Background: Eating disorders have been described as challenging to treat, with the most severe cases requiring inpatient admission. Previous studies have explored staff's perspectives on eating disorders and service provision. However, little is currently known about how staff experience working with severe and complex eating disorder presentations in inpatient settings and how they may be impacted by their work.
Aims: This study aimed to explore the experiences of staff who contribute towards the treatment of severe and complex eating disorder presentations in inpatient settings.
Methods: Participants were recruited purposively via clinical contacts and a private hospital group in the UK. Semi-structured interviews were conducted, recorded, transcribed verbatim, and analysed guided by the principles of reflexive thematic analysis.
Results: Interviews were completed with twelve staff members, including frontline nursing staff and multidisciplinary team (MDT) staff, from both private and public specialist settings. Participants expressed uncertainty about the treatment approach for service-users with severe and complex presentations. As service-users often resisted treatment, participants felt positioned as a 'punisher' rather than a 'helper' in initial treatment stages. Many had experienced physically and emotionally impactful events at work, including violence and aggression, as well as serious incidents of self-harm and suicide attempts. Participants generally found support in their colleagues, however considered organisational support insufficient.
Conclusions: This research highlights an urgent need to consider the wellbeing of staff who works in eating disorder inpatient settings, as well as their support needs. Retention and recruitment strategies should be reviewed to reduce staff turnover and improve patient care. Further research should investigate whether specialist inpatient staff are impacted by symptoms of vicarious or direct trauma, moral injury and compassion fatigue.
Keywords: Eating disorders; Inpatient; Interview; Mental health; Qualitative; Reflexive thematic analysis; Staff wellbeing; Trauma.
This study explored how staff who treat severe and complex eating disorders experience working in inpatient settings. The researchers interviewed twelve staff members from inpatient eating disorder services based throughout the UK. The themes identified from the interview data described challenges related to treating people under the Mental Health Act (without their consent) and the dynamics that arise in this context – staff often found it hard to be seen as ‘the punisher’ when delivering treatment, as it felt like a contradiction to their career in helping others. Staff described physically and emotionally taxing work and their reliance on co-workers in coping with this, as they found organisational support insufficient. Several staff described experiencing directly and indirectly (vicariously) traumatising events at work. This highlights an urgent need to investigate trauma responses in the context of inpatient work with severe and complex eating disorders, as this will enable organisations to implement appropriate staff support. This is likely to in turn improve patient care.
© 2023. The Author(s).