Nurse Mary is caring for a client with bulimia. Strict management of dietary intake is necessary. Which intervention is also important?

Correct Answer: C. Let the client choose her own food. If she eats everything she orders, then stay with her for 1 hour after each meal

Allowing the client to select her own food from the menu will help her feel some sense of control. 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.

• Option A: She must then eat 100% of what she selected. During the early stages of treatment when patients are still new to recovery, they look to nurses to provide them with a highly structured environment, which sometimes involves nurses making food and behavioral decisions on their behalf. While this might not be an ongoing issue for primary care nurses, they may still be required to offer decisive advice on these areas. Here, it is imperative that nurses offer such advice with a clear message that patients have the power to make these decisions themselves.
• Option B: Remaining with the client for at least 1 hour after eating will prevent purging. As treatment progresses, patients eventually grow to appreciate nurses who act as role models and educate them on how to normalize their diet and involvement in social activities. Towards the end of treatment, nurses become more of a support system, encouraging the patient to move forward autonomously, while providing them with guidance on where to seek help if it is needed.
• Option D: Bulimic clients should only be allowed to eat food provided by the dietary department. From awareness of the eating disorder to recovery maintenance, the role of the primary care nurse evolves, but what doesn’t change is the positive influence nurses can have on those with an eating disorder. With the skills of listening, empathy, adaptability, and communication, primary care nurses can assist in identifying at-risk individuals and optimizing the delivery of a multidisciplinary and holistic approach to care.