During postprandial monitoring, a female client with bulimia nervosa tells nurse, “You can sit with me, but you’re just wasting your time. After you had sat with me yesterday, I was still able to purge. Today, my goal is to do it twice.” What is nurse’s best response?

Correct Answer: D. “I know it’s important for you to feel in control, but I’ll monitor you for 90 minutes after you eat.”

This response acknowledges that the client is testing limits and that the nurse is setting them by performing postprandial monitoring to prevent self-induced emesis. Clients with bulimia nervosa need to feel in control of the diet because they feel they lack control over all other aspects of their lives. Since recovery involves patients having to face their deepest, most painful, and traumatic thoughts and emotions, supporting them as they go through treatment can be emotionally challenging for nurses. This emotional challenge can be exacerbated when the patient has also been diagnosed with Obsessive-Compulsive Disorder (OCD), depression, or substance abuse, as these may require more intensive one-to-one support.

• Option A: Because their therapeutic relationships with caregivers are less important than their need to purge, they don’t fear betraying the nurse’s trust by engaging in the activity. They commonly plot to purge and rarely share their secrets about it. As this might take nurses out of their comfort zone or clinical remit, worksheets are available for nurses to use in efforts to help patients challenge and overcome their obsessive and ritualistic behaviors and to adopt a more flexible perspective in day-to-day life.6 These can be supplemented by nurses familiarising themselves with the detailed guidelines and resources offered by NICE.
• Option B: Learning motivational interviewing techniques can help facilitate communication with those who might be resistant to discussing topics related to food, weight, and recovery. Such techniques can help develop the skills of empathic understanding, rolling with resistance, and gently assisting patients to make their own, autonomous decision to work towards recovery. Often, the aim is to help patients learn new and healthier ways of coping, and nurses can achieve this through a mix of emotional support, education, and signposting.
• Option C: An authoritarian or challenging response may trigger a power struggle between the nurse and client. Assisting patients to remain strong and adhere to treatment requires nurses to develop a relationship that is caring, empathetic and trusting, and in line with the person-centered approach to care. Patients affected by eating disorders require individualized support to better understand their condition, rediscover their identity, learn to accept themselves, enhance a positive body image and sense of self-worth, and achieve a balance in their lives so that they can move towards better health and wellbeing.