Recommendations
Some nurses suggested that the ideal form of treatment (when
patients were out of immediate danger) would be a ‘day
programme’, ‘day care facility’ or ‘safe-house’, with appropriately
trained staff, rather than the acute setting. Geanellos
(1999, p. 139) has commented on the lack of mental health
education for nurses and ‘the displacement of emotionally
disturbed adolescents into services that are not age appropriate
and whose staff are inadequately prepared to work with
them’. The institutionalization of adolescents with anorexia is
one of the problems inherent in a hospital system. Goffman
(1961) described a ‘total institution’, as a ‘controlled environment’
where people are forced to comply with rules and
regulations, otherwise penalties are applied. Adolescents with
anorexia, in this hospital, were similarly expected to comply
with the eating disorder programme, which relied on
‘rewards’ and ‘punishment’, to modify their behaviour.
However, if treatment continues to occur in hospitals, the
hospital system as a whole needs to be more responsive to
issues of mental health, and in particular to the need for time
to develop therapeutic relationships and not to ‘move people
on quickly’ (Breeze & Repper 1998, p. 1303), since this leads
inevitably to their readmission.
There continues to be a tremendous need for education
and support for nurses caring for adolescents with anorexia
in acute care settings. There is also a need for adequate
staffing levels on these particular wards to ensure consistency
among staff. For any nursing care plan to be
effective, nurses and patients must be intimately involved
in its development and evaluation. Nurses who do enjoy
and show aptitude for working with adolescents suffering
from anorexia are more likely to form therapeutic alliances
with their patients and are well suited to continue to
see ex-patients as regular outpatients, to consolidate
recovery.