A Concept Analysis: Assuming Responsibility for Self-Care among Adolescents with Type 1 Diabetes

PURPOSE. This concept analysis clarifies “assuming responsibility for self-care” by adolescents with type 1 diabetes. METHODS. Walker and Avant's (2005 ) methodology guided the analysis. RESULTS. Assuming responsibility for self-care was defined as a process specific to diabetes within the context of development. It is daily, gradual, individualized to person, and unique to the task. The goal is ownership that involves autonomy in behaviors and decision-making. PRACTICE IMPLICATIONS. Adolescents with type 1 diabetes need to be assessed for assuming responsibility for self-care. This achievement has implications for adolescents' diabetes management, short- and long-term health, and psychosocial quality of life.     

Cognitions in Obese Binge Eaters and Obese Non-Binge Eaters

The aim of this study was to examine the frequency and content of several cognitions (negative self-schemas and weight, shape, and eating-focused cognitions) in obese binge eaters and obese non-binge eaters. We used a structured clinical interview to detect differences in cognitions. The majority of obese binge eaters mentioned negative self-schemas that could be characterized as negative generalizations about the self combined with weight, shape, or eating concerns, whereas the majority of obese non-binge eaters mentioned weight, shape, and eating concerns that were not combined with negative generalizations about the self. Participants with negative self-schemas, irrespective of binge category, were more depressed and had lower self-esteem than the other participants. Finally, with respect to the content analyses of negative self-schemas, we found that both groups most often mentioned themes such as rejection, unworthiness, and lack of willpower. However, obese non-binge eaters mentioned more self-schemas regarding lack of willpower, whereas obese binge eaters were more preoccupied with rejection and unworthiness. Implications for future work are discussed, including how cognitive techniques focusing on negative self-schemas might improve treatment for obesity.     

Eating Disorders and Adolescents: An Overview of a Maladaptive Behavior

TOPIC: Eating disorders among the adolescent population are a serious health problem. The author provides an overview of anorexia nervosa and bulimia nervosa. PURPOSE: To present information on eating disorders that includes DSM-IV criteria and typical profiles of the client. Current hypotheses about the etiology of eating disorders, medical complications, treatment approaches, morbidity and mortality data research, and outcome research of treatment are reviewed. Research, treatment, and educational considerations for nursing care are discussed. SOURCES: Published literature, clinical experience. CONCLUSIONS: Advanced practice nurses are particularly suited for working with adolescents because of their holistic approach to client care. Inconsistencies and gaps in the knowledge base of eating disorders regarding incidence, etiology, treatment approaches, pharmacology, and outcome are areas for future nursing research.     

Binge Eating Disorder: A Psychiatrist's Commentary on Clinical Considerations

PurposeOf the 3 major eating disorders, anorexia nervosa, bulimia nervosa, and binge eating disorder (BED), BED is the most common and exists in the practices of most primary care and psychiatric clinicians. However, BED often goes unrecognized and thus untreated.MethodsReviewed in this commentary are the basic elements in the diagnosis of BED, demographic and clinical characteristics, screening options, the importance of comorbidities, pathophysiology, and available treatments.FindingsPsychological treatments, including cognitive-behavioral therapy, interpersonal therapy, and behavioral weight loss, have been recommended as first-line options and are supported by several different meta-analytic reviews. Lisdexamfetamine is currently the only medication approved by the US Food and Drug Administration for the treatment of BED. Effect sizes for lisdexamfetamine versus placebo for response, remission, and avoidance of relapse in BED are robust, but its use may be limited by tolerability. This is also the case for topiramate, an anticonvulsant that has been used “off-label” to treat BED.ImplicationsAdditional medication choices approved by the US Food and Drug Administration for the treatment of BED are needed. Moving forward, opportunities to leverage modern technology to broaden access to treatment are highly desirable.     

Changes in eating behaviour following group therapy for women who binge eat: a pilot study

Survey research is demonstrating that binge eating and compulsive eating may be a significant problem in the obese population. There is higher incidence of binge eating among women, associated with subjective distress and poor prognosis for weight control. Despite attendant health risks, researched clinical responses have not been developed. A before and after uncontrolled pilot study aimed to evaluate the effectiveness of group therapy for women who binge eat and compulsively eat. Participants attended a weekly integrative therapy group for 6 months. Measurements before and after the group intervention were taken using the Binge Eating Scale and Clinical Outcomes in Routine Evaluation inventories. Before and after interviews were thematically analysed for changes in eating behaviour. Following the group intervention, all participants demonstrated changes in eating behaviour measured by the Binge Eating Scale, the overall effect from baseline to 1 year demonstrates statistical significance. Qualitative data revealed four categories that underpinned reduction in binge eating: changes in dichotomous thinking, awareness of eating behaviour, detachment from food and dietary changes. An integrative model of group therapy warrants further research and refinement for this population, a group protocol for nurses working in the field of obesity and eating disorders could be developed.     

An evolutionary concept analysis of caring

AIM: The aim of this paper is to identify the core, enduring attributes of nursing caring in order to increase understanding of the concept and to identify its implications for research and practice. BACKGROUND: Caring is considered a core concept in nursing as a practice discipline. During the past 20 years, research into nurse caring has been evolving, but the concept of caring remains ambiguous. METHODS: Using a rigorous evolutionary method of concept analysis, the concept caring was examined for its significance, use and application as it has unfolded over time, between 1988 and 2002. After applying inclusion and exclusion criteria and a sampling method, a total of 61 articles was included in the final analysis. RESULTS: Defining attributes, antecedents, and consequences of caring were identified. Core attributes included relationship, action, attitude, acceptance and variability. CONCLUSION: Identification of the core attributes of concepts, including caring, allows nurses to determine appropriate research questions, develop theory and identify practice priorities at a time of increasing demands and constrained resources.     

Cognitive Factors Associated with Binge and Purge Eating Behaviors: The Interaction of Body Dissatisfaction and Body Image Importance

This investigation examined the association of body dissatisfaction, body image importance, and the interaction of these variables with the disordered eating behaviors of bingeing and purging. Undergraduate women (n = 311) completed the Shape and Weight Based Self-Esteem Inventory (SAWBS; J. Geller, C. Johnston, & K. Madsen, 1997) to assess body image importance, the Body Esteem Scale (BES; S. L. Franzoi & S. A. Shields, 1984) to assess body dissatisfaction, and a self-report measure of binge and purge frequency. Hierarchical multiple regressions predicting binge and purge behaviors were conducted with body mass index and neuroticism controlled first, SAWBS and BES entered next, and the interaction of SAWBS and BES entered last. A main effects model significantly predicted binge frequency (p < .05), but was not improved by the addition of the interaction term. In contrast, the interaction term made a significant contribution to the prediction of purge frequency (p < .05). These findings indicate that body image importance and body dissatisfaction are both important factors to consider in understanding bulimic behaviors, particularly purge behavior; however, the associations of these variables with binge and purge behaviors may differ.     

Compliance: A Concept Analysis

Compliance has a myriad of definitions. Understanding it as a phenomenon is complicated by the different perspectives fo different disciplines. Nurses need to define compliance in a manner that best fits the philosophy of the nursing discipline. This article makes a distinction between the ordinary use and the scientific use of the term compliance. Nurses are challenged to embrace an interactive, transactional process in order to form a partnership with clients, which allows for client choice and control in decision making about carrying out the prescribed behavior.     

Treatment of Eating Disorders in Adults Versus Adolescents: Similarities and Differences

FindingsAlthough several individual psychotherapies for adults with eating disorders are empirically supported, with family-based treatment (FBT) being the leading recommended empiric treatment in adolescents, patients with eating disorders are still difficult to treat, and outcomes are often poor. In some countries, the clinical services for adolescents and adults are separate, and it is common for patients to receive treatments that differ in terms of both theory and content when they are switched from adolescent to adult services. Changes in the nature of treatment also often occur when patients move from less intensive types of care to more intensive treatment, and vice versa. These transitions may create a discontinuity in the care pathway and disorient patients and their significant others about the strategies and procedures used for addressing eating problems. However, the observation that younger and older patients essentially share the same eating-disorder psychopathology has led to evidence-based enhanced cognitive–behavioral therapy (CBT-E) being adapted for use in adolescents. Originally an evidence-based treatment for adults with eating disorders, CBT-E has yielded promising results in trials in cohorts of adolescent outpatients and inpatients, and is recommended as an alternative to FBT in adolescent patients.ImplicationsWith a unified treatment such as CBT-E, several issues that plague conventional eating-disorder services could be partially overcome, as patients can move seamlessly from adolescence to adulthood and through different levels of care, with no change in the nature of the treatment itself. Future randomized, controlled trials should compare FBT to CBT-E to better clarify the specific therapeutic needs of subgroups of adolescents and adult patients with eating disorders.