“Do you see what I mean?” staff collaboration in eating disorder units during mealtimes

Abstract

BackgroundEating disorders are psychiatric illnesses with potentially life-threatening consequences. Inpatient treatment is typically required for the most severely ill patients, who are often emaciated or significantly malnourished. A core therapeutic objective is to normalize eating patterns and facilitate weight gain. These goals guide the efforts of milieu therapeutic staff working with this patient group, who support renourishment through the positive manipulation of a structured environment, as well via relational aspects. However, there is a lack of empirical research exploring inpatient staff members’ perspectives concerning various aspects of this work. This article explore staff’s teamwork during mealtimes on inpatient eating disorder units. Specifically, we investigated the collaborative strategies employed to support core therapeutic goals of meal completion and normalized eating behavior, while concurrently maintaining a supportive, friendly atmosphere during mealtimes.MethodsThis was a exploratory qualitative study. Data was collected through 20 semi-structured in-depth interviews with staff members working on a specialized eating disorder unit. The interviews were performed after the conduction of meal time support. Cultural historical activity theory was used as the key theoretical tool for analysis.ResultsThe analysis revealed three main themes: 1) strategic seating arrangements mediates division of labor, 2) the use of verbal and nonverbal communication as collaborative tools, and 3) the importance of experience as a collaborative resource.ConclusionsThe present study found that mealtime collaborative strategies on inpatient EDUs were mainly of non-verbal nature, with level of experience as an important premise for staff collaboration. Greater awareness about how collegial collaboration is practiced may help staff members to learn routines and regulate scripts for mealtime practices.

The lived experience of working with people with eating disorders: A meta‐ethnography

“…Hage, Rø, and Moen (2017b) Explore staff deliberations and actions during mealtimes at an EDU 20 healthcare professionals. Sample appears to be the same as in Hage et al (2017a).…”

“…As almost one-third of the included studies focused exclusively on AN, findings may be most pertinent to those working with this condition (Hage et al, 2017a;Ryan et al, 2006). Exclusion of unpublished studies may have led to the loss of information (Petticrew et al, 2008).…”

Improving mealtimes for patients and staff within an eating disorder unit: understanding of the problem and first intervention during the pandemic—an initial report

“…We hypothesised that if there is a reduction in factors that cause distress in the main dining room, this should impact on and lower ED behaviours for patients. This hypothesis was informed by knowledge that anxiety experienced by patients has been suggested as having a key role on ED behaviours specific to mealtimes 11 and the high number of ED behaviours observed in the dining room. It was acknowledged that due to the nature of ED illnesses it would be unrealistic to expect the project to eliminate ED behaviours at mealtimes.…”

‘It stopped you thinking about food’ – The experiences of mealtimes and attending a post‐meal support group for young people with anorexia nervosa

“…The importance of mealtimes in re‐establishing normal eating behaviours, and the anxiety associated with this, means that mealtime support is a key feature of inpatient treatment of people with an eating disorder (Hage et al . 2017a). However, while there is a body of literature focusing on how young people can be supported by mental health nurses during mealtimes (Bakker et al .…”

“…These ED cognitions during meals culminate in ED behaviours after meals including restriction, weighing oneself, body checking, over-exercising, purging, or other compensatory behaviours (Levinson et al 2018). The importance of mealtimes in re-establishing normal eating behaviours, and the anxiety associated with this, means that mealtime support is a key feature of inpatient treatment of people with an eating disorder (Hage et al 2017a). However, while there is a body of literature focusing on how young people can be supported by mental health nurses during mealtimes (Bakker et al 2011;Beukers et al 2015), there is little research available on the provision of support for young people in the important period directly after mealtimes.…”