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Original Research: An Inpatient Program for Adolescents with Anorexia Experienced as a Metaphoric Prison

Ramjan, Lucie Michelle PhD, RN; Gill, Betty I. PhD

AJN The American Journal of Nursing: August 2012 - Volume 112 - Issue 8 - p 24–33
doi: 10.1097/01.NAJ.0000418094.31317.52
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Objective The purpose of this study was to explore the experiences of adolescents within an inpatient behavioral program for the treatment of anorexia nervosa, as well as those of the nurses who cared for them. In particular, the study focused on the effects of the program's behavior modification principles on the relationship between patient and nurse.

Methods Using a qualitative, naturalistic design, the investigator (LMR) conducted in-depth, face-to-face, semistructured interviews with adolescent patients being treated for anorexia in an acute care setting and the pediatric nurses working there. She invited all patients and nurses involved in the program to participate in the study, and then conducted interviews up until the point of saturation (when responses ceased to reveal any new information or themes). She interviewed 10 adolescent patients and 10 pediatric nurses in total.

Results Study findings illuminated the challenges nurses and patients face in forming therapeutic relationships within an environment the patient often experiences as a de facto prison, with nurses taking on the role of prison warden. In interviews, both patients and nurses frequently used language suggestive of incarceration, and from their accounts of life within the program, three major themes emerged: “entering the system,” “‘doing time’ within the system,” and “on parole or release.”

Conclusion Thematic analysis revealed that an oppressive prison metaphor colored the experiences of both patients and nurses within this program and negatively affected the development of therapeutic relationships between them. Findings suggest that policy changes regarding length of stay, nurse training, visitation, initiation of psychological therapy, and mealtime may improve therapeutic relationships within such programs.

This study describes how the perception of an inpatient behavioral program as a metaphoric prison negatively affected the development of therapeutic relationships between nurses and their patients.

Lucie Michelle Ramjan is a senior lecturer at the School of Nursing and Midwifery, University of Western Sydney, Penrith, New South Wales, Australia, where Betty I. Gill is associate pro vice chancellor (education)–health and science, Office of the Pro Vice Chancellor (Education). Contact author: Lucie Michelle Ramjan, The authors have disclosed no potential conflicts of interest, financial or otherwise.

© 2012 Lippincott Williams & Wilkins, Inc.