Evidence-based practice in nursing: A case study on anorexia nervosa

Introductions:

Nursing, as an integral part of the health care system, encompasses the promotion of health, prevention of illness, and care of physically ill, mentally ill, and disabled people of all ages, in all health care and other community settings. Within this broad spectrum of health care, the phenomena of particular concern to nurses are individual, family, and group ‘’ responses to actual or potential health problems’’ (American Nurses Association)(ANA)1980
                                                                                                              
Evidence – based practice has been described as “The conscientious, explicit and judicious use of current best evidence in making decisions about the care of the individual patients. The practice of evidence- based medicine means integrating individual clinical expertise with the best available external clinical evidence from systematic research” Sackett et al 1996. Evidence- based nursing is the application of valid, relevant, research-based information in nurse decision -making. Cullum et al (2007). 

The National Institute for Health and Care Excellence(NICE)(2017) estimated that 1.6 million people in the UK have eating disorder while 10% of the estimate suffers from Anorexia Nervosa and 20% of the sufferers will die prematurely.

 Resmark et al (2019:1) suggests that Anorexia nervosa is the most severe eating disorder; it has a protracted course of illness and the highest mortality rate among all psychiatric illnesses. It is characterised by a restriction of energy intake followed by substantial weight loss, which can culminate in cachexia and related medical consequences. Anorexia nervosa is associated with high personal and economic costs for sufferers, their relatives and society.  One major importance of evidence-based practice is aimed to support all groups involved in the care of patients with anorexia nervosa by providing them with scientifically sound recommendations regarding diagnosis and treatment (Resmark et al,2019)

Anorexia nervosa appears at a rate of 80-85% in young women at the age of 12- 25years old. Some physical characteristics include extreme weight loss and fatigue,  this can be seen in the case of Miss x who appeared extremely thin with a BMI of 10.79 ( weight-38kg Height- 1.76m) while family networks, gender and educational attainment is ascribed to the social attributes of AN.
A major psychological characteristic of AN that receives support from empirical literature is that of low self-esteem. It has been found to be the major predictor of anorexic tendencies in adolescents (Grant & Fodor 1986). Beals(2004) suggests that People with AN generally have low self-esteem, which appears to be the key behind their drive for thinness. Rosenberg (1989) defines self-esteem as a positive or negative approach to one’s own persona. People with low self-esteem are dissatisfied with themselves, are self-loathing and lack respect for their own persona.   

Study results shows that anorectic children come from families that have lost a member or have been abused. It can be seen in the case of Miss X in which a major life transition (Death of her father) is a contributing factor to her illness.  Steiger et al (1995) argues that family studies point to increased rates of eating disorders where dysfunctional family systems co-exist. This is also evidenced in the case of Miss X where both parents were extremely controlling. Many Scientist suggests that communication plays a significant role in development of AN. This statement is supported by  Dallos &Denford (2008) who suggest the significance of communication in the development and maintenance of eating disorders, identifying the theme of ‘’false or fragile reality’’ in which young people do not trust the communicated parental messages.

One theme that is consistent when looking at the aetiology of AN is the problems in autonomy. The issue of control for the anorexic individual has been looked at by so many researchers. Bruch (1982) proposes that because of lack of control in other areas of their lives, anorexic individuals use control of food and their bodies to provide this. A study by Rezek & Leary (1991) provides further support in that individuals with AN react to perceived loss of control by restricting their food intake. There has been more debate about how AN people have difficulty in exp experiencing their inner worlds (Bruch,1978; Selvini-Palazolli,1974).