Anorexia Nervosa Patient Case Study

Anorexia Nervosa Patient Case StudyFor my six week clinical practice military position in an adolescent mental health unit I chose to focus my project on a 15-year-old anorexia nervosa patient. This disorder for the most part affects young women and is an extremely challenging problem to treat. I felt that running(a) with an anorexia nervosa patient in this controlled environment, under the advocate and supervision of a mentor, would be a tokenly good application of follow through learning because execute learning dismiss rapidly develop critical skills.1 In particular I destinyed to develop interpersonal skills necessary to communicate sanitary with patients and colleagues, and learn to relate to any issues raised by my patient world a teenager. As I learn better from hands-on cooking than through just reading and discussion I felt this would a valuable use of my clinical placement.Anorexia nervosa patients often have low c at one timeit and a desire for achieving perf ection in all the things they do2 this was something I had to be aware of during the placement because it raises the problems with maneuver saddle horse. With anorexia it is difficult to agree on finiss with a patient because the main goal, from a health perspective, is weight gain, which they want to avoid.3 The other issue is that the patient is 15-years-old. This fits the universal case that many patients test therapy at the insistence of parents so the patient arrives at for the consultation poised to resist, anticipating the selfsame(prenominal) pressures for transfigure.4 These factors combine to make interference extremely difficult first, the patient is broad 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 controlling behavior i.e. trying to lose weight.My mentor was especially dish upful in highlighting some of these points to me with regards to the patient, and helping me conceive close 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 utilizable. in that respect is extensive 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 concur that since cognitive behaviour is key to the illness it has potential to break the proscribe public opinion cycle.I used clinical guidelines to agnize more about the possible benefits of CBT for anorexia nervosa. One item of interest is that The CB approach has two especially valuable sources of flexibility and creativity applicable to the issue of use. These are organise assessment and models of impedance structured assessment can be actually(prenominal) helpful in dev eloping an in-depth understanding surrounding resistance to services.7With the guidance of my mentor and other clinic staff I reported 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, perhaps because change involves a patient giving up a cherished and valued state.8 If this had been in an unsupported mount I would have anchor this very discouraging and probably would have doubted my methods. However, through using the learning attitude of the process I found that motivation and engagement are ordinarily poor or ambivalent in patients with eating disorders, particularly anorexia nervosa9 and that patients with anorexia nervosa reply to stress both in childhood and adulthood with a bemused style of coping and a tendency to use avoidance strategies.10 These findings tapered that I was dealing with a widespread problem, not something specific to my pa tient.This insight, and the supportive aura from the other clinical staff, helped me keep my focus on the patient, and not think of the challenges as personal failings. In the space of six weeks I didnt have time to work through these issues with this particular patient, but the do learning process gave me the confidence that I would be able to comprehend them in future. It excessively put in perspective that the patient keep to lose weight. That is obviously not the outcome desired but subtle that 70 percent of the eating disordered subjects for CBT remained symptomatic11 assured me that this is withal a common problem.During the placement my mentor and I discussed these problems and talked about unalike methods that might be useful to overcome them. One area I decided it was of the essence(p) for me to focus on is relational skills with patients. With anorexia nervosa, especially, the interpersonal process needs to defer this ambivalence or indeed resistance into account . The skills of motivational interviewing are invaluable.12 We also talked about the possibility of using other types of therapy along with CBT. Most of the clinical data supports CBT as effective, but at that place 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 suggested I check some literature. I found out that women with anorexia nervosa typically describe both their parents negatively and women with eating disorders depict their parents as typically unsupportive of their independence.14 This would suggest treating family therapy with caution. It could be that patients come from unfeignedly unhappy families, or it could also be that anorexia nervosa patients resent their parents perceived ravishment of trying to make them eat as an attack on their independence. Im glad my ment or raised this issue, because it do me echtise that forwards using additional therapies you need to consider patient history 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 atom during my time working with the patient, as they modelled good patient care and helped me chew over on my own work. They emphasised to me that reflection is important within dinner dress 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 larn how that could happen in a busy clinical setting for 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 number of what I learned during my project my development goal is to practice my redress 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. create strong 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 much(prenominal) as possible family i ssues in anorexia nervosa.It was somewhat discouraging to not see a better result with this patient, but the placement taught me that in attain reading the emphasis is on the courageous struggle to act and understand not on short cuts and quick fixes17 and I think that experience will enhance my confidence as I approach the challenges of astir(p) my communication skills and taking forward what I learned.BibliographyBennett-Levy, J., Butler, G., et al., Oxford guide on to behavioural Experiments in cognitive Therapy, Oxford University Press, 2004Bulman, C. and Shutz, S., Reflective Practice in nurse The Growth of the original Practitioner, Blackwell Publishing, 2004Cassidy, J. and Shaver, P., Handbook of Attachment Theory, Research, and Clinical Applications, Guilford Press, 2002Costin, C., The have Disorder Sourcebook A all-embracing Guide to the Causes, Treatments, and Prevention of have Disorders, McGraw-Hill Professional, 2006Garner, D. and Garfinkel, P., Handbook of Tr eatment for Eating Disorders, Guilford Press, 1997Grant, A., Mulhern, R., et al., Cognitive Behavioural Therapy in Mental wellness Care, SAGE, 2004Marquardt, M. and Callahan, M., Action Learning, American ball club for Training and Development, 1997Newell, R. and Gournay, K., Mental Health nursing An Evidence-based Approach, Elsevier Health wisdoms, 2000Norman, I. and Ryrie, I., The Art and Science of Mental Health Nursing A text edition 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 Treatm ent for Eating Disorders, p. 956 Ibid, p. 1067 Grant, A., Mulhern, R., et al., Cognitive Behavioural Therapy 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 Practice, Gower Publishing, Ltd., 1997, p. 22917 Ibid, p. 32