Running Head: Prevention of Eating Disorders Prevention of Eating Disorders: A Literature Review Grand Canyon University NRS 429V 7 August 2010 Prevention of Eating Disorders: A Literature Review “An ounce of prevention is better than a pound of cure” is a common saying that summarizes the gist of prevention. Edelman and Mandle (2011) define prevention as “averting the development of the disease in the future”. Broadly, it consists of all measures possible; including “definitive therapies” that confines the development of the disease.
There are three levels of prevention: primary, secondary and tertiary. There are five steps within the three levels of prevention. These steps include “health promotion and specific protection (primary prevention); early diagnosis, prompt treatment, and disability limitation (secondary promotion); and restoration and rehabilitation (tertiary prevention)” (Edelman and Mandle, 2011). This paper will present a review of related literature on each of the three levels of prevention with a focus on eating disorders.
Primary prevention is done before the disease is encountered. It includes promotion of healthy habits or educating clients on the risk factors of the disease and specific protection such as immunization against polio. Its main idea is to decrease the susceptibility of the person or the community to disease. Primary prevention also includes advocating for policies that support the health of the population and choosing public officials who his willing to defend the wellbeing of the community.
Berger, Sowa, Bormann, Brix & Strauss (2008) studied the characteristics of the PriMa program for the primary prevention of anorexia nervosa for girls up to age of 12 in 42 schools in Thuringia, Germany. The PriMa program involves nine guided lessons with special posters and group discussion. It is implemented by specially trained female teachers. Berger and her colleagues used a parallel control trial with pre and post measurements and a three-month follow-up.
Primary outcomes were conspicuous eating behavior, body self esteem and anorexia nervosa related knowledge. They observed significant improvements in the areas of knowledge and self esteem but not for eating behavior. Secondary prevention measures ranges from providing screening activities and treating the early stages of the disease to limiting disability by averting or delaying the consequences of advanced disease (Edelman & Mandle, 2011). The main goal of screening is to identify individuals in an early detectable stage of the disease process.
Screening activities have contributed to the control of many forms of cancer, heart disease and stroke. Linville, Benton, O’Neill & Sturm (2010) conducted a paper and pencil survey coupled with in depth interviews of 750 frontline medical providers in Oregon. They found out that seventy-eight percent of survey respondents reported that they had patients with eating disorders who they were unsure how to treat and 54% reported either moderately or strongly supporting universal screening for eating disorders with all patients regardless of presenting issue.
Many qualitative themes such as challenges and barriers to effective screening, desire for increased eating disorder trainings, and fear of incompetence emerged from the interviews. They discussed training implications and future research directions. Tertiary prevention occurs when the defect or disability is permanent and irreversible. It focuses on rehabilitation to help people attain and retain an optimal level of functioning regardless their disabling condition (Edelman & Mandle, 2011).
The objective of tertiary prevention is to return the affected individual to a useful place in society or maximize the remaining capacities. Snell, Crowe & Jordan (2010) investigated the experiences of nurses in developing a therapeutic relationship with patients admitted to a specialized eating disorder inpatient service for weight recovery. They used a grounded theory methodology to interview seven registered nurses about their experiences of establishing therapeutic relationships. They found out that the central variable in the study is the development of a connection with the patient.
They further categorized the variable into developing the therapeutic connection, negotiating the therapeutic connection and coordinating the therapeutic connection. The nurse’s role in every level of prevention is ever evolving and is becoming more independent. The nurse can be an advocate, a care manager, a consultant, a deliverer of services, an educator, a healer or a researcher (Edelman & Mandle, 2011). The first literature presented about primary prevention of eating disorder in the school setting, the school nurse has a definite role.
The school nurse can act as a consultant to the teachers who were trained to teach the PriMa program. The nurse can lend his/her expertise for more complicated matters that the teachers might face in the course of the implementation of the program. The nurse can also liaise with the parents in the follow-up program. Nurses also play an important role in the screening activities like in the study investigated by Linville, et al (2010). Nurses can provide clinical expertise and educationally sound health information during the screening process (Edelman & Mandle, 2011).
In the study made by Snell et al. (2010), nurses play a crucial role in enabling the smooth functioning of the eating disorder unit and the successful treatment of the patient’s eating disorders. The round the clock care provided by nurses in in-patient settings for eating disorders provide unique challenges and opportunities in the key task of developing a strong therapeutic relationship to engage patients with the treatment and recovery process. Three studies were presented about primary, secondary and tertiary prevention.
The study on primary prevention of eating disorders was done in a school setting, while the study on the secondary intervention for eating disorders was done in a clinic setting. The study on tertiary prevention was done on an inpatient eating disorder unit. All the studies presented show that there is still a lot of things that needs to be done to make the programs more effective. The study in the school setting made improvements in improving the child’s self esteem and knowledge but has to make grounds in improving eating habits. There is also an uncertainty in how the program should be replicated in other areas.
The study in the clinical setting discussed training implications and future research directions. The study in the inpatient setting left the challenge to the nurse to create and maintain a therapeutic relation with the patient which is the most crucial part of the intervention. References: Berger, U. , Sowa, M. , Bormann, B. , Brix, C. , & Strauss, B. (2008). Primary prevention of eating disorders: characteristics of effective programmes and how to bring them to broader dissemination. European Eating Disorders Review, 16(3), 173-183. Retrieved from EBSCOhost.
Edelman, C & Mandle, C. (2011). Health Promotion throughout the Lifespan. 7th Ed. [Electronic Version]. St Louis MO: Mosby Elsevier. Linville, D. , Benton, A. , O’Neil, M. , ; Sturm, K. (2010). Medical providers’ screening, training and intervention practices for eating disorders. Eating Disorders, 18(2), 110-131. doi:10. 1080/10640260903585532 Snell, L. , Crowe, M. , & Jordan, J. (2010). Maintaining a therapeutic connection: nursing in an inpatient eating disorder unit. Journal of Clinical Nursing, 19(3-4), 351-358. doi:10. 1111/j. 1365-2702. 2009. 03000. x