I am submitting three discussion postings and i need you to respond to the individually. In your responses to the posts provide constructive and insightful comments that go beyond that of agree or disagree. Paula stated: Anorexia Nervosa is not a choice or decision, but actually, a brain-based mental illness, according to our reading. Nurses will encounter people with eating disorder in a number of clinical settings. In schools, camps, community health care settings, pediatric units, medical-surgical units, and intensive care units, nurses must be aware of the characteristics of eating disorders so they can provide prompt attention to those in need (Fontaine, 2009). The nurse becomes an advocate for the patient when the patient is brought to the clinic or admitted to the hospital for treatment. Having a genuine, trusting relationship with a patient who is suffering from anorexia nervosa is very important. The patient needs to feel that they can rely on the nurse and trust the nurse for the proper treatment. The first step towards a proper diagnosis of anorexia nervosa is to admit the existence of an eating disorder. Nurses should also encourage parents to act on their children`s behalf. Nurses can model for parents and support them in the difficult challenge of sympathizing (but not colluding) with the child`s demands, and tolerating the child`s fury commonly triggered by the idea of treatment (Silber, Lyster-Mensh, and DuVal, 2011). Nurses have an important role in educating both the adolescent living with anorexia nervosa and the family. The patient and family need to be informed regarding the disease process, plans, and expectations through a working team relationship with the health care staff. Nurses should model good communication skills with the adolescent affected with anorexia nervosa and their families (Fontaine, 2009). There are several approaches to take when treating a patient with anorexia nervosa. Screening test such as Eating Disorder Examination (EDE) is an interview of the patient by the doctor. Another test called the SCOFF (Sick, Control, One, Fat, Food) questionnaire is used to diagnose a person with anorexia nervosa should the patient answer "yes" to two or more of the following questions: *Do you make yourself Sick because you feel uncomfortably full? *Do you worry you have lost Control over how much you eat? *Have you recently lost more than One stone`s worth of weight (14 pounds) in a 3 month period? *Do you believe yourself to be Fat when others say you are too thin? *Would you say that Food dominates your life? A measurement of BMI (Body Mass Index) will also be performed. The doctor may also refer a patient to a psychiatrist or counselor for psychological treatment. Anorexia nervosa does not respond well to drug treatment, although SSRI`s are sometimes used as an adjunt to psychotherapy. Nutritional rehabilitation therapy, which may include the entire family, is an important part of the treatment process (www.advocateheatlh.com). The nurse can play a role in the treatment goals for the patient diagnosed with anorexia nervosa by helping with the following goals and referring the patient as well. Some of the treatment goals are: Helping the patient to restore normal body weight, treating physcial complications and any associated psychiatric disorders, teaching the patient proper nutritional habits, how to develop healthy eating patterns, and preparing meal plans, changing the patients dysfunctional thoughts about the eating disorder, help to improve self-control, self-esteem, and behavior, provide family counseling, and to help prevent relapse (www.advocatehealth.com). Nurses can advocate for acceptance and implementation of the "Maudsley Method" in their own settings (Silber, Lyster-Mensh, and DuVal, 2011). The Maudsley Method is for adolescent and younger patients in the early stages of anorexia nervosa. The Maudsley Methos is a type of family therapy that enlists the family as a central player in the patient`s nutritional recovery. Weekly family meetings and family-based counseling are also part of this therapeutic approach (www.advocatehealth.com). When a nurse can share the belief that the disease is not the fault of the parent nor the result of a child`s "stubbornness," their therapeutic presence helps to empower parents and alleviate parental-and patient-feeling of guilt (Silber, Lyster-Mensh, and DuVal, 2011). Two websites that I would give to my families suffering with this disease would be www.maudsleyparents.org and www.feast-ed.org. These websites will give the families support and information about managing eating disorders and a 24/7 online forum (Silber, Lyster-Mensh, and DuVal, 2001). 2)Nadine stated: Discuss methods the professional nurse may use to assist with this shift in understanding suggested by the authors. Anorexia Nervosa is an eating disorder surrounded by misunderstandings, leaving outsiders to place blame on patients and at times their family. Before becoming a LPN, I was one of those outsiders. I knew nothing of the disorder, only myths, one of which was they are starving themselves to look skinny; therefore, educating others and advocating for these individuals are effective ways to assist in helping families and others understanding this form of eating disorder. In what circumstances can the RN advocate for the individual with an eating disorder? The RN can advocate for the individual starting in their settings such as at school, in health centers and outpatient clinic and even in the acute care settings. In each setting, the RN promotes health and work to prevent illness; therfore, the RN should take the opportunity to educate on eating disorders, becoming a source of information while encouraging individuals to live healthy lives. What are viable approaches to treat individuals with a diagnosis of anorexia nervosa? The first and foremost approach for the RN is to establish a trusting relationship with the individual who is dealing with issues as denial, disturbed body image and/or low self-esteem. The nurse must be accepting, available, and honest, keeping all promises. This will provide the foundation for a strong, therapeutic relationship. The RN should provide positive feedback to help the individual to accept their strengths and weaknesses. This is to help the individual understand that he/she is not expected to be perfect and can control his/her life in other ways than weight loss and dieting. Also do not argue or bargain with the individual while implementing the treatment plan, but let him/her know behaviors that are not acceptable, and that privileges will be restricted for non-adherence. Keep in mind the individual in denial has a weak ego, and will try using manipulation to gain control. How would the RN provide information to families about the treatment options for their children? The RN will provide information to families by including them in the plan of care, being non-judgmental and unbiased. Informing the family of the neurobiological influence of the disorder, affecting their family member`s ability to make the sensible decision in resisting the anorexic compulsion, may give some relief, more so if there are other family issues at hand. Fontaine (2009) stated that if there is any teasing, criticism, or social comparisons about weight occurring in the family, these must be stopped if the client is to improve” (p. 287). The RN may also give information on support groups and research websites. 3)Kathryn stated: Where I currently work as an LPN in a University Health Clinic, I have seen a number of cases of anorexia. The standards written in the book about the population at risk being young female athletes I find very accurate. It is very saddening to watch a young girl suffer from an eating disorder when they have seem to have no idea of the damage they are doing to their bodies. What I find even more saddening is when people react to these patients like they are making conscious decisions. Even some of the older nurses I work with react in this manner, but they were taught differently about the disease and from the evidence that we now have. I think that to make this shift in understanding that facts need to be presented to disprove previous notions about the disease. This disease is actually a neurobiological loss of ability to make sensible decisions, it is not about vanity. Research now shows that brains can be predisposed to eating disorders by identifying specific neuropsychological deficits, unilateral abnormalities on imaging scans, and specific neurotransmitter profiles (Silber, Lyster-Mensh & Duval, 2011). This research provides proof that eating disorders are not cognitive actions. Presenting solid facts can help people change their views on these disorders. Nurses can advocate for patients in any setting that are being treated for an eating disorder. As far as advocating for the patient, I think that it is important to act as an advocate for optimal health and part of that is notifying providers and family (if appropriate) if there is a possibility of an eating disorder. I think this is a main point to focus advocacy on because it is speaking for a patient who does not understand the underlying issues. Also, it is important to identify eating disorders early to prevent possible life-long damage (Silber, et al, 2011). Advocating for this patient can also be with other health care providers that take the stance that the patient is making conscious decisions that they know are harming them. Individuals that are being treated with anorexia need to be treated with a combination of techniques. Anorexia is not just a physical illness but a psychological one as well so a combination of psychological, behavioral, and nutritional techniques are all used during treatment. This multifaceted treatment targets all of the areas that can impact eating disorders. For example, food restriction becomes a habitual pattern so behavioral therapy can focus on breaking this habit (Fontaine, 2009). These therapies can include a number of different settings and techniques that can benefit the individual client. When providing information to families about treatment options for their children it is imperative not to place blame on the family for the patient`s eating disorder, as well as support them and encourage them to take part in the client`s treatment. One method of treatment called the “Maudsley Method” helps empower parents to help their child. Teaching this method to parents can help them understand the balance between being empathetic for their child while still being firm about eating habits (Silber et al, 2009). By presenting this method as well as removing any blame that the parents may feel, the nurse can build a positive relationship with the family based on support.