Tesi sul tema "Nursing eating disordered patients"

This study is a critical, feminist psychological investigation of nurses’ experiences, understandings and perceptions of nursing eating disorder patients. Specifically 19 in-depth semi-structured interviews were conducted at a large metropolitan Australian hospital complex with nurses who care for eating disordered patients. A qualitative discourse analytic methodology was used to analyse the data. The analysis investigates the different ways that the eating disorder patients and the nurses are constituted in a web of explicit and implicit discursive constructions and discursive practices. The analysis also considers how relations of power between the nurses, the patients and the doctors and other health care workers are constituted in discourse and practice, as well as exploring how the eating disorder patient group and the role of the nurse is feminised
Master of Arts (Hons)

This study is a critical, feminist psychological investigation of nurses’ experiences, understandings and perceptions of nursing eating disorder patients. Specifically 19 in-depth semi-structured interviews were conducted at a large metropolitan Australian hospital complex with nurses who care for eating disordered patients. A qualitative discourse analytic methodology was used to analyse the data. The analysis investigates the different ways that the eating disorder patients and the nurses are constituted in a web of explicit and implicit discursive constructions and discursive practices. The analysis also considers how relations of power between the nurses, the patients and the doctors and other health care workers are constituted in discourse and practice, as well as exploring how the eating disorder patient group and the role of the nurse is feminised

Thesis (M. A.) (Hons) -- University of Western Sydney, 2004.
A thesis submitted in part fulfilment of the requirements for the degree of Master of Arts (Hons) at University of Western Sydney, 2004. Includes bibliographical references and appendices.

Aim: To further the understanding of psychiatric comorbidity, personality pathology and eating disorder (ED)-related quality of life (QOL) of ED and obese patients with ED behaviours. Methods: Participants consented to participation and were ≥16 years, female Australian ED in- or outpatients (N=380), Australian obese weight loss surgery outpatients (N=164), German obese outpatients from psycho-educational weight loss courses (N=41), or from the Australian community (N=477). The studies involved an interview (International Personality Disorder (PD) Examination) and/or questionnaires (Composite International Diagnostic Interview; Eating and Exercise Examination, including QOL Relating to ED Scale (QOL ED) or the QOL Relating to ED Scale in German). The University of Sydney and Northside Clinic Human Ethics Committees granted ethical approval. Results: DSM-IV avoidant PD is the most common PD among ED patients. ‘Self-uncertainty’, reflecting poor self-concept, was identified in ED patients. ‘Purging’ marks differences between ED diagnostic groups. “Vomiters’ have more lifetime and recent psychiatric comorbidity and borderline PD than ‘non-vomiters’. Assessing obese patients, the ED-related QOL measure, in English and in German, is useful; it discriminates between those with and without binge ED Conclusion: ED and PD diagnoses may need reviewing. Using ED behaviours to form comparison groups will assist to enhance treatment outcome.

Many eating disordered patients fail to respond to traditional cognitive behaviour therapy. As a result it has been suggested that further research needs to be completed to determine the cognitive processes and mechanisms that underpin these disorders. This research aims to empirically test Young’s Schema Mode concept (Young et al., 2003) within the eating disordered population and determine the relationship between schema modes and early maladaptive schemata, experience of invalidation of emotion during childhood and symptoms of anxiety and depression. In total 15 patients from an outpatient eating disorders service and 28 non patient controls completed the Schema Mode Inventory, The Young Schema Questionnaire, the Hospital Anxiety and Depression Scale, The Invalidating Childhood Environment Scale, and measures of eating disordered pathology. Non parametric analyses were completed to determine the differences between the two groups. The relationship between all measures was determined using correlation analyses. The eating disordered group were significantly more dysfunctional than the control group across all schema modes and early maladaptive schemata. Both groups did not display uniformity in their dysfunctional schema modes. The eating disordered group had raised scores in the detached self soother, the compliant surrender and the vulnerable child mode, whereas the control group had lower scores in the detached protector and the vulnerable child modes. The measure if eating pathology was not associated with the total score on any questionnaire measure. This research indicates that the schema mode concept may be a useful addition to the schema model of eating disorders.

Eating disorders are mostly prevalent in young females, with rates of disordered eating up to five times higher than diagnosable cases. There is evidence to suggest females from a South Asian background have higher rates of eating disorder symptomatology than their White counterparts. Culture plays a role in susceptibility to eating disorders, and factors such as parental control, stigma and ethnic stereotyping by health professionals can be additional barriers to seeking and receiving appropriate help. This thesis was concerned with the clinical decision-making processes of UK mental health practitioners and whether the ethnicity of clients affected this. Three vignettes were devised, one including clinical features indicative of a restrictive eating pattern, one of a binge eating pattern and one with depression and anxiety symptoms. Each vignette was presented with a picture of either a young Asian female or a White female. One hundred and fifty six participants, all clinical staff in IAPT services, filled in an online survey comprising of one vignette and a questionnaire exploring factors involved in clinical decision-making and potential barriers to engagement. Mental health practitioners were less likely to rate the vignette as showing symptoms of anorexia nervosa when the picture presented was that of an Asian female as opposed to a White female, and more likely to rate the Asian version with bulimia nervosa. There were no significant differences between ethnic groups in terms of treatment recommendations. Social and cultural factors were identified as areas of concern in the White vignette version, an unexpected finding. These findings indicate there may be ethnic bias present in decision-making regarding eating disorders and disordered eating patterns. It is recommended training in both identifying eating disorder symptomatology and cultural competency is emphasised more in training courses and beyond. Further research into decision-making by mental health providers is also needed.

Hetsätningsstörning är en av de vanligaste ätstörningarna i USA och antalet patienter med hetsätningsstörning ökar konstant. Flertalet patienter väljer att avsluta sin behandling kort efter att de påbörjat den. Anledningen är vanligtvis att relationen mellan sjuksköterska och patient inte fungerat, eller att behandlingen inte är lättillgänglig för patienten. Syftet var att undersöka patientens upplevelse av vård vid hetsätningsstörning. Detta för att öka kunskapen om hur vården uppfattas från patientens perspektiv och för att förbättra vården inom denna sjukdom. Resultatet visade att patienter som drabbats av hetsätningsstörning ansåg att vården var för oböjlig och inte tillräckligt individanpassad. Patienterna menade även på att sjuksköterskan inte alltid verkade förstå deras känslor och tankar de hade kring hetsätningen. Det ansågs positivs att ha en kontaktperson som redan genomgått behandling som komplettering till den standardiserade vården för sjukdomen. Personcentrerad vård och en möjlighet för patienten att sätta upp sina egna mål i behandlingen samt en god kommunikation mellan sjuksköterska och patient ansågs vara de viktigaste åtgärderna för att åtgärda problemen som uppstår när en patient med hetsätningsstörning söker vård.
Binge eating disorder is one of the most common eating disorders in the USA and the number of patients suffering from the disease is constantly increasing. Many patients choose to refrain from treatment shortly after it’s begun. The cause for this is usually due to a poor relationship between the nurse and the patient, or that the treatment is not easily accessible by the patient. The aim of the study was to investigate the patients experience of care when suffering from Binge eating disorder. The purpose of this aim was to increase the knowledge about how care is perceived by the patient as well as improve the care for the disorder. The result revealed that patients afflicted by Binge eating disorder considered the care too non-flexible and not adjusted to individual needs. The patients also mentioned that the nurse did not always understand their feelings and thoughts around binge eating. Having a contact person that had already undergone treatment was considered a positive experience. Person-centered care, the possibility for the patient to set up individual treatment goals as well as the communication between the nurse and the patient were considered the most important aspects when treating patients with binge eating disorder.

Bakgrund Ätstörningar är en växande sjukdom i dagens samhälle och den mest utsatta gruppen är unga kvinnor mellan 15 och 25 års ålder. Ätstörningar är en global sjukdom men som framförallt ses i västvärlden där det smala idealet länge betraktats som det vackra och det framgångsrika och kan vara en stor riskfaktor för insjuknandet. Sjukdomens uppkomst kan bero på biologiska, psykologiska och/eller sociokulturella faktorer. För att kunna skapa ett fördelaktigt möte mellan hälso- och sjukvårdspersonal och individen med ätstörning är det viktigt att se personen bakom sjukdomen samt att relationen innehåller kunskap, tillit, trygghet och hopp. Syfte Syftet var att belysa vad patienten upplever främjar tillfrisknandet från en ätstörning i mötet med hälso- och sjukvårdspersonalen. Metod Metoden som användes var en icke-systematisk litteraturöversikt. Sökandet efter vetenskapliga artiklar utfördes på databaserna Cinahl, PubMed och PsycINFO. 16 artiklar med övergripande kvalitativ metod, men även mixad och kvantitativ metod, inkluderades i resultatet. Resultat Det framkom sex huvudkategorier som patienterna med ätstörning upplevde vara viktiga i en vårdrelation för att kunna främja ett tillfrisknande: Behovet av att överlämna kontrollen till vårdpersonalen, Vikten av att känna tillit i mötet, Modergestaltens betydelse, Hälso- och sjukvårdspersonalens kunskap och erfarenhet, Se personen bakom ätstörningen samt Hoppets betydelse. Slutsats Hälso- och sjukvårdspersonalen bör ha en fördomslös inställning i vårdandet av en patient med ätstörning. Det är viktigt att vårdpersonalen har kunskap och är bekant med sjukdomen samt att lyckas förmedla tillit, hopp och trygghet i relationen för att främja behandlingen. Patienten med ätstörning vill separeras från sin ätstörning och bli sedd som personen bakom ätstörningen. Det är ytterst viktigt att som vårdpersonal och sjuksköterska kunna skilja på sjukdom och person för att kunna skapa en patientnära relation och vara en hjälpande hand i att främja hälsa.
Background Eating disorders are an increasing problem in the current society. Although it is considered a global disease, it is most common in the western world, and the highest prevalence is seen among young females aged 15-25. The ideal of being slim is considered equivalent to beauty and success and can easily be a risk factor of becoming ill. The onset of eating disorders could be connected to biological, psychological and/or sociocultural factors. In order to create a positive encounter between the ill person and the healthcare professionals, it is important to see the person behind the disease as well as to create a relationship with knowledge, trust, comfort and hope. Aim The aim was to illuminate the patient experience of what promotes recovery from an eating disorder when meeting healthcare professionals. Method The method used was a literature review. Databases Cinahl, PubMed and PsycINFO was used to find relevant scientific articles. 16 articles with mainly qualitative design, but also quantitative design and mixed methods, were chosen for the result. Results Six main categories constitute what patients with an eating disorder found was important in the interrelationship to promote recovery: The need of surrendering control, The importance of feeling trust in the relationship, The meaning of a maternal figure, Health care professionals’ knowledge and experience, To see the person behind the disease and The meaning of hope. Conclusions Health care professionals should carry a non-prejudiced attitude while caring for a patient suffering from an eating disorder. To be able to support recovery it is shown to be important for caregivers to possess knowledge about eating disorders and to convey trust, hope and the feeling of being safe in the relationship. The patient with an eating disorder wish to be distinguished from the eating disorder and for caregivers to see the person behind the disease. It is of great importance for health care professionals, including nurses, being able to distinguish the person from the eating disorder in order to establish a trusting relationship and promoting health.

Ätstörningar har blivit mer välkäntoch är en återkommande sjukdominom vården. En ohälsosam relation till mat finns i alla åldrar och relationen till mat utgör stor del av människors liv. Syfte: Syftet var att belysa hur patienter med ätstörningupplever vården. Metod: Studien är en allmän litteraturstudie där en innehållsanalys använts för att få framresultatet. Resultat: Resultatet består av tre ämnen:relationer, behandling och kunskap. Relationen med vårdpersonalen upplevdes hastorbetydelse för patienternas återhämtning. Inför behandlingen upplevde patienterna ambivalens,därför var det viktigt att patienterna fick vara delaktiga. Vårdpersonalens erfarenheter och kunskap innebar vägledning för patienterna att ändra sittbeteende. Konklusion: Relationer är behandlingensgrund och vårdpersonalen behöver ge ett braförstaintryck hos patienterna eftersom detförsta intrycket tenderaratt hålla sig kvar hos patienterna. Kontinuitet i vårdpersonalskapartrygghet och förtroende. Patienterna belyste vikten av att bli hörda och attindividenbakom ätstörningenuppmärksammades. Deupplevde ambivalens mot behandling då de var rädda att förlorakontrollen över ätstörningen, genom delaktighet upplevde patienterna en personcentrerad vård. Kunskap och erfarenheter hos vårdpersonalen belystes vara en viktig beståndsdel i behandlingen av ätstörningar.
Eating disorders are well-known and is a reoccurring concept within health care. An unhealthy relationship towards food is found within all ages, and the relationship to food constitutes a large part of human’s lives. Purpose: The purpose was to shed light on how patients with eating disorders experience health care. Methods: The study is a literature study where a content analysis was used. Results: The results consist of threesubjects: relationships,treatment and knowledge. The relationship to the care personnel was experienced to have a big impact on the patient’s recovery. Before treatment the patients experienced ambivalence, therefore it was important for them to be included in the treatment process. The care personnel’s experiences and knowledge meant guidance for the patients to change their behavior. Conclusions: Relationships are the foundation for thetreatment process and the care personnel should make a good first impression as it stays with the patients. Continuity among the personnel created safety and trust. The patients highlight the importance of being heard and seen as individuals. Patients experienced ambivalence towards treatment as they were afraid to lose control over the eating disorder. Knowledge and experience among the care personnel was an important part of the treatment.

The aim of this descriptive literature study was to describe the patients’ experience of the need for social support and the choice of coping strategies during treatment for eating disorders. Further, the authors wanted to describe the relationship with the parents and also to highlight the caring relationship between nurse and patient. Results that came to light, concerning the patients’ experience, were that patients with eating disorders, in a majority of studies, indicated a deficient social network. The authors´ studies point out a need for social support in the convalescence and a need for assistance when it comes to changing coping strategies in stressful situations or events. Furthermore, the authors also intend to seek strategies for successfully changing the dysfunctional eating behaviour. The family should be seen as a resource in the treatment without challenging the patients’ autonomy. Further, the family plays an important role to encourage new patterns of behaviour and to provide support and help during the patients’ treatment. Building a lasting relationship between patient and nurse is a significant part of the nursing care and thus an important step in the recovery process. The nurses´ caring work with this patient group can consist of help for patients to identify strategies for seeking social support in addition to facilitating the communication between the patient and its family. In order to provide these patients the possibility of good nursing care, it requires that nurses have basic knowledge about eating disorders, which the nurses should be prepared for during their education.

Syftet med denna deskriptiva litteraturstudie var att beskriva patientens upplevelser av socialt stödbehov och val av copingstrategier under pågående behandling av ätstörningar. Vidare ville författarna utifrån litteraturen beskriva relationen till familjen samt belysa den vårdande relationen mellan patient och sjuksköterska. Resultat som framkom angående patientens upplevelser var att patienter med ätstörningar i flertalet studier angavs ha bristande sociala nätverk. Studierna påvisar ett uttalat behov av socialt stöd för att kunna tillfriskna samt få hjälp att förändra copingstrategier vid stressfulla situationer eller händelser för att kunna ändra det dysfunktionella ätbeteendet. Familjen bör ses som en resurs i behandlingen utan att patientens autonomi utmanas. Familjen spelar bland annat en viktig roll till att uppmuntra nya beteendemönster och för att ge stöd och hjälp under behandlingsprocessen. Att bygga en hållbar relation mellan patient och sjuksköterska är en betydelsefull del av omvårdnaden och således ett viktigt steg i tillfrisknandeprocessen. Sjuksköterskans omvårdnadsarbete med denna patientgrupp kan innefatta hjälp för patienter med ätstörningar att identifiera strategier för att söka socialt stöd samt underlätta kommunikationen mellan patienten och dennes familj. För att kunna ge dessa patienter en möjlighet till att få god omvårdnad krävs det att sjuksköterskor har grundläggande kunskaper om ätstörningar vilket sjuksköterskan borde förberedas inför redan under sin utbildning.

Stroke is one of the major causes of eating difficulties (EDs). It is one of the leading causes of death and disability and one of the most important factors contributing to health-care costs. There is a clear association between EDs after stroke and undernutrition, where studies have shown that structured screening of eating function among stroke patients can predict nutritional problems as well as need for subsequent institutional care. Reliable and valid instruments that can identify EDs exist, but there is lack of knowledge on how persons experience living with EDs after stroke. Stroke unit care is evidence-based and grounded in multidisciplinary collaboration and continuity of care. The overall aim of this thesis is to explore and describe EDs after stroke as represented by health care professionals in patient records (PRs) and transferred information, and as described by persons living with EDs after stroke. An additional aim is to explore methodological aspects related to the inclusion of persons with EDs and communication impairment in research studies. Both quantitative and qualitative methods were used. Two studies used descriptive designs (I, II), one an explorative design (III) and one applied a methodological discussion (IV). In one of the studies PR data were used (I), in another study data were derived from three sources: PRs, screening of patients and interviews with nurses (II). Persons with EDs after stroke participated in Study III while literature, empirical data and researchers' experiences served as the data in study IV. Data were analysed by categorisation of phrases (I), content analysis (II) and descriptive statistics (I, II), by qualitative analysis (III) and by processing of literature and empirical findings in two research groups (IV). The main findings from the studies on representation of stroke care in PRs (I, II) showed that, despite that >50% of patients in Study I and all patients in Study II had EDs, there were few signs of multidisciplinary collaboration dealing with this problem. Unsystematic screening for swallowing difficulties was routine, whereas screening for nutritional risk and EDs was lacking (I, II). Multidisciplinary discharge summaries proved to have low quality and entailed little information on patients' eating ability (I). The two EDs most frequently documented were swallowing and lack of energy to complete a meal (I,II). EDs were described in vague terms (I, II). In Study II, all patients had swallowing difficulties and most patients had lack of energy to complete a meal. The electronic information transfer tool held information on eating ability for most patients (II), but the nursing staff in residential home care perceived deficiencies in that information, even identifying several EDs not reported at discharge (II). Experiences from persons living with EDs after stroke were presented in one main theme: Striving to live a normal life, including three sub-themes: Abandoned to learn on one's own (little support from health care professionals to learn to handle eating), Experiencing losses (loss of eating functions and loss of valued activities) and Feeling dependent in mealtime situations (III). One major finding from the methodological exploration (IV) is that creative approaches and suitable methods for inclusion of participants with EDs and communication impairment into qualitative studies can be found in the fields of aphasiology and learning disabilities. Another major finding from Study IV is that researchers need good communication skills as well as knowledge in neuropsychology. A general conclusion is that screening for EDs should be routine in stroke care and that a multidisciplinary terminology to express EDs must be developed to provide accurate information transfer. Health care professionals need to enhance their knowledge in nutrition and provide support to stroke patients with EDs with the goal that they can eat and perform meal-related activities in accordance with their habits before the stroke. To gain access to the experiences of persons with EDs and communication impairment researchers need to test participatory approaches when planning for inclusion of those persons.

Bakgrund: Enligt Hälso- och sjukvårdslagen ställs kravet att vården ska bygga på respekt   för patientens integritet och självbestämmande. Trots detta visar studier att kravet inte uppnås, då patienter inte känner sig delaktiga i vården i den utsträckning de önskar. Studier visar på att det inom psykiatrin kan ta tid att införliva patientdelaktighet, då ett gammalt paternalistiskt synsätt på patienter lever kvar på sina håll. Inom ätstörningsvården beskrivs patientdelaktighet som en ledstjärna i behandlingen, men många människor med ätstörningar är svåra att engagera i behandling då de kan vara ambivalenta eller förnekar och inte ser allvaret i sjukdomen. I vårdsituationer uppstår ibland en konflikt mellan patientens rätt till delaktighet i sin egen vård och vad vårdpersonal tänker är det rätta och bästa för personen. Sjuksköterskan är den som står patienten närmast i omvårdnaden och har ett professionellt ansvar att göra patienten delaktig i sin behandling.  Syfte: Syftet med föreliggande studie är att undersöka hur sjuksköterskor beskriver  patientdelaktighet vid ätstörningsbehandling i psykiatrisk heldygnsvård. Metod: Studien är en kvalitativ studie med induktiv ansats där semistrukturerade intervjuer genomfördes med sex sjuksköterskor verksamma inom ätstörningsvården, från två olika heldygnsavdelningar i Stockholm. Intervjuerna spelades in och transkriberades för att sedan analyseras enligt kvalitativ innehållsanalys. Resultat: Studien resulterade; i sex huvudkategorier; Påverkan, Bemötande, Relation,  Organisation och vårdmiljö, Sjuksköterskans situation och Patientens situation med vardera tre underkategorier. Diskussion: Resultatet diskuterade utifrån Kari Martinsens omvårdnadsteori samt annan relevant forskning.
Background: The Swedish Health Care Act states that all care in Sweden should be based in the respect for patient integrity and self-determination. Despite     this, studies show that this requirement is not achieved, as patients do not feel involved in the care to the extent that they would wish. Studies have shown that in psychiatric care, it may take time to incorporate patient- participation, as healthcare professionals' view of patients in many places still tends to be characterized by paternalism. Patient participation is described to be a guiding principle in the treatment within eating disorder care, but as patients can often be either ambivalent to their illness, deny it or not take it seriously, their involvement in the treatment can be difficult to achieve. In situations of care giving, a conflict sometimes occurs between the patient’s right to participate in his or her own care, and the healthcare professional´s ideas of what is right and best for the person. The nurse is the one working the closest to the patient in nursing care and hence has a professional responsibility to make the patient involved in the treatment. Aim: The aim of the study is to investigate nurses’ descriptions of patient participation in eating disorders treatment in psychiatric inpatient care. Method: The study is a qualitative inductive study. Semi-structured interviews were conducted with six nurses from two different inpatient care wards specialized in treatment of eating disorders. The interviews were recorded and transcribed and then analyzed through qualitative content analysis. Results: The study resulted in six main categories; Influence, response,  Relationship, Organization and care environment, The nurse´s situation and The patient´s situation with each three respective subcategories.  Discussion: The results were discussed based on Kari Martinsens theory about nursing       and other relevant research.

Aim: The overall aim of this thesis was to acquire knowledge about daily life with focus on eating problems during the trajectory of care for patients with head and neck cancer treated with radiotherapy. Method: The data in study I were gained from medical and nursing records of 50 patients. Documented parameters of eating problems, their causes and consequences, and undertaken interventions were collected before treatment, during radiotherapy, and one, six, and twelve months after completion of treatment, using a study-specific audit instrument. Data were analysed with descriptive and inferential non-parametric statistics. In study II eight patients were interviewed during the radiotherapy treatment period with focus on experiences of eating problems. In study III nine patients were interviewed six to twelve weeks after treatment with the focus on experiences of daily life during the trajectory of care having eating problems. In study IV twelve patients were interviewed about their conceptions of the significance of a supportive nursing care clinic during the whole trajectory of care. Data were analysed with interpretative phenomenology (II, III) and phenomenography (IV). Findings: The four studies showed that being a patient in the trajectory of care often meant that life was disturbed and threatened. This was partly due to the eating problems and their consequences, which could occur during the whole trajectory of care (I, III, IV) but was experienced as most intense and severe during radiotherapy (II) and the nearest weeks after completion of radiotherapy (III, IV). The disturbances and threats experienced due to eating problems could affect the whole person as they were physical (I-IV), psychological, social and existential (II, III). The experiences of eating problems due to the tumour and its treatment and the experience of having cancer per se were strongly connected as one phenomenon, which disturbed and threatened the informants’ daily life. The other part that disturbed the patients’ life was the waiting in suspense. A long and trying waiting in uncertainty was experienced due to lack of knowledge and support, practical as well as emotional. This was most pronounced during pauses in radiotherapy (III) and after completion of the treatment when the lack of support from the health care was obvious (I, II, III). The patients were then most often left to their own devices. In order to endure, they needed both inner strength, described as own coping strategies, and strength from outside, described as support from family, friends and health care professionals (II, III). The nurse clinic was found to give a hand to hold during the whole trajectory of care (IV). It could meet these patients’ needs of knowledge, care and support, both concerning practical measures related to the eating problems and other side-effects of the treatment, and concerning their emotional needs. In addition the nurse clinic could support the relatives in their worries and anxiety (IV). Conclusion: This thesis showed the necessity of continuous assessment, treatment and evaluation of patients’ problems, and the patients’ needs of information and support throughout the trajectory of care.

Gastric banding as a weight loss surgery has increased in popularity in the United States since its approval by the Food and Drug Administration in 2001. Successful weight loss after weight loss surgery is most frequently defined as greater than 50 percent of excess weight loss (EWL). Systematic reviews show that the band is widely effective in achieving successful weight loss in most patients, however individual studies show more inconsistent outcomes. Although previous research supports gastric bypass surgery as having a positive effect on quality of life after gastric bypass, there is very little data to support this relationship in gastric banding patients. Weight loss outcomes after gastric banding surgery at Virginia Commonwealth Health System were less than 50 per cent EWL at one and two years. A retrospective, descriptive study sought to answer the following questions: 1) What is the relationship between physical activity, eating behaviors and hunger control on weight loss and quality of life after gastric banding surgery and 2) Does successful weight loss at one year predict successful weight loss at two years. The International Physical Activity Questionnaire Sort Form (IPAQ) was used to assess participation in physical activity. The Medical Outcomes Study Short Form (SF-36) was used to determine quality of life. Weight loss outcomes were 34.6 per cent at one year and 39.7 per cent at two years, which was less than the established success rate of greater than 50 per cent EWL, However, most patients lost some weight and demonstrated a significant improvement in most domains of health related quality of life. Participation in physical activity increased fro preoperatively to year one but decreased in year two. Although participation in physical activities overall decreased from year one to year two, there was a significant relationship between participation in greater than 150 minutes per week of moderate or vigorous physical activity and adequate weight loss (p =0.025) and participation in health enhancing physical activities and adequate weight loss (p < 0.05). There was no statistically significant relationship noted between any of these eating behaviors and the percentage of excess weight loss at one or two years. There was a significant relationship between degree of hunger reported by patients and successful weight loss at one year (p < 0.05). There is sufficient statistical evidence of a positive linear relationship between two- year weight loss and one- year weight loss (p < 0.05). That is, one-year weight loss is a significant predictor for two- year weight loss. Based on the results of this study, it is recommended that gastric banding patients participate in at least 150 minutes per week of moderate to vigorous physical activity. Additionally, clinicians should consider development of adjustment protocols that achieve early reduction of hunger in the banding patient.

1 online resource (vii, 138 leaves : ill.)
Following an awareness of an increased turn over of staff in the eating disorder unit as compared with other specialised units, in a psychiatric hospital in Johannesburg, South Africa, Tara Hospital, the researcher was motivated to investigate the issue. An exploratory, descriptive based research was chosen to explore and gain information about the topic and its implications. A qualitative research approach was used to gain insight into the perceptions and needs of the team working on the unit. The case study method was used. A pilot study was undertaken to test the validity of the interview schedules. The sampling category was a non- probability one. Individuals were selected from the population of staff working on the unit. Participants were selected from two groups, those who were presently working on the unit and those who had previously worked on the unit and now working in other units. Interview procedure involved personal semi-structured interviews conducted by the researcher and analysed qualitatively and a structured interview questionnaire analysed quantitatively. The researchers assumption that many staff members move from working in an eating disorders unit was confirmed and is due to the following: Staff turnover is due to constant exposure to occupational stress and burnout. Feelings of helplessness, a sense of being unappreciated and excessive exposure to conflict from the patients. In addition, staff experience minimum rewards leading to lowered job satisfaction due to the patients slow recovery rates and a poor prognosis of the illness. Staff also experience a change in their eating patterns and an increased awareness around food and food issues. Recommendations to the staff include: * Psycho-education on eating disorders. * Implementation of strategies to provide supportive care for all staff members. * Education on stress management and strategies to prevent staff burnout and lowered job satisfaction. * A multidisciplinary teamwork approach by the staff, when working in the unit.
Social Work
M. A. (Social Science in Mental Health)

The present study examined the claim that neuropsychological deficits in set-shifting and emotional decision making are present in eating disordered patients, and to what extent these deficits relate to specific aspects of disordered eating. Sixteen eating disordered patients and 38 controls were given a battery of neuropsychological measures, as well as questionnaires measuring disordered eating. Compared to controls, patients demonstrated poorer performance on tasks of set-shifting, but not decision making, psychomotor speed, working memory, or IQ. Across groups, poor set-shifting was correlated with food-, shape-, and weight concerns, and restricting, whereas poor decision making was correlated to restricting. The study demonstrates that set-shifting deficits are present in eating disordered patients, and that specific relations exist between cognitive performance in different domains and disordered eating.

碩士
國防醫學院
護理研究所
94
The main purposes of this study are: (1) to investigate of the current condition for female nursing undergraduates who are at the risk of eating disorders, (2) to compare the differences of the personal factors, body images, depression index, executive cognitive function, social impact and eating disorder inventory between students at risk of eating disorders and those who are not, (3) to establish a predictive model of risk of eating disorders. Three hundred and thirty-six female students from two different four-year nursing colleges in Taipei were recruited in this study. The tools for this study include personal data, Multidimensional Body-Self Relations Questionnaire, Beck Depression Inventory-II, social impact scale, Eating Disorder Inventory, Wisconsin Card Sorting Test and Mini International Neuropsychiatric Inventory. The data are analyzed by Mann-Whitney U test, Chi-Square and Logistic regression. The results revealed that 43.2% of female nursing students in this study are at the risk of eating disorder, 67% ever tried to reduce their body weights, 51% by diet, 43% by exercise, almost 20% by some medications, and some even fewer visited weight control clinics, or IX searched for cosmetic liposuction surgery. Students at the risk of eating disorder show higher average scores on body dissatisfaction, depression index, social impact index, and eating disorder index than normal group. Perseveration reaction and perseveration errors are higher among eating disordered students than normal students in computerized Wisconsin Card Sorting Test. In establishing the predictive model, body mass index, body dissatisfaction, bulimic behaviors, use of laxative, and depression index are effective explanatory variants for prediction of the risk of eating disorder.