Anorexia Nervosa and Handling Its Patients

Graduate Certificate Nursing Education

Learning of Anorexia Nervosa & Handling Its Patients

Final Learning Report


Drafting a learning contract and adhering to it along with constant support from my supervisor, was an effective activity which constituted of four weeks. every objective had a milestone plan and necessary measures which were required to be taken for achieving them. Self-expectation after reaching these goals was also documented in order to have a clear picture of my proficiency level in the developing knowledge of Anorexia Nervosa after this activity. The primary objective was to have clear understanding of Anorexia Nervosa, its causes, symptoms and possible treatments. Furthermore, second main objective was to deal with patients having this disorder and their families. These two major goals encompassed the rest. Through reading of the concerned topic were performed and were brought into practical application. Furthermore, efforts were made to achieve a certain level of interpersonal skills required to be proficient as a nurse. Demos, visas and quizzes were given to the supervisor various times and logs of these activities were also maintained to ensure documentation of every activity. At the end, a written testimonial was shared by me supervisor for achievement of the objectives set as per learning contract.


This report is based on the learning contract shared by me with my senior, SUPERVISOR NAME XXX, on 26th May 2012. The report entails the objectives that I have and the description about how they are achieved. Each objectives is discussed one by one and contains the details of my understanding about the subject matter.



My first objective was to increase some background knowledge about the a variety of substances clients use, as well as the medications they have taken earlier. For this particular objective, my expected outcome was to understand pertinent materials and be able to Ask questions to staff members and clients.

For this particular objective, the methods used by me were Observing my supervisor and constant debriefing with him. Furthermore, written assessments were part and parcel of it. This practice of constant observation and feedback was accompanied with constant readings of the concerned reading material which includes Journals and articles on Anorexia Nervosa. Given in the bibliography, are the details of various journals that I read about this particular syndrome, its symptoms and cures. This thorough reading along with the frequent question / answers sessions with my supervisor helped me out in gaining a clear understanding of AN (Fassino et. al, 2001).

Where this activity continued for four weeks, I was also involved heavily in the assessment of new and existing patients. Thorough observations of patients’ charts and questions / answers sessions with them, helped in understanding the various stages of AN. Also, how different medicines and treatment methods are used at different stages of AN, was also the subject matter that I was concerned about and this particular activity helped my achieve my target.

For final evaluation of this objective’s achievement, I had an hour long session with my supervisor which constituted of a viva session with him. Secondly, I was asked to analyzed the charts of few patients in this session and the correct answers proved that I have developed an ability of patients’ assessment on my own. Furthermore, after this session, my supervisor instructed me to read and assess patients charts and answer patients’ queries in his presence.


Improve information retrieval from the patients’ chart was my second objective as mentioned in the learning contract. For the achievement of this objective, I took undertaking of reading more relevant literature and trying to perform patients’ diagnosis in the presence of my supervisor. At the end of this activity, the outcome was to be able to extract accurate information from the patients chart and be able to give recommendations about the further treatment. For achievement of this objective, the role of the supervisor was to share the schedule which would help me prepare for charts review and determination of treatments. Also, frequent supervising sessions with the senior during which I could ask questions that I had during the diagnosis sessions, were also planned and executed.

This activity continued for four weeks. Along with reading the research materials regarding Anorexia Nervosa, I also took additional guidance from other seniors available as to how to understand and diagnose patients’ current state correctly. While diagnosing patients’ current stage while going through charts, I was instructed that I need to have complete understanding of the relevant terminology related to Anorexia Nervosa and also understand how each applies to different stages of AN.

For this purpose, I went through medical dictionaries available on web and institute’s library and tried to understand their meanings and relevance with the stages of the syndromes. This activity was once again well-supported by the sessions that I had with my supervisor. For this particular activity, I had a session planned with senior on every 5th working day at the time assigned by my supervisor. A written test regarding these terminologies was taken at the end of fourth week. Results can be taken from my supervisor.


The third objective involved the risk assessment of the patients. For risk assessment, my objective was to be able to Extract information related to patient’s current status by studying patient’s chart and give recommendations for suitable plan, Understanding the relationship between Body Mass Index and the relationship between high risk and anorexia, performing physical examination with the specialists, Understanding the outcomes of the bold tests, and Understanding and evaluating the results of ECG (Golden et. al, 2008).

For this goal, I was required to Perform thorough readings about Anorexia Nervosa, understand its causes, symptoms and the relationship between the risk level and patients current status. Study case studies which will help me gain insight about what the level of Sodium and Potassium in the bold tests indicate about Patient’s AN. Furthermore reading more about ECG and perform frequent analysis on its outcomes, Understanding the basics of SUSS, low core temperature and Taking frequent guidance from the supervisor, were the tools used.

For this objective, reading literature about the tests involved was a pre-requisite. Therefore, along with reading journals and articles about AN, studying more about its indicators as per the tests results was also required. For this purpose, I took out patients’ histories as available in institutes records and perform a correlation between my understanding of the syndrome and the contents of their test reports. After frequent analysis, I was able to perform the risk assessment individually. For examination purposes, few reports were shared with me by my senior at the end of fourth week and I did the analysis in front of him. There were some errors in the initial viva; therefore similar activity was repeated after fourth day of first viva and as mentioned by the supervisor, the results were satisfactory.


Part of my leaning contract was to learn and display an attitude which involved taking enough initiatives during my employment as a nurse. Since I had Difficulty in showing initiatives, therefore To become an effective team member by knowing where I can assist them and what needs to be done without being instructed about it, was part of my learning a professional. The techniques used to exhibit this attitude was by Handling. The flow of patients without always looking for instructions and constant prompting.

For this objective, my efforts started with keeping a log of patients I handled individually on daily basis. This involved handling the flow of new patients as well as answering the queries of the old ones. Handling already admitted patients in the absence of my supervisor was another technique of showing initiative. To avoid any mistake, communication to the supervisor was done after answering the queries of the patients or performing their daily examination independently. Another part of showing initiatives was to ask for individual cases and nursing suits from my supervisor. Adding to the list of assigned duties not only helped me gain professional proficiency but also helped in getting rid of my hesitation which I had earlier while dealing with my seniors, patients and peers.

The log which was maintained for this purpose was also shared with my supervisor on bi-weekly basis and nature of patients handled was also discussed. Furthermore, a session of question / answers was also conducted to ensure that this particular activity is also helping me in getting insight of Anorexia Nervosa. Furthermore, I was assigned with the task of conducting orientation for new nurses and I was also appointed for giving preliminary orientation session of Anorexia Nervosa to the students of first year batch.


Another objective of learning contract was to understand adult learning theory by enhancement of experiences given by nursing experiences and take personal responsibility about it. The basic outcome which was expected after achieving this objective was to Have thorough knowledge of the subject matter which will supported by giving right answers of the concerned questions.

For this purposes, researches involving adult learning theories were studied. It was established that Typical adult learning theories encompass the basic concepts of behavioral change and experience. From there, complexities begin to diverge specific theories and concepts in an eclectic barrage of inferences. Furthermore, there are “four invariant stages of cognitive development that are age related” (Merriam & Caffarella, 1999, p. 139). According to the authors, Piaget contends that normal children will reach the final stage of development, which is the stage of formal operations, between the age of twelve and fifteen. According to a literature review by Owen (2002), humanism, personal responsibility orientation, behaviorism, neobehaviorism, critical perspectives, and constructivism are all important facets of, and perspectives on, adult learning theory. The most common treatments of the research of these areas of self-directed adult learning are learning projects, qualitative studies, and quantitative measures. Collins (1991) explores adult learning as the interactive relationship of theory and practice. In basic terms, the adult learner studies a particular theory and then puts it into practice when presented with the opportunity to do so. Thus, the understanding of an adult learning theory can prompt practice and practice can prompt adult learning theory revision.

The given literature also helped me establish that there is a limited coherence found in between these learning theories; therefore in order to identify these differences and gain clarity on them, queries were shared with the supervisor who cleared them well. Furthermore, while analyzing the state of the patient, effort was made to apply adult learning theories. Differences between patients at different chronological stages were analyzed and compared with the teachings of these theories. For further leaning, behavior differences between colleagues were also analyzed and discussed with the supervisor.


This objective surrounded around describing the importance of dietary plans to the patients. Since Anorexia Nervosa is a highly dysfunctional and hazardous disorder which forces patient to reach the state of starvation, it was highly difficult to convince the patient regarding restoring a healthy diet . The first step in treating patients with AN is to establish a good therapeutic alliance with the patients by respecting their realities and their rhythms of change, which are very slow because of their absolute denial of their thinness (Colton & Pistrong, 2004).

Also, the impact of chronological stages was also considerable while performing this activity. Since AN appears usually during adolescence which itself is a complex biopsychosocio-cultural period causing mental distress. Part of achieving this objective was to understand the causes of this syndrome which can vary in different patients. Furthermore, understanding the cultural differences that patients had, was also an important factor in handling such patients (Couturier & Lock, 2006).

Efforts were made to develop suitable interpersonal skills for achieving this target. For this purpose, reading of the suitable reference material was done to acquire suitable knowledge about handling such patients. Furthermore, while orientation was required to be given to these patients, I did review exercises with my colleagues and demo orientations were given to them. Initially, this exercise of orientation was performed in the presence of my supervisor to ensure that hazards of AN are communicated well to the patients. Feedbacks from the supervisor were taken at the end of these sessions which were documented in the log maintained for this purpose and its findings were considered while preparing for the next one (Fox, 2009).

One important part of this objective was to handle patients from different cultural backgrounds. Medical counselors and nurses while treating patients from different cultural backgrounds may face a lot of difficulties. There is a clear distinction between what a mental illness can be in the eyes of science and how it can be seen by the patient. This brings responsibility on the shoulders of the counselor to bring the patient and science on the same page. And while doing so, counselors may have to face number of difficulties. This cross-cultural difference may develop a discrepancy between the views of the medical practitioner and the patient. For this purpose, I studied the concept of cultural competence. This required to develop an understanding that first of all, the nurse is expected to develop and exhibit a deep value for cultural diversity. Being aware of the dynamics when people from various social and cultural backgrounds correspond to each other, will help the burse understand the behavior of various cultures towards each other. Secondly, the nurse is expected to move away from theory and take practical measures to meet the diverse needs of the patients (George, 1997). Thirdly, it is important for the counselor to conduct cultural competence self-assessment time and again to gain insight about his competence level (Betancourt et. al, 2003). Furthermore, language barriers and communication styles, are the factors which are important to be considered before actually initiating the treatment. Furthermore, where families are part of the counseling sessions, a family member who can act as an interpreter may appear helpful. However, this does leaves a room for the counselor to gain familiarity with the key terms of the particular language so that the patient feels comfort. Furthermore, mode of communication should also be considered during communication.

Having sound knowledge of the values of the patient is also of significant importance. Gaining familiarity with negative cultural or ethnic stereotypes, male-female roles etc., interactions between individuals and general family cultures, is also part of acquiring cultural competence. Where the nurses are expected to be well-versed with the application of basic behavioral theories, familiarity with the RESPECTFUL Counseling Cube, will prove equally beneficial. This multidimensional cube gives thorough consideration to religion and spirituality (R), economic class background (E), sexual identity (S), psychological maturity (P), ethnic and racial identity (E), chronological stage (C), trauma (T), family background (F), unique physical characteristics (U), and geographical location (L) (Dander & Daniels, 2001). Gaining an understanding of these areas helped me greatly to gain an understanding of patients background.

By the end of fourth week of this activity, a list of patients who were handled by me independently was maintained and their current diet intake was analyzed. The outcomes were shared with my seniors and it was established that out of fifteen patients, twelve showed a healthy diet intake which established the achievement of this target.


Having discussions with family to turn the treatment into family centered care, was another task which required special effort by me (Carlton & Pyle, 2007). It is an established fact that family care can increase the benefits of the treatment exponentially. However, there is always a higher probability that the patient does not have suitably cordial relationship with his family members, or the family members are not willing to invest time and effort into patients’ treatment (Ma, 2008). Overcoming these barriers required exceptional interpersonal skills as it was directly related to altering human behavior. sharing patient’s state with his/her relatives and then gaining their support was the core objective of this activity (Dallos & Danford, 2007).

by the end of this activity, my expectation was to Be able to have thorough sessions with families of the patients where they can be elaborated about the role that they can play in making patients follow the treatment effectively. This further includes convincing families understand the seriousness of the medical condition that the patient is facing and elaborating them about how they can make the difference. For this purpose, I did demos of sessions with my peers and had impersonated question answers session with them. Also, I was asked by my supervisor to perform communication with patients families during which his role was to Observe me closely while handling the patient and provide me with feedback later (Honey et. al, 2008).

since this objective was difficult to quantify; therefore me and my supervisor established a system of sharing constructive feedbacks after every session and also decided to prepare a log along with the testimonials from few patients families which stated that they understand well the importance of their support because of the efforts of hospitals’ staff or if there was any other feedback, they were requested to share that too. On the basis of seven testimonials, out of which five were positive, my supervisor gave me a written recommendation regarding the achievement of this target.


Developing a systematic understanding of learning theories which includes Andragogy, Pedagogy and geragogy as applied to various learning situations at my current educational institute and also during my employment and Understanding application of adult theory in nursing was my objective as mentioned in the learning contract draft.

By achieving this goal, I was expected to Be capable of accurately and comprehensively refer to the concerned theories when analyzing the literature given and reviewing the work of peers, Apply the learning theories and other concepts in the patient’s treatment, Be able to quote the theories and principles correctly, Be able to understand, discuss and quote adult learning theories to my peers, superiors and lecturers. This activity further made me analyze the differences between the learners belonging to different chronological groups (Brookfield, 1981-1990).

For this purpose, Thorough and frequent participation in the discussions with the peers and instructors and Reviewing the work of my peers to enhance my understanding was the primary activity performed by me. also, Spending considerable time reading concerned literature and Assessing the theories in common day practice along Share a written review of these theories after gaining sufficient understanding of the theories was another part performed under the supervision of my supervisor.

For this purpose, me and my supervisor had sessions planned during which we shared our views about these particular theories. Furthermore, I was observed closely by my seniors while handling the patients. Oral viva was also conducted for this purpose and I shared small reports on these different theories which were checked by my seniors and feedback was also shared about them. By the end of this activity, I knew how to apply these theories while educating my patients and their families and how techniques for handling each group differ greatly.


After four weeks of thorough activity which involved readings of required literature, giving demos and quizzes, I achieved a certain level of proficiency in Anorexia Nervosa. Due to this, risk assessment of the patients by evaluating their test results and charts became my strength. furthermore, I had difficulty communicating with patients and their family, which was resolved after adhering to this learning contract. I also developed an attitude of taking initiatives which not only proved beneficial for me as a student but will also help in my professional life.


Brookfield, S.D. (1981). Independent adult learning. Studies in Adult Education, 13, 15-27.

Brookfield, S.D. (1984). Self-directed learning: A critical paradigm. Adult Education Quarterly, 35, 59-71.

Brookfield, S.D. (1986). Understanding and facilitating adult learning. San Francisco: Jossey-Bass.

Brookfield, S. (1990) Using critical incidents to explore learners’ assumptions. In Mezirow, J. (ed.) Fostering Critical Reflection in Adulthood: A Guide to Transformative and Emancipatory Learning. Jossey-Bass Inc., San Francisco, pp. 177 — 193.

Betancourt, R.J., Green, A.R., & Ananeth-Firempong II, O. (2003). Defining cultural competence: A practical framework for addressing racial/ethnic disparities in health and health care. Public Health Reports 118, 293302.

D’Andrea, M., & Daniels, J. (2001). RESPECTFUL counseling:An integrative model for counselors. In D. Pope-Davis & H. Coleman (Eds.), The interface of class, culture and gender in counseling (pp.417-466). Thousand Oaks, CA: Sage.

Carlton, P. & Pyle, R. (2007) A program for parents of teens with anorexia nervosa and eating disorders not otherwise specified. International Journal of Psychiatry in Clinical Practice 11(1) 9-15.

Colton, A. & Pistrong, N (2004) Adolescents’ experiences of inpatient treatment for anorexia nervosa. European Eating Disorders Review 12, 307-316.

Couturier, J. & Lock, J. (2006) Denial and minimization in adolescents with anorexia nervosa. International Journal of Eating Disorders 39(3) 212-216.

Collins, M, I. (1991) Adult Education as Vocation London, Routledge

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Dallos, R. & Denford, S. (2008) A qualitative exploration of relationship and attachment themes in families with an eating disorder. Clinical Child Psychology 13, 305-322.

Fassino, S., Doga, G., Piero, A., Leombruni, P. & Rovera, G. (2001) Anger and personalities in eating disorders. Journal of Psychosomatic Research 51, 757-764.

Fox, J. (2009) A qualitative exploration of the perception of emotions in anorexia nervosa: A basic emotion and developmental perspective. Clinical Psychology and Psychotherapy 16, 276-302.

George, L. (1997) The psychological characteristics of patients suffering from anorexia nervosa and the nurse’s role in creating a therapeutic relationship. Journal of Advanced Nursing 26, 899-908.

Golden. N., Jacobson, M., Sterling, W. & Hertz, S. (2008) Treatment goal weight in adolescents with anorexia nervosa: Use of BMI percentiles. International Journal of Eating Disorders 41(4) 301-306.

Honey, A., Broughtwood, D. Clarke, S., Halse, C., Kohn, M. & Madden, S. (2008) Support for parents of children with anorexia: What parents want. Eating Disorders 16, 40-51.

Ma, J. (2008) Patients’ perspective on family therapy for anorexia nervosa: A qualitative inquiry in a Chinese context. Australian & New Zealand Journal of Family Therapy 29(1) 10-16/

Merriam, S.B., & Caffarella, R.S. (1999). Learning in Adulthood. San Francisco: Jossey-Bass.

Owen, T. (2002). Self-Directed Learning in Adulthood: A Literature Review.

William, J. (2009), Anorexia Nervosa: Self Sabotage in Adolescence

Final Report-Anorexia Nervosa Page 4

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