Anorexia Nervosa Patient Case Study

Anorexia Nervosa Patient Case StudyFor my six week clinical get along placement in an youthful mental health unit I chose to focus my project on a 15-year-old anorexia nervosa enduring. This disorder largely affects young women and is an extremely challenging problem to treat. I felt that working with an anorexia nervosa patient in this controlled environment, under the guidance and supervision of a mentor, would be a particularly good application of action acquirement because action learning can rapidly develop critical skills.1 In particular I wanted to develop interpersonal skills necessary to communicate sanitary with patients and colleagues, and learn to relate to any issues raised by my patient being a teenager. As I learn better from hands-on training than by dint of just reading and discussion I felt this would a valuable use of my clinical placement.Anorexia nervosa patients often have low self-esteem and a commit for achieving perfection in all the things they do2 t his was something I had to be aw be of during the placement because it raises the problems with goal setting. With anorexia it is difficult to agree on goals with a patient because the chief(prenominal) goal, from a health locating, is slant gain, which they want to avoid.3 The other issue is that the patient is 15-years-old. This fits the common case that many patients seek therapy at the insistence of parents so the patient arrives at for the consultation poised to resist, anticipating the same pressures for change.4 These factors combine to make intercession extremely difficult first, the patient is resistant to change second, the patient specifically wants to avoid weight gain, which is the main goal third, if you can get the patient to agree on a goal they might feel anxiety because of their perfectionism, leading to more exacting demeanour i.e. trying to lose weight.My mentor was especially helpful in highlighting some of these points to me with regards to the patient, and helping me think more or less ways we could deal with them clinically. In my last placement I did a training course in cognitive behavioural therapy (CBT) and my mentor and I felt this could be useful. There is capacious clinical evidence supporting the use of CBT in treating anorexia nervosa5 and once the disorder is initiated, it is the cognitive self-reinforcement that becomes the key factor in regulating it.6 We agreed that since cognitive behaviour is key to the illness it has potential to break the negative thought cycle.I used clinical guidelines to understand more about the possible benefits of CBT for anorexia nervosa. One position of interest is that The CB approach has two particularly valuable sources of flexibility and creativity applicable to the issue of engagement. These are structured legal opinion and models of resistance structured assessment can be real helpful in developing an in-depth understanding surrounding resistance to services.7With the guidance of my mentor and other clinic staff I worked on my assessment skills with the aim of engaging this particular patient. Unfortunately, in the course of my six week placement the patient proved very difficult to engage with, perchance because change involves a patient giving up a cherished and valued state.8 If this had been in an unsupported setting I would have found this very discouraging and probably would have doubted my methods. However, through with(predicate) using the learning side of the process I found that motivation and engagement are commonly poor or ambivalent in patients with eating disorders, particularly anorexia nervosa9 and that patients with anorexia nervosa react to stress both in childhood and adulthood with a helpless style of contend and a tendency to use avoidance strategies.10 These findings showed that I was dealing with a widespread problem, not something specific to my patient.This insight, and the supportive atmosphere from the other clinical staff, helped me obligate my focus on the patient, and not think of the challenges as personal failings. In the space of six weeks I didnt have era to work through these issues with this particular patient, but the action learning process gave me the confidence that I would be able to address them in future. It also put in perspective that the patient continued to lose weight. That is obviously not the outcome desired but knowing that 70 percent of the eating disordered subjects for CBT remained symptomatic11 assured me that this is also a common problem.During the placement my mentor and I discussed these problems and talked about assorted methods that might be useful to overcome them. One area I decided it was Copernican for me to focus on is relational skills with patients. With anorexia nervosa, especially, the interpersonal process needs to take this ambivalence or indeed resistance into account. The skills of motivational interviewing are invaluable.12 We also talked about the po ssibility of using other types of therapy along with CBT. Most of the clinical data supports CBT as effective, but there have been some studies that show family therapy can be beneficial13, which we thought might be a useful avenue to explore since the patient is 15. However, my mentor cautioned me that family difficulties often lie at the root of eating disorders and betokened I check some literature. I found out that women with anorexia nervosa typically describe both their parents negatively and women with eating disorders described their parents as typically unsupportive of their independence.14 This would suggest treating family therapy with caution. It could be that patients come from genuinely unhappy families, or it could also be that anorexia nervosa patients resent their parents perceived intrusion of trying to make them eat as an flack catcher on their independence. Im glad my mentor raised this issue, because it made me realise that before using additional therapies yo u need to consider patient tale and resistance, and you also need to understand the reasons they might not want to do a particular therapy, to allow you to make the best decision about treatment options.During the placement there was a good mix of clinical work and theory. I found my relationship with my mentor was the most important element during my meter working with the patient, as they modelled good patient care and helped me reflect on my own work. They emphasised to me that reflection is important within formal professional courses and for demonstrating work-based learning,15 which is something I probably wouldnt have really thought about without their guidance. One of the possible weaknesses of action learning, according to some practitioners, is that where real work and learning are explicitly associated, the excitement, significance and immediacy of the action element can often submerge the learning element.16 I can see how that could happen in a busy clinical setting f or example an AE department but I felt that within the setting of the mental health clinic there was adequate time for learning and there was a chance to access books, clinical guidelines and advice from the staff.As a essence of what I learned during my project my development goal is to practice my therapeutic communication skills and make an effort to get feedback on them. This placement made me see how important interpersonal skills are, as well as the different challenges. In working with my patient I felt lack of engagement was one of the biggest difficulties, and led to an unsuccessful outcome in the short term. Developing unassailable therapeutic communication skills is a way to overcome resistance to treatment. Using the listening skills of therapeutic communication will also help understand the patients needs and challenges related to treatment such as possible family issues in anorexia nervosa.It was somewhat discouraging to not see a better result with this patient, b ut the placement taught me that in Action nurture the emphasis is on the courageous struggle to act and understand not on short cuts and ardent fixes17 and I think that knowledge will enhance my confidence as I approach the challenges of improving my communication skills and taking forward what I learned.BibliographyBennett-Levy, J., Butler, G., et al., Oxford surpass to Behavioural Experiments in Cognitive Therapy, Oxford University Press, 2004Bulman, C. and Shutz, S., Reflective Practice in Nursing The Growth of the Professional Practitioner, Blackwell Publishing, 2004Cassidy, J. and Shaver, P., vade mecum of Attachment Theory, Research, and Clinical Applications, Guilford Press, 2002Costin, C., The Eating Disorder Sourcebook A Comprehensive Guide to the Causes, Treatments, and Prevention of Eating Disorders, McGraw-Hill Professional, 2006Garner, D. and Garfinkel, P., Handbook of Treatment for Eating Disorders, Guilford Press, 1997Grant, A., Mulhern, R., et al., Cognitive Beha vioural Therapy in Mental wellness Care, SAGE, 2004Marquardt, M. and Callahan, M., Action Learning, American nine for Training and Development, 1997Newell, R. and Gournay, K., Mental Health Nursing An Evidence-based Approach, Elsevier Health Sciences, 2000Norman, I. and Ryrie, I., The Art and Science of Mental Health Nursing A Textbook of Principles and Practice, McGraw-Hill International, 2004Pedler, M., Action Learning in Practice, Gower Publishing, Ltd., 1997Footnotes1 Marquardt, M. and Callahan, M., Action Learning, American Society for Training and Development, 1997, p. 132 Bennett-Levy, J., Butler, G., et al., Oxford Guide to Behavioural Experiments in Cognitive Therapy, Oxford University Press, 2004, p. 2673 Ibid, p. 954 Garner, D. and Garfinkel, P., Handbook of Treatment for Eating Disorders, Guilford Press, 1997, p. 995 Garner, D. and Garfinkel, P., Handbook of Treatment for Eating Disorders, p. 956 Ibid, p. 1067 Grant, A., Mulhern, R., et al., Cognitive Behavioural Therap y in Mental Health Care, SAGE, 2004, p. 1498 Newell, R. and Gournay, K., Mental Health Nursing An Evidence-based Approach, Elsevier Health Sciences, 2000, p. 2539 Bennett-Levy, J., Butler, G., et al., Oxford Guide to Behavioural Experiments in Cognitive Therapy, p. 28210 Newell, R. and Gournay, K., Mental Health Nursing An Evidence-based Approach, p. 24711 Costin, C., The Eating Disorder Sourcebook A Comprehensive Guide to the Causes, Treatments, and Prevention of Eating Disorders, McGraw-Hill Professional, 2006, p. 11812 Norman, I. and Ryrie, I., The Art and Science of Mental Health Nursing A Textbook of Principles and Practice, McGraw-Hill International, 2004, p. 46313 Ibid, p. 46714 Cassidy, J. and Shaver, P., Handbook of Attachment Theory, Research, and Clinical Applications, Guilford Press, 2002, p. 50815 Bulman, C. and Shutz, S., Reflective Practice in Nursing The Growth of the Professional Practitioner, Blackwell Publishing, 2004, p. 3016 Pedler, M., Action Learning in Practi ce, Gower Publishing, Ltd., 1997, p. 22917 Ibid, p. 32