Dynamics of nurses’ authority in the inpatient care of adolescent consumers with anorexia nervosa: A qualitative study of nursing perspectives

Abstract

Nurses caring for adolescent consumers with anorexia nervosa in the inpatient setting are challenged in a unique way, in that they are caring for people with whom they do not have a mutually held concept of well-being. Their efforts to ensure weight gain are frequently against the wishes of the consumer. This dissonance results in challenging interactions, where nursing care and authority may be undermined. This study investigated the dynamics of nurses' authority within this context. Interviews with nurses (n = 10) were conducted and analysed through thematic analysis. Nurses reported that consumers, compelled by the psychopathology of anorexia nervosa, often sought to challenge or undermine their authority. Some nurses experienced the opposition and conflict as demoralizing, whereas others were able to maintain confidence in the therapeutic merit of their care. Younger, inexperienced nurses in this study were particularly vulnerable to interactions that mitigated their authority, due to their tendency to engage in friendlike relationships. Nurses caring for adolescents with anorexia nervosa should be prepared to be confronted by interactions that overtly and surreptitiously undermine their capacity to exercise professional authority. It is important that nurses recognize the importance of maintaining their authority, and how it can be threatened in subtle and unexpected ways.

What mental health nurses have to say about themselves: A discourse analysis

“…Zugai et al . (2019) interviewed ten nurses (enrolled and registered nurses) regarding their care of adolescents with anorexia nervosa (only one of whom had a ‘specific mental health nursing qualification’; MHNs = 4). They state that establishing ‘… a therapeutic alliance is a fundamental activity in mental health Nursing’ and discuss the complexities of doing so with this population (p. 946).…”

“…They acknowledge a long tradition of conceptualizing the 'therapeutic-relationship' as an 'interpersonal intervention'. Zugai et al (2019) interviewed ten nurses (enrolled and registered nurses) regarding their care of adolescents with anorexia nervosa (only one of whom had a 'specific mental health nursing qualification'; MHNs = 4). They state that establishing '.…”

Nurses’ perceptions on and experiences in conflict situations when caring for adolescents with anorexia nervosa: A qualitative study

“…2020; Zugai et al . 2019). Nursing staff are regarded by patients as supervisors with authoritarian roles; as a result, patients cannot entirely trust the nursing staff, and the nurses and patients are suspicious of each other.…”

“…2017a; Zugai et al . 2019). It is difficult to establish trust in therapeutic relationships, and caregivers are vulnerable to stress and frustration (King & Turner 2000; Ramjan 2004).…”

Patients’ Experiences and Perceptions of Recovering from Anorexia Nervosa While Having Contact with Psychiatric Care: A Literature Review and Narrative Synthesis of Qualitative Studies

“…However, when the relationship becomes too friendly, it could be problematic for caregivers in establishing a good relationship and remaining professional. From the caregivers' perspective, if the relationship becomes too friendly, it could be more difficult for the caregiver to challenge and support the patient in his/her thoughts and behaviour through recovery (Zugai et al, 2019). Thus, finding ways for caregivers to maintain a sense of professionalism while still delivering a personal and friendly relationship with the patient is important.…”