Maintaining a therapeutic connection: nursing in an inpatient eating disorder unit

Abstract

The aim of this study was to investigate and theorise the experiences of nurses in developing a therapeutic relationship with patients admitted to a specialised eating disorder inpatient service for weight recovery. Nursing in in-patient eating disorders units can be both challenging and intensive work. It is an area of practice associated with high rates of stress, burnout and frustration. The establishment of therapeutic relationships is difficult because of the nature of patients' symptoms. This is a qualitative study exploring nurses' descriptions of practice in an inpatient eating disorder unit. This study used a grounded theory methodology to interview seven registered nurses about their experiences of establishing therapeutic relationships. The process of analysis involved open and axial coding and the integration of theory. The central variable that emerged from the analysis was 'connecting'. This variable was fundamental to the three major categories: (1) developing the therapeutic connection, (2) negotiating the therapeutic connection and (3) coordinating the connection. The central category that emerged was maintaining the therapeutic connection. The contextual variables that had the strongest influence on shaping the categories were the specific nature of eating disorders and the unit's approach to treatment. Nurses play a crucial role in enabling the smooth functioning of the eating disorders unit and the successful treatment of the patients' eating disorders. This role was at times invisible and it was through these nurses' descriptions that it became apparent. The round the clock care provided by nurses in in-patient settings for eating disorders provides unique challenges and opportunities in the key task of developing a strong therapeutic relationship to engage patients with the treatment and recovery process.