Nursing of eating disorder inpatient by trial of clinical-navigation (tentative name) program: Effect of the team approach trying to establish attachment

Abstract

Among eating disorder patients there are many so-called good children with no external problems. It needs to be concerned with the inner conflict which is latent in such cases. However, the cause in connection with an inner problem has been hard to be acquired by the nursing team. Therefore, the focus of nursing becomes ambiguous and a patient and nursing team also tends to have impatience and a powerless feeling paying attention to the eating action itself, such as binge eating and purging. Then, in Goryokai Mental Hospital, the Clinical-Navigation (henceforth, Cli-Navi) which arranged the pathological model of eating disorder and the recovery model was created as a road map to reach the aimed direction. This is the new remission process model set on the basis of attachment theory, and a (Attachment-Detachment-Commitment) program with time progress develops the medical treatment indicator. We introduce Cli-Navi first and report the consideration for actual nursing problems accompanying this program. We attempt to clarify an advantage, a fault of Cli-navi, by considering a case progress. We inquired for the case of an eating disorder in which the informed consent for medical treatment by Cli-Navi was achieved by the doctor. We developed nursing in alignment with Cli-Navi to the 22-year-old woman. Medical treatment was advanced with the periodical conferences by us, a doctor, a psychologist and a nurse, and the result was analyzed. We considered the hospitalization for 4 months from the formation process of an attachment, and classified it at four terms. The first term is a period of encounter. The fourth term is a period of stable- independence. This case needed to take distance too much with others, and an attachment with others has not been established. Then, in the first term, we decided to watch concern. In the second term, we performed relation towards an attachment according to mitigation of wariness, consequently, the patient obtained a sense of security and came to open her heart to a staff member or other patients. Moreover, the patient understood that the eating disorder was a problem resulting from conflict of inside herself. In the third term, the physical bad condition continued and the patient became depressed. However, the patient confronted her problem and she gained a deeper insight. Furthermore, the patient established an attachment and the opportunity to tell a nurse and other patients was increased. In the fourth term, the patient came to control a binge eating impulse, maintained a sense of stability, and gained a deepened self-understanding. Even if the patient overate, she had the confidence to recover and wished to leave hospital. In this case, formation of the nursing attachment was especially important. Confrontation of the patient's problem progressed in parallel with attachment formation, and self-insight deepened. The viewpoint of attachment formation – nursing was able to have the relation which turns a viewpoint to the patient's inside and led to recovery, without being caught by direct binge eating and purging. The viewpoint of medical staffs’ occupational description was unified, and the conference based on Cli-Navi unified the patient image in the whole medical treatment team. Using Cli-Navi had the advantage that the advance state of medical treatment was sharable. Nursing using the Cli-Navi program was performed, and progress was analyzed. Consequently, it turns out that nursing to which the focus tended to become ambiguous since the restorative index was indefinite until now, can grasp a patient's action with the viewpoint of the formation process of an attachment, and it becomes easy to offer the effective relation for recovery. Moreover, integration of the patient image was completed as a medical treatment indicator common to a medical treatment team, and it was also suggested that each occupational description (a doctor, a psychologist and a nurse) can bear a role effectively. Also we considerd that the good medical treatment effect was brought since this patient was intellectual and could deepen self-insight. We want to apply Cli-Navi to various cases and continue to examine its effectiveness.