith and Final Reflection

According to the Christian faith it
is not our role to judge anyone. Nurses who apply Christian principles to their
work should be compassionate and open minded to other cultures and always aim
to understand them rather than judging them. They should perceive everyone as
equal and provide the best quality of care for each patient because all of them
deserve the best. I now see the critical importance for a nurse to have a
non-judgmental, patient and family-centered approach, and the need for
adolescents affected to have a strong relationship with their nurses. I firmly
believe that all these factors will enhance the patient’s experience and help
with their recovery.