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神经性厌食症住院护理中对体重的关注:消费者观点的定性调查

The focus on weight in the inpatient care of anorexia nervosa: A qualitative investigation of consumer perspectives.

作者信息

Zugai Joel Sebastian, Gill Katherine, Molloy Luke, Raeburn Toby, Ramjan Lucie

机构信息

School of Nursing, University of Wollongong, Liverpool, New South Wales, Australia.

Consumer Led Research Network, the University of Sydney, Sydney, New South Wales, Australia.

出版信息

Int J Ment Health Nurs. 2024 Apr;33(2):388-396. doi: 10.1111/inm.13242. Epub 2023 Oct 13.

Abstract

Anorexia nervosa has a high mortality rate and is often treated in the inpatient setting, where close monitoring and medical support are available. Consistent with objective biomedical benchmarks, conventional inpatient treatment is often focussed on weight gain. Consumers report that clinicians provide care focussed on weight and physical restoration without adequate consideration of their full spectrum of needs. The aim of this study was to explore consumers' perspectives of the biomedical focus on weight gain in the inpatient care of anorexia nervosa. This study employed a qualitative approach, involving semistructured interviews, and participants were recruited from relevant social media communities. This study was ethically approved by a university ethics committee and the COREQ checklist ensured ethical reporting. Ten women participated in interviews. Participants reported that the biomedical imperative of weight gain is focussed on at the exclusion of other relevant determinants of well-being, and the narrow focus on weight gain does not suitably prepare consumers for discharge. The conflict between clinicians' biomedical focus and consumers' broader unmet needs leads to harmful interpersonal dynamics and feelings of invalidation. The inpatient care of anorexia nervosa needs to develop beyond biomedically driven objectives and incorporate the merits of an approach that substantively integrates person-centred care, therapeutic relationships and trauma-informed principles.

摘要

神经性厌食症死亡率很高,通常在住院环境中接受治疗,在那里可以进行密切监测并获得医疗支持。与客观的生物医学基准一致,传统的住院治疗通常侧重于体重增加。患者报告称,临床医生提供的护理侧重于体重和身体恢复,而没有充分考虑他们的全部需求。本研究的目的是探讨患者对神经性厌食症住院护理中生物医学对体重增加的关注的看法。本研究采用定性方法,包括半结构化访谈,参与者从相关社交媒体社区招募。本研究获得了一所大学伦理委员会的伦理批准,并且COREQ清单确保了伦理报告。十名女性参与了访谈。参与者报告称,增加体重的生物医学要求被置于首要地位,而忽视了其他与幸福感相关的决定因素,并且对体重增加的狭隘关注并不能让患者为出院做好充分准备。临床医生的生物医学关注点与患者更广泛未得到满足的需求之间的冲突导致了有害的人际动态和被忽视感。神经性厌食症的住院护理需要超越生物医学驱动的目标,纳入实质性整合以患者为中心的护理、治疗关系和创伤知情原则的方法的优点。

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