Eating Disorders Nursing: Interview with Lisa Palm, RN, NSN, CPN
Providing psychiatric and behavioral therapies along with medical care
Lisa Palm, RN, BSN, CPN
Torrance Memorial Medical Center, Medical Stabilization Program for Patients with Eating Disorders
Briefly describe your nursing career.
I have worked as a pediatric/adolescent nurse for 14 years. I worked for an outpatient pediatric multidisciplinary clinic at Children's Hospital Los Angeles in the cardiac, renal and gastrointestinal units, and at Children's Hospital San Diego in the cardiac critical care unit. I have been at Torrance Memorial for the past seven years in the pediatric/ adolescent unit.
What brought you to specialize in eating disorders?
Honestly, the patients found me. I was assigned to take care of one of the sickest anorexia patients we had seen at that time, and I was anxious and nervous. I found that day after day she requested me to be her nurse and at that point I realized, “I can do this.”
I enjoy this patient population and the emotional aspects of developing a caring relationship. The relationship is different than your average med/surg patient. It takes a firm attitude in helping patients to stand up to their eating disorder, and setting limits while caring for them and supporting them. All in all, it’s challenging. I attend eating disorders association conferences to learn more about the dynamic of this population and how I can help the process of recovery. I find that every patient has a different situation and learning from them helps me become a better nurse.
Please describe your duties in the Torrance Memorial ED program.
Our medical stabilization program is unique in the sense that we take care of adolescents and young adults who are too unstable to participate in a residential or outpatient eating disorders treatment program. We are based out of the pediatric/adolescent unit at TMMC. We have patients that come from residential facilities, intensive outpatient programs or from home. I, along with the team of nurses I work with, take care of their hourly and daily needs. We provide emotional support in addition to monitoring for “refeeding syndrome,” fluid/electrolyte imbalance, pain control, gastrointestinal discomfort, skin issues and safety.
The usual stay is two to three weeks. During that time I work to develop a trusting relationship with each patient. We have patients that come from all over the country. Most arrive alone, scared and anxious about treatment. My job is to help transition them into a safe place with the goal of restoring health and well-being.
It seems that your program takes a very collaborative interdisciplinary approach to treatment. Can you speak to that?
Our program is team-based and led by Dr. Linda Schack, medical director, who sets a tone that ensures effective communication and collaboration. Dr. Schack makes daily rounds along with the RN that is assigned to each ED patient. Our clinical psychologist, Bobbi O'Brien, RN, Ph.D., provides individual psychotherapy for patients as well as guidance and continuing training of the nursing team.
Before pursuing her Ph.D. in psychology, Dr. O'Brien was a practicing registered nurse with 13 years of experience in psychiatric and eating disorders nursing. Having been a nurse, Dr. O'Brien is a major support person for the RNs on the unit as she knows first hand the challenges we face, and she gives us tools to work through them.
In addition to Drs. Schack and O'Brien, our team consists of Michele Manarino, R.D., Jennifer Kromberg, Psy.D. (family therapy), Mini Mehra, M.D. (gastroenterology) and Tejinderpal Rai, M.D. (pediatric and adolescent psychiatry). Everyone involved is experienced in the treatment of eating disorders, comfortable with this population and dedicated to providing the highest quality of care.
What about your work feeds your spirit?
The team of people I work with feeds my spirit. Torrance Memorial adopted a version of Joanne Duffy's Quality Caring Model which is geared not only toward providing caring relationships with our patients, but with each other as well. The hospital’s vision and mission are consistent with my personal values as a nurse by treating every patient with respect. The dedication to the community and each other is consistent throughout the hospital.
I precept new graduate nurses and the general feeling is that all of the staff is "so nice,” which is surely appreciated when you are starting your career. Our recent Magnet designation is extremely exciting and I think the staff is excited to see what the future holds. The longevity of the staff motivates me to continue my career at Torrance Memorial. I work with staff members that have been in their positions here for over 30 years, and that speaks volumes about our dedication to the organization.
Is there a patient story or anecdote that you can share with us to illustrate the challenges or successes of your work? (Without violating HIPAA, of course.)
I remember something about every patient we have, as they are unique in their own way, as well as in the things that they have taught me. There is one patient that I took care of, and I am unsure if it was the severity of her illness that sticks with me or her incredible fight for recovery. She was 5'4” and about 60 lbs. This patient was the first ED patient I took care of where I had thought to myself, "She will not survive... she is so malnourished, her heart is not going to continue to function."
I remember visiting her in ICU. I was trying to explain to her that if her heart did stop beating, I was not sure she would survive a code situation, as her bones were extremely fragile. She shook as she grabbed my hand and told me that she didn't feel sick, but she really wanted to get better. She said, "Please do what you can to help me!" It was a long six weeks, but her strong will pushed her through.
We recently got a letter from her. She is working actively on her recovery and living life. I will never forget the challenge of her case and I will forever celebrate her success. I apply her experience to my practice today as an example that you can do anything you set your mind to.
Do you have any plans for professional or personal development in the future?
I am working toward the CEDS designation. I’m currently raising a family, and may go back to school at some point for my master's degree.
Because eating disorders are widely prevalent in our society, the healthcare industry has responded by developing specialized units and facilities where both medical and psychiatric treatment can be offered. The nurse working in this specialty area may encounter a broad range of approaches to the treatment of this group of disorders that are typically considered psychiatric in nature, although genetic and familial factors play a role.
Nurses are often expected to conduct thorough assessments of patients prior to and during treatment. Comprehensive physical assessment, weights, vital signs, medication administration, and mental health assessment and support are all skills that the nurse will use.
Patients with eating disorders are treated in psychiatric facilities, inpatient residential clinics, hospitals and outpatient treatment centers. The treatments offered are numerous, and may include art therapy, Cognitive-Behavioral Therapy (CBT), culinary therapy, Dialectical-Behavior Therapy (DBT), family therapy, group therapy, individual therapy, movement therapy, music therapy, support groups, nutritional therapy and comprehensive medical care.
Acute and chronic illnesses that can result from long-term eating disorders, include but are not limited to: severe weight loss or weight gain, dental complications, fluid and electrolyte imbalances, renal and gynecological dysfunction, gastrointestinal complications, bone loss, seizures, and psychiatric conditions, including anxiety and depression. The nurse involved with this patient population must be aware of all aspects of these conditions and assess for complications as appropriate.
Education is paramount in treating an providing psychosocial support to clients with eating disorders.
National Eating Disorders Association: www.nationaleatingdisorders.org
International Association of Eating Disorders Professionals: www.iaedp.com
American Psychiatric Nurses Association: www.apna.org
The International Association of Eating Disorders Professionals (IAEDP) offers certification for Certified Eating Disorders Specialist (CEDS) and Certified Eating Disorders Registered Nurse (CEDRN).