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Background: Eating disorders (ED) are an increasingly prevalent problem with serious consequences for different spheres of life. This study aims to analyze nurses' perspectives and experiences of the care provided to people diagnosed with an ED., Methods: Hermeneutical phenomenological qualitative study. Nineteen nurses from Alcalá de Henares (Madrid) collab-orated in the research sharing their experience through interviews and stories, which were recorded, transcribed and analyzed thematically., Results: Three issues were obtained: a fight between the heart and mind, conscious reflection: the body says what the head keeps silent and learning how to care holistically. Nurses experience a struggle with their feelings of transference / countertransference when caring for patients. They set out to combine skills acquired from their experience with new research, without losing sight of the individual and the factors involved (family, society and work), which are key to understand the patient's experience and recovery., Conclusions: Nurses need more specialization, ongoing training, coordination and teamwork with other professionals to provide people with holistic care. Gender perspectives should be taken into account to enable care to be adapted to the needs of men and women. This study takes an in-depth look at the care relationship between nurse and patient, to obtain a hitherto unknown perspective of care, which makes it possible to expand knowledge and individualize the care provided.

Purpose: The aim of this study was to examine the psychometric properties of the Spanish version of the Experience of Caregiving Inventory (ECI-S), which is designed to assess the caregiver's appraisal of the impact of caring for a relative with a serious mental illness., Methods: A cross-sectional study was conducted among 320 caregivers of a relative with an eating disorder to examine: (a) descriptive statistics; (b) internal consistency reliability; (c) the fit of the original ten-factor structure of the ECI through exploratory factor analysis, using a semi-confirmatory approach, for each subscale individually, and (d) concurrent validity. A total of 307 caregivers completed the scale., Results: Reliability of the ECI subscales scores was acceptable (α = 0.63-0.89). Results replicated the original ten-factor structure of the instrument. The concurrent validity was supported by correlations of the ECI-negative subscale with psychological distress (GHQ-12, 0.43), and with depression and anxiety (HADS, 0.48 and 0.49, respectively)., Conclusions: The Spanish version of the ECI (ECI-S) demonstrated good psychometric properties in terms of validity and reliability that were similar to the original version. It is an acceptable and valid instrument for assessing the impact on family members of caring for a relative with an eating disorder and can be recommended for use in clinical settings in Spain., Level of Evidence: Level V, cross-sectional descriptive study.

We focused on carers of subjects suffering from eating disorders (ED), and studied the characteristics that mostly expose them to high levels of stress, anxiety, depression and expressed emotion, favoring the accommodation of the family system to the cared person. We administered the accommodation and enabling scale for eating disorders (AESED) questionnaire, the family questionnaire (FQ) and the depression, anxiety and stress scale (DASS-21) questionnaire to 97 carers of 62 ED patients, and investigated the carer's characteristics associated with the scores in the three questionnaires. A personal history of ED, being the primary carer, and caring for a person with a diagnosis of anorexia nervosa are the characteristics that contribute most to aggravate the carers' burden in terms of stress, anxiety, depression, accommodation and enabling. Our findings may help doctors to provide effective support to caregivers and eventually improve the treatment of subjects with ED.

Purpose: Family nursing interventions, focusing on therapeutic conversations, have been found to benefit primary caregivers dealing with chronic and acute illnesses. Less is known, however, about the benefit of these interventions for partner caregivers. The aims of this study were to develop and test the Family Strengths-Oriented Therapeutic Conversation (FAM-SOTC) intervention for partner caregivers of young individuals with eating disorders (EDs)., Methods: Eighteen partner caregivers of adolescents and young adults with ED participated in this quasi-experimental study. The FAM-SOTC intervention was offered over 4 months, during which time the focus was on establishing the therapeutic relationship and identification of the family relationships. The five key elements of the FAM-SOTC intervention are (a) drawing forward illness stories; (b) asking therapeutic questions; (c) identifying strength, resiliency, and resources; (d) offering evidence-based information and recommendations; and (e) strengthening helpful beliefs and challenging hindering beliefs. These elements provided the foundation for the study., Findings: Significantly higher family support and illness beliefs were reported after five sessions of the FAM-SOTC intervention and again after 3 follow-up booster sessions. The FAM-SOTC intervention demonstrated a positive benefit for participants., Clinical Relevance: The FAM-SOTC intervention was found to benefit families, both in the short and long term, in psychiatry settings. After having participated in five sessions of the FAM-SOTC intervention and 3 booster sessions, partner caregivers of young individuals with ED experienced higher family support and reported better knowledge, more confidence, and more positive illness beliefs regarding the disorder., (© 2018 Sigma Theta Tau International.)

WHAT IS KNOWN ON THE SUBJECT?: Individuals with eating disorders (EDs) experience hopelessness, suicidal thoughts and behaviours at elevated rates compared to the general population. Current knowledge of recovery from EDs does not address nurse engendered hope. This study aimed to explore differences between patients' and nurses' perceptions of hope-engendering nurse actions and the relationship actions have with patients' perception of hope. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: This is the first study to explore differences between patients' and nurses' perceptions of hope-engendering nurse actions in an inpatient ED facility and find significant differences; nurses' scores were higher than patients' scores. The study explored the relationship perceived self-reported nurse hope-engendering actions have with patients' and nurses' perception of hope. There were no significant relationships. This study provides additional evidence to support that there are common patient needs for nurse hope-engendering practices such as caring and providing for patients; supporting and encouraging patients' connection to others; facilitating patients' adaptive belief systems; and helping to set goals and attain resources for patients. WHAT ARE THE IMPLICATIONS FOR MENTAL HEALTH NURSING PRACTICE?: Nurses who work with patients who have EDs should be prepared to work with patients who are feeling hopeless about their future. Thus, nursing continuing education should focus on strategies that enable nurses to deliver care that reduces hopelessness, improves connection, and inspires hope in those who are recovering from EDs. The results revealed that nurses perceived that they offered patients with EDs hope-engendering actions more often and effectively than patients believed; this finding pinpoints a future direction for research that may improve care for patients. Patient feedback identified ways nurses may improve care to engender hope: providing an open caring environment, nurse presence, comfort/pain relief, and involving patients in their care. Actions by nurses aimed to enhance interpersonal connection and nurse presence could facilitate hope in patients with ED. ABSTRACT: Introduction Individuals with eating disorders (EDs) experience suicidal thoughts and behaviours at elevated rates compared to the general population. Hope-engendering nursing actions may increase patients' levels of hope for the future, improve coping self-efficacy, and possibly reduce suicidality. Although nursing staff are integral ED treatment team members, little is known about nursing actions targeting hopefulness. Aim Explore differences between patients' and nurses' perceptions of hope-engendering nurse actions and the relationship actions have with patients' perception of hope. Methods Descriptive, cross-sectional, comparative, correlational research design was used. Responses for 97 ED patients and 10 nurses were entered into analysis. Hope-engendering nurse intervention and hope questionnaires were administered and analysed. Results Nurses' total hope-engendering nurse intervention and hope scores were higher than patients' scores. Discussion Patients reported that the most effective nursing actions were providing an open caring environment, comfort/pain relief, and involving patients in their care and treatment. Nurses perceived that they offered patients hope-engendering actions more often and effectively than the patients believed. Implications for Practice Findings indicate that patients with EDs have low levels of hope. Nursing educators should further develop strategies that enable nurses to deliver care that inspires hope and improves connectedness in those who have EDs., (© 2019 John Wiley & Sons Ltd.)

Occupational therapy offers support through actuation via a suggested activity. It opens up a differentiated space, a space of experiences where patients can contemplate themselves through play. The therapeutic relationship, assured by the occupational therapist, offers flexibility and malleability to welcome, contain and support the person with an eating disorder. It aims to be compassionate without judgement to favour the experience of movement. 'Making do with oneself' to 'be with oneself' while respecting the temporality of the patient's possibilities., (Copyright © 2018 Elsevier Masson SAS. All rights reserved.)

Background: Family carers of patients with advanced cancer living at home have an important role in providing the patient's food and drink. Little attention has been paid to the support needs, particularly of the nutrition needs, of family carers., Objective: The aim of this study was to report support needs of family carers of patients with advanced cancer and eating problems., Methods: The research is an inductive secondary analysis of baseline interview data from an exploratory trial conducted in the south of England. The interviews explored the management of eating problems in the home. A sample of 31 patients was selected where the patient's partner/spouse had also agreed to take part in the primary study., Results: The analysis and interpretation reveal family carers to have a nourishing role, which is taken for granted by the patient and the carer themselves. This role is typically seen as an extension of the normal role of wife, mother, or homemaker in the family and no more than what a family carer should do. This obscures a need for information and advice on the nutritional care of patients with cancer with fickle appetite and other eating problems that are difficult to manage. Family carers may also be at a nutritional risk because their own dietary intake was found to mirror the patient's with some of them losing weight., Conclusions: Family cancer carers have a nourishing role that requires knowledge and skill beyond the everyday., Implications for Practice: Cancer carers need education in how best to provide nutritional care. They also need support in managing their own nutritional risk.

This article outlines how the application of a reflecting team from systemic family therapy practice was used as a learning strategy for a postgraduate programme for healthcare students. The programme was designed to increase the students' skills, knowledge and awareness of the needs of people with eating disorders, and their families. There were some benefits to this learning strategy. Students reported that the use of a reflecting team enabled them to gain a deep understanding of the emotional impact of eating disorders on individuals and their carers. However, as this method of learning was new to the students, they needed some initial instruction on the approach. During the programme of study, it became evident that the health professionals were deeply affected by the experiences of people with eating disorders. This would suggest that possibly it was the presence of the sufferers themselves as part of the reflecting team that provided the pivotal learning opportunity, rather than the reflecting team per se.

Caring for a relative with an eating disorder (ED) is associated with heightened psychological distress, which, according to a stress-coping model, may be influenced by coping and appraisal. However, limited quantitative studies have assessed coping in ED caregivers. This cross-sectional study aims to assess 1) the differences in coping between caregivers of three groups: patients with an ED, patients with a substance use disorder, and healthy teens, and 2) the patient and caregiver variables associated with coping and appraisal of the caregiving experience. A one-way MANOVA was significant for caregiver group for mothers, but not fathers. Mothers of both patient groups used more self-sufficient problem focused coping than mothers of healthy teens. Patient caregivers did not significantly differ from caregivers of healthy teens in their use of avoidance. Mothers used social support strategies more than fathers. A positive experience of caregiving was significantly associated with the use of approach-oriented coping in ED caregivers and a negative experience of caregiving was significantly associated with avoidance in ED mothers. Older ED caregivers were less likely to use avoidance. Future interventions could help ED caregivers to recognize their coping preferences and how to appropriately use these strategies when faced with illness-related stressors., (Copyright © 2017 Elsevier B.V. All rights reserved.)

Aims and Objectives: To prove the effects of an enteral feeding improvement massage for premature infants with regard to their feeding, growing and superior mesentery artery blood flow aspect by a randomised controlled trial., Background: Premature infants have feeding-related problems related to eating and absorbing nutrition due to their immature gastrointestinal function. Studies regarding the effectiveness of premature infants' enteral feeding improvement by tactile stimulation massage are rare., Design: The study group was composed of 55 patients. Of the 55 patients, 26 were randomised into an experimental group and 29 were randomised into a control group., Methods: They were all born <34 weeks of gestational age between 1 July 2011 and 30 March 2012. Premature infants in the experimental group received enteral feeding improvement massage twice a day for 14 days, and infants in the control group received a sham exercise. The collected data were analysed by spss 19.0, through t test, chi-square test (Fisher's exact) and ANCOVA., Results: (i) The experimental group had reached the day of full enteral feeding significantly faster. (ii) The experimental group had a higher superior mesentery artery peak velocity (V max ) and lower RI (resistant index). (iii) The experimental group of the feeding-intolerant subgroup had a higher superior mesentery artery V max and V min . (iv) The experimental group had a heavier weight and larger head circumference after 14 days., Conclusions: This study demonstrates that enteral feeding improvement massage can be helpful for achieving earlier full enteral feeding, more increased superior mesentery artery, and faster growing. In particular, it can be a therapeutic, independent and evidence-based nursing intervention for feeding-intolerant premature infants., Relevance to Clinical Practice: Neonatal nurses in neonatal intensive care unit can apply enteral feeding improvement massage massage for feeding-intolerant infants., (© 2017 John Wiley & Sons Ltd.)

The focus of medical hospitalization for restrictive eating disorders is weight gain; however, no guidelines exist on how to achieve successful and safe weight gain. Meal supervision may be a supportive intervention to aid in meal completion and weight gain. The aim of this study was to examine the effect of standardized meal supervision on weight gain, length of stay, vital signs, electrolytes, and use of liquid caloric supplementation in hospitalized adolescents and young adults with restrictive eating disorders. A chart review compared patients who received meal supervision from admission through discharge to an earlier cohort who received meal supervision as needed. There were no differences in weight, electrolytes, or vital signs between the two cohorts. Length of stay for those who received meal supervision from admission was 3 days shorter than earlier cohort. Nursing supervised meals beginning at admission may shorten length of stay and decrease health care costs.

Purpose: To describe the perceptions of inpatient pediatric hospitalist physicians (HPs), registered nurses (RNs), and care assistants (CAs) at a tertiary pediatric hospital regarding caring for children with eating disorders (EDs) who are hospitalized for medical stabilization., Design and Methods: A qualitative descriptive study was conducted using semi-structured individual interviews with aforementioned health care workers (HCWs) to explore their perspectives on caring for children/adolescents with EDs in relation to recent initiatives to transform their care. These initiatives focused on admitting patients to a designated "ED Unit", development of an ED consult team, providing ED education to staff, and development of ED standardized order sets (SOSs)., Results: Twenty HCWs representing the three disciplines completed individual interviews. Most participants reported that the system changes led to more consistent care of patients with ED. Content analysis of the interviews revealed the following themes: awkwardness and uncertainties of care, navigating family dynamics, establishing therapeutic boundaries, and finding rewards in ED care., Conclusions: Education, structure, and support for staff improved care for adolescents with EDs as perceived by HCWs. HCWs found satisfaction in providing care during the medical stabilization process. Study findings were positive for staff and future studies should include perceptions of patients/families to further design a therapeutic environment., Practice Implications: Providing a standardized order set, expert consult team, and ongoing staff training can strengthen the therapeutic hospital environment for adolescents with EDs. Pediatric hospitals can provide excellent care for children with EDs while supporting their staff to provide a therapeutic environment., (Copyright © 2017 Elsevier Inc. All rights reserved.)

'Take yourself back to the age of 15. What thoughts swirled around your head? Did you worry about how you looked or what your friends and teachers thought of you?' Wendy Clarke, specialist lead for eating disorders at Aneurin Bevan University Health Board in South Wales, believes nurses should be asking themselves these questions if they are to fully empathise, engage with and help young people with eating disorders.

Shelley Perry is a dedicated and passionate mental health practitioner who specialises in supporting people with eating disorders across Lancashire. She is also a social entrepreneur.

Caring for an offspring with an eating disorder (ED) is associated with high levels of distress, and health problems. Indeed, ED caregivers have to cope with a range of challenges related to their caring role, which represents a chronic stress situation. This tends to alter body homeostasis and caregivers' health status. This study aimed to analyse the electrodermal reactivity and psychological response to acute stress in ED caregivers compared to non-caregivers. As expected, caregivers showed lower electrodermal (p < .001, η2partial = .269 for SCL and p < .01, η2partial = .214 for NSCRs) and psychological response (p < .05, η2partial = .198) to acute stress than non-caregivers. The findings suggest the existence of physiological adaptation to chronic stress in family caregivers of people with EDs.

Little known in this contexte, the association between eating disorders (EDs) and schizophrenia is however common. EDs are involved in impaired quality of life and the development of many metabolic disorders in these vulnerable patients. Antipsychotic medications may lead to EDs and should be more extensively explored. We should sensitize patients, their families and caregivers, to improve screening and management of EDs in schizophrenia., (Copyright © 2015 Elsevier Masson SAS. All rights reserved.)

Background: Feeding difficulty is common in infants younger than 6 months. Identification of infants in need of specialized treatment is critical to ensure appropriate nutrition and feeding skill development. Valid and reliable assessment tools help clinicians objectively evaluate feeding., Purpose: To identify and evaluate assessment tools available for clinical assessment of bottle- and breastfeeding in infants younger than 6 months., Methods/search Strategy: CINAHL, HaPI, PubMed, and Web of Science were searched for "infant feeding" and "assessment tool." The literature (n = 237) was reviewed for relevant assessment tools. A secondary search was conducted in CINAHL and PubMed for additional literature on identified tools., Findings/results: Eighteen assessment tools met inclusion criteria. Of these, 7 were excluded because of limited available literature or because they were intended for use with a specific diagnosis or in research only. There are 11 assessment tools available for clinical practice. Only 2 of these were intended for bottle-feeding. All 11 indicated that they were appropriate for use with breastfeeding. None of the available tools have adequate psychometric development and testing., Implications for Practice: All of the tools should be used with caution. The Early Feeding Skills Assessment and Bristol Breastfeeding Assessment Tool had the most supportive psychometric development and testing., Implications for Research: Feeding assessment tools need to be developed and tested to guide optimal clinical care of infants from birth through 6 months. A tool that assesses both bottle- and breastfeeding would allow for consistent assessment across feeding methods.

Caring for children diagnosed with a chronic psychological disorder such as an eating disorder (ED) can be used as a model of chronic stress. This kind of stress has been reported to have deleterious effects on caregivers' cognition, particularly in verbal declarative memory of women caregivers. Moreover, high depressive mood and variations in testosterone (T) levels moderate this cognitive decline. The purpose of this study was to characterize whether caregivers of individuals with EDs (n = 27) show declarative memory impairments compared to non-caregivers caregivers (n = 27), using for this purpose a standardized memory test (Rey's Auditory Verbal Learning Test). Its purpose was also to examine the role of depressive mood and T in memory decline. Results showed that ED caregivers presented high depressive mood, which was associated to worse verbal memory performance, especially in the case of women. In addition, all caregivers showed high T levels. Nonetheless, only in the case of women caregivers did T show a curvilinear relationship with verbal memory performance, meaning that the increases of T were associated to the improvement in verbal memory performance, but only up to a certain point, as after such point T continued to increase and memory performance decreased. Thus, chronic stress due to caregiving was associated to disturbances in mood and T levels, which in turn was associated to verbal memory decline. These findings should be taken into account in the implementation of intervention programs for helping ED caregivers cope with caregiving situations and to prevent the risk of a pronounced verbal memory decline.

The aim of this study is to evaluate the recent literature on carers/parenting interventions for people with eating disorders. Interesting and important new findings are highlighted as well as the implications that this may have for treatment. We have reviewed and critically analysed the recent literature. Close others often play an important role in recognising the early signs of eating disorders and accessing and implementing treatment. Their role in helping with recovery is to give support and hold a united front themselves and with the professional team to avoid those common interpersonal reactions that adversely impact on outcome such as accommodating to the illness and reacting with high expressed emotion (overprotection and hostility). Managing this role is difficult, and coping resources are often strained. Carers ask for and are now getting expert training in skills to manage this role. There is an overlap between carer/parenting interventions and family therapies. The interface with close others is critical both for early recognition and access and implementation of treatment. Interventions which equip families and close others with the skills to manage eating disorder behaviours are showing potential at improving outcomes.

Background: Malnutrition is a common phenomenon in acute care institutions accounting for many negative health consequences for the patient. In many hospitals, therefore, malnutrition risk screening and nutrition management programs were established; however, programs were commonly developed without integrating the patients' perspective. It is unknown if the program covers the patients' needs and if the interventions are worthwhile., Aim: Because patient experience is known solely from everyday conversations, the aim of the study was to explore affected patients' experience regarding nutrition management., Method: The study has a qualitative, inductive approach. From September 2011 till May 2012, seven women and one man were interviewed. To analyse the guided interviews, content analysis was used., Results: The analysis shows that patients find themselves between ‘to want but not be able to eat’. Patients at risk encounter barriers due to their physical condition, such as swallowing- and chewing pain, nausea and dysgeusia and barriers associated with the system when ordering meals, such as fixed mealtimes, a limited variety of the menu and non-tasting supplements. To overcome these barriers patients are left to develop self-management strategies and to be in charge of their nutrition., Conclusions: Therefore, targeted training for caregivers is a key, enabling them to support patients individually in their nutrition management. At the same time, institutional barriers must be removed.

Children and adolescents who eat unusually large amounts of food, feel guilty about it, and try to hide their overeating may be struggling with binge eating disorder (BED), a condition associated with suicidal ideation and other eating disorders. Although BED is new to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, the syndrome is becoming increasingly recognized. The study of BED in children and adolescents is in its natal phase, but the importance of recognition and possible treatment strategies are discussed in the current article along with psychiatric nursing implications., (Copyright 2015, SLACK Incorporated.)

Background: The consequences of caring for a person with a mental illness can impose a substantial burden. Few studies have compared this burden among caregivers of patients with eating disorders and other mental illnesses. The objective of this study was to compare caregiver consequences in eating disorders (ED) with caregiver consequences in depression and schizophrenia, assessed with the same instrument, the Involvement Evaluation Questionnaire (IEQ). Another aim was to identify factors that may predict these consequences., Methods: We conducted a cross-sectional study involving 251 caregivers of ED patients; 252 caregivers of patients with depression; and 151 caregivers of patients with schizophrenia. Caregivers completed the Involvement Evaluation Questionnaire EU Version (IEQ-EU). Descriptive statistics, ANOVA, and Chi-square were applied to examine the inter-variable relationships. Consequences- indexes were also computed., Results: In all samples, worrying was the most commonly reported consequence of caregiving. Predictive variables for a high level of caregiver burden included being a mother or partner of the person being cared for (p = <.01), and being a caregiver of a patient with ED., Conclusions: The burden of caregiving is higher among caregivers of patients with eating disorders patients than among caregivers of patients with depression or schizophrenia. Our findings suggest that caregivers of patients with an ED could benefit from providing adequate assessment and support.

Objective: A variety of interventions have been developed for caregivers of people with an eating disorder either to help them cope with the burden and distress that commonly accompanies this role or to make them more effective at providing support. The aim of the study is to perform a meta-analysis of quantitative studies that have described the impact of these interventions on caregivers., Method: Electronic databases were searched between September 2001 and September 2013. Thirteen studies were finally selected for inclusion. Pooled effect size estimates were summarized. Meta-regressions were used to determine whether type of intervention, team, measure used or risk of bias were effect modifiers of the relationship. We also summarized the content and form (amount of professional help) of the interventions., Results: Most interventions produced a moderate sized reduction in carer distress and a small/moderate reduction in carer burden and expressed emotion post treatment and these changes were maintained over follow-up., Discussion: Carer distress, burden and expressed emotion can be reduced by a variety of psychoeducational interventions and these changes are sustainable over time. The interventions themselves are easy to disseminate and deliver., (© 2014 Wiley Periodicals, Inc.)

Eating disorders are more common in youth with diabetes, especially females, and not only interfere with diabetes management but can increase the risk for diabetes-related complications. School nurses may be the first to recognize eating disorders among students with diabetes. They are an integral part of a multidisciplinary team, connecting students and families to both health care and community resources, ensuring that mental, physical, and social needs are addressed.

Low birth weight infants (LBW) are reported to be at risk for posttraumatic feeding disorder (PTFD). In this study, we evaluated the outcome of an intervention program for infants with PTFD. LBW infants with PTFD (N=21) completed feeding behavior questionnaires at entry and after completing the program and were compared to a matched control group. PTFD group infants showed a significantly high rate of food disorder symptoms at entry but not at follow-up compared to the control group. The intervention program for PTFD infants resulted in reduced feeding disorder symptoms., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Background: Because of a rise in incidence and more effective treatments, the prevalence of patients with metastatic cancer is increasing fast. When palliative treatment is aimed at maintaining or improving patients' quality of life, knowledge about severe fatigue is clinically relevant because of its debilitating effect, but at present this information is lacking., Objective: This study investigated the prevalence of severe fatigue in patients with various incurable cancers and whether severe fatigue increased with further treatment lines and differed between various cancers and treatment modalities. In addition, a relationship between severe fatigue and other symptoms was examined., Methods: Patients were asked to fill in the Checklist Individual Strength, European Organization of Research and Treatment of Cancer-Quality of Life Questionnaire C30, and the McGill Pain Questionnaire during palliative anticancer treatment, and hemoglobin levels were collected., Results: Of all participating patients (n = 137), 47% were severely fatigued. Patients who received first line of treatment were significantly less often severely fatigued (40%) compared with patients who received further lines (60%). Significantly more severe fatigue was observed when patients had more pain, dyspnea, appetite loss, nausea, vomiting, and constipation., Conclusions: During the phase of palliative anticancer treatment, fatigue was the most common symptom, nearly half of the patients had severe fatigue increasing with further treatment lines. Various treatment-related symptoms were related to more severe fatigue., Implications for Practice: As severe fatigue is significantly related to other symptoms of cancer and its treatment, the screening and treatment of these cancer-related symptoms should be more stringent, as they might negatively influence each other.

The purpose of this inquiry was to develop substantive theory that describes the social process that influences the eating behavior of hospitalized older adults. Undernutrition contributes to negative health outcomes, such as increased morbidity and mortality in hospitalized older adults. Despite the availability of vast nutritional resources within the hospital environment, hospitalized older adults often have inadequate dietary intake. A grounded theory methodology was used to explore this phenomenon. The Theory of Compromised Eating Behavior describes the process of compromise that older adults experience related to eating behavior while hospitalized. The theory has four stages: self-indication, joint action, negotiation, and action. The meaning of hospital food and mealtimes differs from at-home food and mealtimes for the older adult, resulting in compromise. Intervention, which enhances the meaning of food and mealtimes for the older adult during hospitalization, may improve dietary intake and nutritional outcomes., (Copyright 2014, SLACK Incorporated.)

In this qualitative study, we aimed to investigate work demands experienced by health-care workers in an adult eating disorder inpatient service. We also aimed to investigate the use of social support and job satisfaction in this setting. Twelve health-care workers from an eating disorder inpatient ward, including nurses, health-care support workers, and occupational therapists, participated in semistructured interviews. Interviews were transcribed verbatim and analysed using thematic analysis. A number of work demands were discussed relating to therapeutic care, physical care, and organizational demands. Most participants discussed social support at work as being highly valuable, formally and informally, whereas external support was viewed as less important. Despite the challenges of caring for patients with eating disorders, the majority of participants reported good patient-related job satisfaction, but poor job satisfaction in relation to organizational factors. Eating disorder inpatient care is complex and demanding, necessitating effective teamwork, communication, and support systems among health-care workers. Interventions should be developed to target barriers to care, including time constraints, administrative workload, and insufficient allocation of staff., (© 2013 The Authors; International Journal of Mental Health Nursing © 2013 Australian College of Mental Health Nurses Inc.)

Background: Little is known regarding the short-term quality of life (QoL) and predictive factors for QoL after esophagectomy for cancer in Eastern countries., Objective: The aims of this study were to assess QoL and symptoms within 1 and 6 months after surgery for esophageal cancer (EC) and to identify factors predictive of QoL within 6 months after esophagectomy in Taiwan., Methods: A longitudinal, prospective design was used, where convenience samples of 99 patients who had undergone esophagectomy for cancer were recruited from 2 medical centers in northern Taiwan. All participants responded to a questionnaire with a QLQ-C30 (Quality of Life Questionnaire-Cancer) core and a QLQ-OES18 (esophageal module of the European Organization for Research and Treatment [EORTC] QLQ-C30) module in structured interviews at baseline and 1 and 6 months after surgery., Results: The results showed significant decline in social function and global QoL; fatigue, insomnia, eating problems, reflux, and dry mouth were major problems within 6 months. Body mass index, body weight loss before surgery, activity performance status, and anastomosis site showed no significant association with the function and symptom aspect of QoL. Surgical complications, advanced cancer, neoadjuvant therapy before surgery, and tumor location other than at the EC junction had significant deleterious effects on several aspects of QoL., Conclusions: This study describes the demographics of EC and short-term changes in QoL and also the predictive impact factor for QoL after surgery for EC., Implications for Practice: Knowledge of risk factors for poor postoperative QoL would be useful for health providers in detecting and prioritizing problems and treatment options in a busy clinical site.

Unlabelled: Although the vast majority of youths with an eating disorder (ED) are treated as outpatients, some require treatment in an inpatient unit. The purpose of this study was to determine the attitudes of nurses and pediatric residents towards adolescents and young adults with ED., Methods: Nursing questionnaires were distributed through a nurse manager and resident questionnaires were distributed in coordination with the chief residents., Results: A total of 82 individuals (32 nurses and 50 pediatric residents) completed the survey. Only two nurses and six residents had not worked with a patient with an ED in the previous year. The vast majority of nurses and residents recognized that fear of gaining weight, refusal to maintain body weight and, disturbed body image were frequent signs occurring in patients with an ED. Both nurses and residents believed that emotional problems, influence of friends and family, family pressure, influence of the media, and being self-induced were the most likely causes of EDs. Genetics and influence of other medical problems were deemed less likely causes. The majority of residents identified having different rules for different patients and poor communication as factors that make it difficult to take care of ED patients. More than half of all nurses and residents (58.2%) thought that ED patients were responsible for their disease "always" or "in most cases". Residents (68.8%) were more likely than nurses (45.2%) to frequently feel frustrated with ED patients (χ2, p<0.0370)., Conclusion: Adolescents with an ED provide a unique challenge to nurses and residents caring for them.

Patients with eating disorders may have the most complex interdisciplinary treatment plans of any mental illness. Nurses need innovative evidence-based treatment interventions to assist their patients with eating disorders on their road to recovery. Although much has been written about equine-assisted psychotherapy (EAP) and equine-facilitated psychotherapy, the literature has not described a detailed session that can help nurses understand how this experiential treatment works and the impact it can have on the patient. A review of the literature on eating disorders and on the use of equine therapy in its treatment is presented in this article. In addition, the role of the nurse during equine therapy will be highlighted, and an individual example will provide a detailed review of an EAP session., (Copyright 2013, SLACK Incorporated.)

Ambivalence to change is a major obstacle to treating people with eating disorders. Enhancing motivation to change can contribute to recovery from the disorders. This study used an Internet-based self-help program developed in the Asia-Pacific region to identify the motivational stages of change in people with eating disorders. It explored their perceptions of the benefits and costs of taking action against their eating disorders, and assessed their involvement in motivational enhancement exercises and their improvement in eating disorder psychopathology. A total of 185 participants, aged 16-50 years (mean age, 26.5) were involved in the open-trial program with a motivational enhancement component and completed the Motivational Stages of Change Questionnaire (MSCARED), the Eating Disorder Examination Questionnaire version 5 (EDE-Q5) and the Eating Disorder Inventory version 3 (EDI-3). The results show that more participants perceived the benefits of taking action against their eating disorders than the costs. Completer analysis shows that they experienced significant improvement in motivational stages of change and eating disorder psychopathology, from a baseline assessment to 1-month and 3-month follow ups. The self-help program has potential benefit for people with eating disorders and its use could be encouraged by health-care professionals to enhance the motivation to change and facilitate recovery., (© 2012 The Authors; International Journal of Mental Health Nursing © 2012 Australian College of Mental Health Nurses Inc.)

In this article, we report findings from a study aimed at developing the content and implementation of a manual for a research-based intervention on clinical supervision of mental health nursing staff. The intervention was designed to strengthen already existing supervision practices through educational preparation for supervision and systematic reflection on supervision. The intervention consists of three sessions and was implemented on two groups of mental health hospital staff. We present an outline of the manual and explain how the trial sessions made us adjust the preliminary manual. The effects of implementing the manual will subsequently be analysed in an independent randomised controlled trial.

Purpose/objective: To explore patterns of symptoms before and after surgery for cancer of the esophagus., Design: Longitudinal, descriptive study., Setting: An urban comprehensive cancer center in the northeastern United States., Sample: 218 patients with cancer of the esophagus undergoing esophagectomy., Methods: Symptoms were assessed by self-report before surgery, at the first postoperative visit, and at 6 and 12 months postsurgery., Main Research Variables: Symptoms and demographic and clinical variables, including stage, treatment, gender, and comorbidities., Findings: Patients with esophageal cancer reported numerous symptoms before and after esophagectomy. Several patterns of symptoms were identified. General cancer symptoms (e.g., pain, cough, shortness of breath, weight loss) were reported as worse after surgery but recovered to baseline by one year. A second pattern of esophageal-specific symptoms (feeling full too quickly, feeling bloated, nausea, and diarrhea) worsened after surgery and did not recover to baseline by one year. Reflux was the only symptom that did not worsen after surgery but did worsen significantly during the first year of recovery., Conclusions: Patients with esophageal cancer experienced multiple prolonged symptoms following surgical treatment for their disease. General cancer symptoms resolved by one year post-treatment, whereas esophageal-specific symptoms worsened after surgery and did not recover to baseline., Implications for Nursing: Identification of symptom patterns preoperatively and during recovery can assist nurses in developing intervention protocols to minimize long-term complications for patients with esophageal cancer., Knowledge Translation: Patients with esophageal cancer are at risk for multiple prolonged symptoms following surgery. Symptom assessment should occur often after surgery and include a broad range of symptoms.

Carer burden in eating disorders is considerable, but to date no research has examined carer burden from the perspective of the person with an eating disorder. The current brief report assessed carer burden with a short questionnaire, as perceived by 20 matched pairs of sufferers and their carers. Those with an eating disorder significantly underestimated the overall burden experienced by their carer, particularly in relation to nutritional difficulties and conflict within the family. Domains where carers and sufferers had high agreement may be useful in facilitating collaborative involvement between sufferers and carers in treatment, such as multi-family therapy.