Eating Disorders Program Guidelines for families and Support persons St. Paul s Hospital A program for people who struggle with: Anorexia Nervosa Bulimia Nervosa EDNOS (Eating Disorder Not Otherwise Specified) 4NW - Fourth Floor Burrard Building St. Paul s Hospital 1081 Burrard Street Vancouver, BC 604.682.2344 BB.500.Ea111.PHC (Mar-11)
Welcome Welcome to 4NW, the home of the Eating Disorders Program. Our unit is dedicated to caring for those with eating disorders. The focus of our program is to assess, stabilize, and treat people who have a combination of medical, mental health, and nutritional problems. Patients are admitted under the care of a psychiatrist. The psychiatrist is the one who will oversee and coordinate the care. Generally, people who are admitted to this program are here for at least three weeks. However, how long a patient stays depends on their health, treatment, and response to treatment. Before patients leave the hospital, the team will review their transition plan and recommend further treatment options, if appropriate. This booklet explains what patients can expect from us, and what we expect from them. 1
What patients can expect Therapy While in hospital, patients take part in both individual and group therapy. Group therapy Groups have either an education, therapeutic or leisure focus. Most groups take place after meals. The main purpose of the groups is to provide support and supervision during the one hour after meals. We call this post-meal time. Patients are expected to: Attend all groups, unless directed to do something different. Stay for the full duration of each group. Meal support The focus of meal support is to help patients establish more normal eating habits. We do this by: Asking patients to finish their meal within the allotted time frame Getting patients to take part in appropriate conversation Helping patients stop unhealthy eating rituals and behaviours We give patients support during meals by having a staff member eat with them. If patients are being fed by a nasogastric tube, the dietitian will talk to them about whether or not they will take part in meal support. Remain awake and alert during the group. Share thoughts and feelings. Actively listen to other group members. Individual (one-on-one) therapy Members of the treatment team meet with patients individually, usually at scheduled times. These sessions help patients explore the many different areas of health, and learn more about the factors that contribute to the eating disorder. From the first day, patients are encouraged to explore their readiness and desire for further treatment once they leave the hospital. Family involvement Family/support persons are an important part of the treatment. Families may be invited to attend an information meeting with members of the treatment team. The purpose of this meeting is to clarify treatment goals and provide an opportunity for questions about the treatment. With the patient s consent, families/ support persons have ongoing involvement in the treatment, including planning for when the patient returns home. There may also be an opportunity for short term family therapy. 2
Confidentiality and Privacy Everyone in our program is entitled to confidentiality and privacy. Patients are asked to read and sign a Confidentiality/Social Contract. In this contract, patients agree to keep information about other patients private and confidential, meaning they do not share information about other patients with family or friends. This contract helps us maintain a safe and supportive hospital environment for everyone. The patient s ability to decide with whom they will share information is crucial for protecting their right to privacy and for establishing and maintaining the therapeutic relationship. The relationship between health care providers and their patient is established firmly on trust and integrity. Discussing the patient s care and other health care information without the patient s consent could disrupt the trust and integrity of this relationship. While we understand that it may be difficult for family members not to have information about their loved one s care, we do need to respect the individual s right to privacy. The exception to this is when an individual is certified under the Mental Health Act. Rest Generally, all patients spend two hours resting on their beds twice each day. Patients will have to spend more time resting on their bed if: Their medical health is a concern They are not putting on weight There are other medical reasons that the treatment team feel would be helped with more rest Activity While in the hospital, patients are not allowed to do any exercise, even while on passes. Our occupational therapist helps patients to set goals for healthy levels of activity and exercise once they are at home. Here is what we mean when we say exercise : Standing for long periods of time Excessive walking (for example: up and down the halls all the time) General busyness busy doing nothing or activity without a purpose Patients may need to use a wheelchair when off the unit if they are unsteady on their feet. This allows patients to conserve energy and reduces the physical stress on the body. It also reduces the risk of falling. 3
Phone calls and cell phones All patients have a phone in their room to make and receive phone calls. Family members are asked to call patients directly and not to call the nurses station or main desk on the unit. The telephone cannot be used: During meal times During group sessions The time between meals and group sessions Before 7:00 am After 11:00 pm Cell phones are locked up at the main desk on the unit when patients are admitted. Cell phones may only be used on passes. Visitors Visiting hours Monday to Friday 3:15 pm - 5:00 pm Weekends 7:00 pm - 9:00 pm 10:15 am - 12:00 pm 3:15 pm - 5:00 pm 7:00 pm - 9:00 pm Visitors must check in at the main desk on the unit before going to patient areas. Visitors are asked to call before they come, in case patients are going to be busy with a medical test or an appointment with one of the staff. Visitors are not allowed to lie on patient beds. No sexual activity is permitted on the unit. Pets are not allowed to visit the unit. Who cannot visit the unit at any time? Anyone who has been a patient previously on our unit or who is currently a patient in the Eating Disorders Program. Outside health professionals as visitors Patients often ask if they can have their community therapists see them while in hospital. Even though we know the relationship with the community therapist is important, we do not encourage patients to keep in touch with outside therapists while in the hospital. Our approach to treatment may be different from that of the therapists. Different approaches can be confusing. Any items brought to patients by visitors must be checked by a nurse for items not allowed on the unit. 4 Visitors are asked not to bring in food for patients.
Passes During the admission, patients will be given passes to be away from the unit for short periods. Passes to leave the unit for any length of time are ordered by the doctor. Passes are only given to patients when we feel it is safe for them to leave the unit. By safe, we mean that the patient s mental and physical health is stable. Even though the doctor may have said it is okay for a patient to go on a pass, the patient s nurse decides at the time whether they can go, based on their health status at that moment. We do not give passes during the first week of being in the hospital. This is a stressful time and patients may not be well enough to leave the unit. Passes are given so that patients can practice what they are learning. For example, patients will go on a pass to practice having snacks and meals with support people or by themselves. Beginning in the second week of the admission, the first few passes are short (½ hour to 1 hour long), and patients may need someone to go with them. Usually, only one pass is granted each day. As patients progress and move closer to their planned date to go home, passes gradually increase in length and difficulty. Passes should support the goals that patients are working on. All one-on-one appointments with members of the treatment team take priority over passes. If patients are transferred to 4NW from another area in the hospital, all passes will be stopped and patients will need to be seen by a doctor on 4NW before new passes are given. We are smoke-free! Like all government buildings in British Columbia, St. Paul s Hospital and surrounding property are smoke-free. We are scent-free! Many people are sensitive or have allergies to fragrances. Because of this, the unit is scentfree. Please avoid using any scented products and perfumes when you are visiting the unit. Preventing illness Help us stop the spread of germs. The best way to stop the spread of germs is to clean your hands. When you clean your hands well, you kill many of the germs on your hands. It takes less than a minute! To protect you and others, please wash your hands after using the toilet and before eating. When visiting the unit, please clean your hands when you arrive, before and after the activities listed above, and when leaving the unit. Cover your cough or sneeze with a tissue. If you do not have a tissue, cough or sneeze into your elbow. Do not cough or sneeze into your hand. If you have a cold, the flu, or diarrhea, please do not visit the unit until you are feeling better. 5
Fire safety Safety First Teaching and research If the fire bell goes off at any time: Return to the patient s room. Shut the door to the room. Stay in the room until a staff member tells you what to do or tells you it is all clear. Talking about concerns If you have any specific concerns about the care your loved one is receiving, please let us know right away. You can speak to the patient s nurse, the nurse in charge or the social worker. We do our best to see that concerns are addressed as quickly as possible. We are a place of learning for patients, families, staff, and future professionals. We want to share what we learn with others. At times, we have learners join our team to both observe and take part in the treatment. Like all staff, learners from outside Providence Health Care are bound by the same rules for privacy and confidentiality. As professionals, we are always seeking to learn more about the nature of eating disorders as well as best treatments. Sometimes research studies are done in our program to add new knowledge to what is already known about eating disorders. Patients may be invited to take part in a research study while they are in hospital. If you do not feel comfortable approaching any of the staff in the Eating Disorders Program about your concerns, please feel free to contact our Patient Relations office (604.806.8284). 6
Creating a safe and supportive Environment To help us create a safe and supportive environment for patients, families and staff we have identified a set of community values for the unit. Values Verbal and physical abuse A safe and supportive environment is essential. It allows everyone in the program to focus on their recovery. Visitors are asked to refrain from using disrespectful or abusive language while on the unit. Patients are asked to respect the following values while in hospital on 4NW: We value and foster the belief that recovery from an eating disorder is possible. We value consistency and fairness in individual treatment. We value openness about the challenges inherent in living in a shared space. We strive to remember that our environment is reciprocal, and that individual behaviours ripple out to affect other community members. We value meaningful relationships and respect for individual boundaries. We value genuineness and honesty. We value direct, respectful communication. We value the strengths of each individual, and strive to draw out and recognize each other s talents in a supportive way. We value an environment that is emotionally and physically safe. We value a balance between solitary and group time. We value self-nurturing of one s body and soul. 7
Going home We work with patients to help them plan for going home. Patients are encouraged to make a meal plan, a plan for leisure time, a plan for activity and exercise, and a plan for building supports through friends and family before leaving hospital. Patients are supported to identify community resources that may be helpful. 8