Page 75 Complete Your CE Test Online - Click Here The behaviors associated with bulimia nervosa can trigger feelings of revulsion in the general public and even in healthcare professionals. Trying to understand how someone can deliberately force themselves to vomit, abuse laxatives, abuse diuretics, and even give themselves repeated enemas in an effort to prevent weight gain, is incomprehensible for some nurses and other members of the healthcare team. They may think “If she wouldn’t eat all that food in one sitting, she wouldn’t need to make herself vomit.” Part of nursing practice should be to take actions to change the prejudice associated with bulimia and other eating disorders. Part of this prejudice may be an unconscious belief that the eating disorder is self-inflicted and self-induced[1,9,16,18] . It’s as if the disorder is somehow the fault of the person who is suffering from the disease. This attitude is similar to the attitude that lung cancer is somehow the “fault” of the client who smokes, or that heart disease is the “fault” of the person who eats foods high in fat and cholesterol. Such conscious or unconscious beliefs can adversely affect the delivery of client care. Here are some suggestions for nurses as they attempt to improve nursing care and client outcomes in the population suffering from bulimia nervosa[1,9,16,18] : ● ● Nurses and other members of the healthcare team should honestly assess their own feelings regarding bulimia nervosa and other eating disorders. They should ask themselves if they have any personal animosity or feelings of revulsion towards persons with the disease? Can they remain objective? Do they allow feelings of disgust or amusement to influence how they provide care? What can they do to increase their understanding of eating disorders and provide better care? If family dynamics are poor or if there is a history of abuse, can they objectively support family therapy? If their personal beliefs and values are found to have a negative impact on client care, what can they do to change these negative attitudes? ● ● Nurses and other members of the healthcare team should seek out continuing education opportunities regarding bulimia nervosa and other eating disorders. What kinds of educational opportunities exist at work? Can they suggest that these topics be incorporated into the professional development courses provided by the organizations for which they work? If bulimia nervosa and other eating disorders are not part of the organization’s continuing education courses, where can they go to obtain such education? Have they investigated online resources? Have they reviewed the websites of reputable organizations (i.e. Mayo Clinic, CDC, American Psychiatric Association) for more information regarding eating disorders? ● ● Nurses and other members of the healthcare team should be able to differentiate between anorexia nervosa, bulimia nervosa, and other mental health disorders. Some nurses and others are not aware of the distinguishing characteristics between the various eating disorders, nor are they aware that anorexia nervosa and bulimia nervosa can co-exist. All healthcare professionals should be aware of the diagnostic criteria for each of the eating disorders. ● ● Nurses and other healthcare professionals should institute client/ family education regarding eating disorders. Such education should not take place exclusively in inpatient and outpatient settings. Nurses in community settings, school nurses, college campus nurses, and those who work in the field of sports injuries all have excellent opportunities to educate colleagues, as well as young women and men and their families and friends. Recognition of eating disorders is important. But it is perhaps more important for at risk groups to recognize their vulnerability and how to deal with stress and anxiety in healthy ways rather than inappropriate, even dangerous, behaviors. ● ● Some nurses, as well as their colleagues from other professional disciplines, may view bulimia nervosa and other eating disorders strictly as a mental health disorder. Although eating disorders are classified as mental health disorders, nurses must be aware of the physical pathophysiology related to eating disorders. The pathophysiology can lead to serious, even life-threatening, complications. Practice changes should involve the need for a comprehensive understanding of the pathophysiology of bulimia nervosa and how to address both physical and mental health issues. ● ● Unlicensed personnel should also be taught how to recognize signs and symptoms of bulimia nervosa and other eating disorders. Nursing assistants spend a great deal of time with clients and can be critical in providing support as clients struggle to overcome eating disorders. It would also be wise to offer continuing education to non-clinical personnel, since housekeeping staff may be the first to observe purging behaviors or to find evidence of purging as they clean client rooms and bathrooms. Nurses must promote health and wellness by assuming the role of leader and client/family advocate. Nurse leaders must battle the view of the “ideal” woman’s body as portrayed on television, the movies, in print media, and social media. This image is usually an airbrushed version of an extremely, unrealistically thin woman. Persons with eating disorders are often given verbal rewards when family and friends make comments such as, “I wish I were as thin as you,” “You look fantastic,” or “Since you lost weight, your basketball game has really improved.” These kinds of positive reinforcements may make people who suffer from bulimia nervosa and other eating disorders question if they are really ill, and they ask themselves, “How can I be sick if everyone tells me how great I look?” This can be especially true for those dealing with bulimia nervosa since they are usually of normal or slightly above normal weight and may not have the health issues associated with the near- starvation states of those who have anorexia nervosa[1,2,9,16,18] . Nurse leaders can help to dispel myths surrounding bulimia nervosa and other eating disorders by[1,2,9,1,16] : ● ● Promoting the identification of relevant nursing research questions that pertain to bulimia nervosa and other eating disorders. ● ● Promoting the participation of staff nurses in nursing research pertaining to bulimia nervosa and other eating disorders. ● ● Promoting the incorporation of research findings pertaining to bulimia nervosa and other eating disorders into evidence based nursing practice. ● ● Promoting the publication of research findings pertaining to bulimia nervosa and other eating disorders in nursing journals. ● ● Promoting the presentation of research findings pertaining to bulimia nervosa and other eating disorders at local, national, and international nursing conferences and conventions. ● ● Promoting positive role models in print and on visual media. Taking an active role in writing to media leaders to explain the dangers of eating disorders and how unrealistic portrayals of women and men can help to facilitate the development of dangerous medical and mental health problems. ● ● Working with their organizations’ nursing professional development departments to develop continuing education pertaining to bulimia nervosa and other eating disorders. ● ● Encouraging and, as appropriate, mandating that professional nurses and other members of the nursing department attend continuing education pertaining to bulimia nervosa and other eating disorders. ● ● Including, as appropriate, competencies in job performance evaluations that relate to eating disorders. ● ● Facilitating the development of an eating disorder recognition and treatment program as part of employee health and wellness programs within their respective organizations. Many organizations are offering memberships at local gyms, smoking cessation programs, and weight loss initiatives as part of their employee health and wellness programs. What may not be addressed are the dangers and ramifications of eating disorders. The emphasis is often on losing weight without looking at how the weight is lost. Instead, the emphasis should be on achieving and maintaining a healthy weight as part of a healthy lifestyle. CHANGES PERTAINING TO EATING DISORDERS IN THE DIAGNOSTIC AND STATISTICAL MANUAL OF MENTAL DISORDERS (DSM-5) Prior to the publication of the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders, binge eating was not included as a specific eating disorder. The 5th edition includes a number of changes to feeding and eating disorders, including some pertaining to anorexia nervosa and bulimia nervosa, as well as binge-eating disorder.