Hostname: page-component-cd9895bd7-gxg78 Total loading time: 0 Render date: 2024-12-26T08:37:19.928Z Has data issue: false hasContentIssue false
  • English
  • Français

Turning the Tables

The Vulnerability of Nurses Treating Anorexia Nervosa Patients

Published online by Cambridge University Press:  09 March 2016

KAREN WRIGHT  and
DORIS SCHROEDER
Get access Rights & Permissions [Opens in a new window]

Abstract:

In bioethics, the concept of vulnerability is applied almost exclusively to research participants and patients. We turn the tables and apply the concept to nurses caring for anorexia nervosa (AN) sufferers. In doing so, and using results from a qualitative research study undertaken in the UK, we show that AN nurses face a significant probability of incurring identifiable harms (inauthentic relationships and nonreciprocal relationships). Some recommendations on how these harms can be avoided or mitigated are given, but further research is needed.

Keywords

vulnerabilitynursinganorexia nervosatherapeutic relationships
Type
Special Section: Responsibility, Vulnerability, Dignity, and Humanity
Information
Cambridge Quarterly of Healthcare Ethics , Volume 25 , Issue 2 , April 2016 , pp. 219 - 227
Copyright
Copyright © Cambridge University Press 2016 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Notes

1. Forster, H, Emanuel, E, Grady, C. The 2000 revision of the Declaration of Helsinki: A step forward or more confusion? The Lancet 2001;358(9291):1449–53.CrossRefGoogle ScholarPubMed

2. Resnik, DB. Research subjects in developing countries and vulnerability. The American Journal of Bioethics 2004;4(3):63–4.CrossRefGoogle ScholarPubMed

3. Hurst, SA. Vulnerability in research and health care: Describing the elephant in the room? Bioethics 2008;22(4):191–202.CrossRefGoogle ScholarPubMed

4. Meek Lange, M, Rogers, W, Dodds, S. Vulnerability in research ethics: A way forward. Bioethics 2013;27(6):333–40.CrossRefGoogle ScholarPubMed

5. Martin, A, Tavaglione, N, Hurst, S. Resolving the conflict: Clarifying “vulnerability” in health care ethics. Kennedy Institute of Ethics Journal 2014;24(1):51–72, at 54.CrossRefGoogle Scholar

6. Macklin, R. Bioethics, vulnerability and protection. Bioethics 2003;17(5–6):472–86.CrossRefGoogle ScholarPubMed

7. Schroeder, D, Gefenas, E. Vulnerability—too vague and too broad? Cambridge Quarterly of Healthcare Ethics 2009;18(2):113–21, at 117.CrossRefGoogle ScholarPubMed

8. Draper, H. Anorexia nervosa and respecting a refusal of life-prolonging therapy: A limited justification. Bioethics 2000;14(2):120–33.CrossRefGoogle ScholarPubMed

9. Giordano, S. Anorexia nervosa and refusal of naso-gastric treatment: A response to Heather Draper. Bioethics 2003;17(3):261–78.CrossRefGoogle ScholarPubMed

10. George, L. The psychological characteristics of patients suffering from anorexia nervosa and the nurse’s role in creating a therapeutic relationship. Journal of Advanced Nursing 1997;26:899–908.CrossRefGoogle ScholarPubMed

11. Vandereycken, W. Dealing with denial in anorexia nervosa. Eating Disorders Review 2006;17(6):1–4.Google Scholar

12. Wright, KM. The therapeutic relationship—developing a new understanding for nurses and care workers within an eating disorder unit. International Journal of Mental Health Nursing 2010;19:154–61.CrossRefGoogle ScholarPubMed

13. Silver, TJ. Treatment of anorexia nervosa against the patient’s will: Ethical considerations. Adolescent Medicine: State of the Art Reviews 2011;22(2):283–8.Google Scholar

14. Wright, K, Hacking, S. An angel on my shoulder: A study of relationships between women with anorexia and healthcare professionals. Journal of Psychiatric and Mental Health Nursing 2012 Mar;19(2):107–15.CrossRefGoogle Scholar

15. Wright KM. An interpretative phenomenological study of the therapeutic relationship between women admitted to eating disorder services and their care workers [PhD thesis]. 2013; available at http://clok.uclan.ac.uk/9245/2/Wright%20Karen%20Final%20e-Thesis%20(Master%20Copy).pdf (last accessed 12 Mar 2015).

16. Friere, P. Pedagogy of the Oppressed. Harmondsworth: Penguin; 1972.Google Scholar

17. Collins, S. Good communication helps to build a therapeutic relationship. Nursing Times 2009;105(204):11–12.Google ScholarPubMed

18. Schmidt, U, Treasure, J. Getting Better Bite by Bite. London: Routledge; 2004.Google Scholar

19. MHA 2007 Mental Health Act (2007); available at http://www.legislation.gov.uk/ukpga/2007/12/contents (last accessed 12 Mar 2015).

20. Kaplan, AS, Garfinkel, PE. Difficulties in treating patients with eating disorders: A review of patients and clinical variables. Canadian Journal of Psychiatry 1999;44:665–70.CrossRefGoogle Scholar

21. See note 10, George 1997.

22. King, SJ, Turner, DS. Caring for adolescent females with anorexia nervosa: Registered nurses’ perspective. Journal of Advanced Nursing 2000;32(1):132–47.CrossRefGoogle ScholarPubMed

23. Palmer, R. Helping People with Eating Disorders. Chichester: John Wiley; 2000.Google Scholar

24. Connan, F, Dhokia, R, Haslam, M, Mordant, N, Morgan, G, Pandya, C, et al. Personality disorder cognitions in the eating disorders. Behaviour Research and Therapy 2009;47(1):77–82.CrossRefGoogle ScholarPubMed

25. See note 19, Kaplan, Garfinkel 1999.

26. Ramjan, LM. Nurses and the “therapeutic relationship”: Caring for adolescents with anorexia nervosa. Journal of Advanced Nursing 2004;45(5):495–503.CrossRefGoogle Scholar

27. See note 22, Palmer 2000.

28. Williams, S, Reid, M. “It’s like there are two people in my head”: A phenomenological exploration of anorexia nervosa and its relationship to the self. Psychology and Health 2012;27(7):798–815.CrossRefGoogle Scholar

29. Warren, CS, Schafer, KJ, Crowley, MEJ, Olivardia, R. Demographic and work-related correlates of job burnout in professional eating disorder treatment providers. Psychotherapy 2013;50(4):553–64.CrossRefGoogle ScholarPubMed

30. NMC. The Code: Standards of Conduct, Performance and Ethics for Nurses and Midwives; 2015; available at http://www.nmc-uk.org/The-revised-Code/ (last accessed 12 Mar 2015).

31. Department of Health (DH). The NHS Constitution. London: DH; 2013.Google ScholarPubMed

32. Wright KM. An interpretative phenomenological study of the therapeutic relationship between women admitted to eating disorder services and their care workers [PhD thesis]. 2013; available at http://clok.uclan.ac.uk/9245/2/Wright%20Karen%20Final%20e-Thesis%20(Master%20Copy).pdf (last accessed 12 Mar 2015).

33. NHS. Cost of Violence against NHS Staff. London: NHS Security Management Service; 2008.Google Scholar

34. Lynch, TR, Gary, KLH, Hempel, RJ, Ttiley, M, Chen, EY, O’Mahon, HA. Radically open-dialectical behavior therapy for adult anorexia nervosa: Feasibility and outcomes from an inpatient program. BMC Psychiatry 2013;13:293–310.CrossRefGoogle Scholar

35. Smith, P. The Emotional Labour of Nursing: Its Impact on Interpersonal Relations, Management, and the Educational Environment in Nursing. Houndsmills, Basingstoke: Macmillan Education; 1992.CrossRefGoogle Scholar

36. Smith, P. The Emotional Labour of Nursing Revisited: Can Nurses Still Care? Basingstoke, Hampshire: Palgrave Macmillan; 2012.CrossRefGoogle Scholar

37. Treasure, JL, Ward, A. A practical guide to the use of motivational interviewing in anorexia nervosa. European Eating Disorders Review 1997;5:102–14.3.0.CO;2-6>CrossRefGoogle Scholar

38. CFOA. Striking the Balance—Health and Safety; 2010; available at http://www.cfoa.org.uk/11295 (last accessed 12 Mar 2015).

39. Mackenzie, C, Rogers, W, Dodds, S, eds. Vulnerability: New Essays in Ethics and Feminist Philosophy. Oxford: Oxford University Press; 2014.Google Scholar

40. Singer, P. Famine, affluence, and morality. Philosophy and Public Affairs 1970;1(3):229–43.Google Scholar

41. See note 3, Hurst 2008.