By Sylvia Foley, AJN senior editor

Bar the View by HereStanding, via Flickr

For adolescents with severe anorexia, experts have long relied on treatment in specialized pediatric acute care settings, using programs that are based on behavior modification principles and that promote stability through refeeding.

But what is it like to be a young inpatient in such a program? And how does the behavior modification approach affect the nurse–patient relationship? To learn more, nurse researcher Lucie Michelle Ramjan and colleague Betty I. Gill conducted a study in an Australian acute care facility. Their findings are reported in this month’s CE: Original Research feature, “An Inpatient Program for Adolescents with Anorexia Experienced as a Metaphoric Prison.”

The research. Ramjan, the study’s principal investigator, conducted in-depth, face-to-face interviews with 10 adolescent patients being treated for anorexia and 10 pediatric nurses. The interviews were audiotaped; the tapes were then transcribed verbatim, read and reread, and subjected to thematic analysis. As another writer has noted elsewhere, in qualitative research, metaphors often “illuminate the meanings of experiences.” In this study, the researchers found that both nurses and patients “consistently used the metaphor of prison life to articulate their experiences.”

That striking metaphor offered Ramjan and Gill a framework for interpreting the data, and three major themes emerged, as follows:

  • entering the system
  • “doing time” within the system
  • on parole or release

Various subthemes were also identified, and Ramjan and Gill have provided numerous examples from the interviews.

The implications. In discussing the findings, they write,

The challenge of forming positive therapeutic relationships is magnified for nurses working with adolescents being treated for anorexia in an inpatient behavior modification program. In such programs, the ward may function as a metaphoric prison, with patients seeing themselves as inmates and nurses as prison wardens . . . The inherent conflict between administering treatment based on behavior modification, on the one hand, and developing therapeutic relationships, on the other, may pose the greatest challenge for nurses.

Ramjan and Gill also address the nursing implications of their findings, before noting in conclusion, “The challenge before us is to reform the culture of inpatient behavioral anorexia treatment programs without losing their benefits.” They suggest several policy changes that might do just that. The full article is free online.

Have you worked with patients being treated for anorexia through an inpatient behavior modification program? How does your experience compare with what Ramjan and Gill describe? Please let us know.

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