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THE EDEN UNIT

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THE EDEN UNIT GUIDE FOR PATIENTS & THEIR FAMILIES & FRIENDS The Eden Unit, Block C Clerkseat Building, Royal Cornhill Hospital, Cornhill Road, Aberdeen AB25 2ZH – PowerPoint PPT presentation

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Title: THE EDEN UNIT


1
THE EDEN UNIT
  • GUIDE FOR PATIENTS
  • THEIR FAMILIES FRIENDS
  • The Eden Unit, Block C Clerkseat Building,
  • Royal Cornhill Hospital, Cornhill Road,
  • Aberdeen AB25 2ZH

2
We dont want you to feel overwhelmed -
please dont feel you have to read all of this
folder on the first day or indeed ever. Some
people keep the information for reference and
others like to consult it to get an idea of
expectations, guidelines and attitudes to
treatment. Let us know if you notice any
inaccuracies or omissions. We are always open to
improvements and welcome creative suggestions.
  • Using this Folder
  • We want you to feel welcome here and we know
    it takes a while to get used to the way things
    are done. Eden Unit Patients asked for this
    information pack, and have been lead authors and
    editors in its production. We are indebted to
    Amanda Brooks who produced the first draft in
    consultation with her peers in May 2010. Many
    other patients, carers and staff members have
    contributed to each draft, and the aim is to
    continue to update the folder with each new
    development.

3
CONTENTS
  • The Eden Unit history and geography
  • What happens when you are first admitted?
  • Your rights and responsibilities as a patient
    here
  • The dining room and afterwards
  • Confidentiality
  • Whos who?
  • Our Weekly Timetable
  •  Treatment for patients with weight-losing
    disorders
  • Arrangements for discharge
  •  Day Programme
  • Further work of the Eden Unit research,
    publicity, education

4
  • The Eden Unit
  • history and geography
  • For many years Scottish patients suffering
    from severe eating disorders had to go to
    England, at great expense and with the added
    hardship of being treated far from home and often
    the transition back home led to relapse because
    of lack of continuity.. Even when private
    facilities opened in the South of Scotland there
    were similar problems
  • In 2005 Grampian, Highland Tayside set up
    the North of Scotland Managed Clinical Network
    for Eating Disorders. The work of this group and
    its Lead Clinician, Dr Harry Millar, resulted in
    the decision, in 2006, to open our 10 bedded
    inpatient unit and its associated Day Programme.
  • On 25th May 2009,we had our official opening
    by Sheila Robison,
  • Minister for Health and Sport.

5
The Eden Unit history and
geography
  • The Unit is hosted by NHS Grampian and
    situated in the Royal Cornhill Hospital in
    Aberdeen. We take referrals not only locally from
    Aberdeen and wider Grampian but also from
    Tayside, Highland, Orkney, Shetland and the
    Western Isles.
  • We have close links with specialist
    outpatient eating disorder services and general
    adult mental health services in all of our
    partner areas. In addition we enjoy a close
    relationship with Dr Alastair McKinlay and
    colleagues in the specialist Gastrointestinal
    services at Aberdeen Royal Infirmary.

6
What happens when you are first admitted?
  • When you first arrive you will have a physical
    and psychological examination from the admitting
    doctor and nurses if they have serious concerns
    about your medical state you may be temporarily
    treated in Dr McKinlays ward at the Infirmary to
    make sure it is safe for you to start the Eden
    programme of treatment
  • You will be allocated a key nurse who will take a
    special interest in your care and will ask about
    your medical and personal history as well as
    asking you to complete some assessment
    questionnaires. The whole nursing team will be
    looking after you, but the key nurse leads the
    development of your care plan

7
When you first join us
  • You will have your own bedspace and if
    possible your own room, at least in the early
    part of your admission. There also is a dorm of
    four beds, each with curtains . It is not
    possible to guarantee that you will occupy the
    same bed for the whole of your stay this is a
    hospital rather than a hotel! and staff may not
    always be able to give as much warning as they
    would like before asking people to move. Please
    do try to be understanding about this.
  • Voluntary patients are of course free to come
    and go as they wish the door is locked to keep
    patients safe from theft or inappropriate
    visiting. It is also helpful for staff to have
    to open the door for people so that they are
    aware of who is out and who is in the Unit.

8
  • When you first join us
  • Some of your biggest anxieties will be about
    the dining room and about the rules. So the
    next page is an attempt to explain what the
    hospital expects and what the Eden Unit
    prescribes as the best treatment for its
    patients.
  • We try to be as flexible as possible in
    making treatment an individual matter for each
    patient this means that you may be asked to do,
    or not do, things that do not apply to other
    patients. It may seem unfair it may even BE
    unfair. But we believe it would be wrong to make
    everyone follow the same treatment plan if they
    have different needs or find themselves at a
    different stage of treatment.
  • All the same there are certain matters which
    have been laid down as essential by the Hospital
    Management or other authorities to protect all of
    us - staff and patients - who live and work here.

9
  • YOUR RESPONSIBILITIES IN THE EDEN UNIT
  •  You are expected to make reasonable efforts to
    take part in the unit programme and work with
    staff on treatment. Ambivalence is part of the
    disorder, but we ask you to open your mind to
    the experiment of recovery whilst you are a
    patient here.
  •  Violent, abusive or destructive behaviour is
    unacceptable and is treated seriously. Being a
    resident of the Inpatient Unit does not protect
    against the involvement of Police when necessary
    (in cases of violence or stealing, for instance).
    We do of course attempt to assess to what
    extent people were behaving badly under the
    influence of illness.
  • The use or possession of non-prescribed drugs,
    solvents and alcohol is not allowed. Patients
    must not return to the Unit under the influence
    of any intoxicating substance. In an eating
    disorders service, items of food and drink are
    regarded as medicines which are prescribed for
    patients. Individuals should not keep supplies .
  • Smoking is discouraged and is not allowed inside
    the hospital building. We accept that this is
    too stressful a time to ask someone to give up
    smoking. So patients may smoke in designated
    places (outdoors from the Unit) at times
    permitted by staff. We are delighted to provide
    help and support if you do chose to give up
    smoking.
  •  There is no sexual contact between people in
    the Unit.
  • We expect staff and patients to respect each
    other. Racist, sexist, or size-ist bullying
    and intimidation are unacceptable and will be
    taken very seriously. 
  • Confidentiality must be maintained - we
    particularly ask patients and their families not
    to make public any information which was
    entrusted to you by fellow patients or their
    families. You must not take any photographs of
    staff or patients.
  •  
  •  

10
FINDING YOUR WAY AROUND
  • On the ward there are two lounges - the
    larger lounge is used for supervision and many of
    the groups whilst the smaller one is a cosy
    sitting room for more informal use. There are
    freeview televisions with dvd players in all
    bedrooms and in each lounge and also a
    Playstation and in the big lounge.
  • The tables adjacent to the main lounge can
    be used with the sewing machine and arts and
    craft supplies. There is also an array of DVDs
    and board games. There are two computers in the
    smaller lounge but you will need your own
    dongle to use internet.
  • The hospital asks you not to bring in
    blankets or duvets from home but to use what they
    supply this is because of fire safety
    regulations.
  • There are laundry facilities in Edens
    Sluice Room washing machine, tumble dryer,
    clothes airers, iron and ironing board. You are
    requested to provide your own washing powder
    but just ask if you dont have any.
  • Beyond the Unit, up by the Clerkseat
    Entrance to the Hospital, there is a visitors
    canteen and voluntary-run newsagents shop which
    also sells a few toiletries. Opening hours are
    10-4 on weekdays and 2-4 at weekends for shop.
    At weekends visitors may use the Staff Canteen
    (just down the same corridor) since the Visitors
    canteen is shut. Visitors can also use staff
    canteen 2.30-5pm on weekdays.
  • There is a visitors overnight stay room
    that can be booked through nursing staff for 5
    if available.
  • The Hospital has a side entrance at Berryden Road
    which is most convenient for the Unit, especially
    when shopping, but this and the door from the
    Corridor close at 9pm sharp every night and
    people must then use the main entrance from
    Cornhill Road and main door at the Clerkseat
    Building.

11
  • Around the Cornhill/Berryden area -
  • There is a Sainsburys, Next, Mothercare,
    Toysrus, JJB Sport, Argos, PC World, post
    office and other shops right by side entrance to
    Royal Cornhill Hospital and walking distance to
    Rosemount Place and Rosemout Viaduct where
    smaller shops, hairdressers and cafes are.
  • It is a 15-20 minute walk to Union Street and
    shopping centres.
  • Travelling by bus
  • Regular buses run from by hospital and a short
    bus ride will take you to newest shopping centre,
    Union Square, where the main Guild Street bus
    station and railway station are found.
  • Buses that serve Aberdeen city centre to Royal
    Cornhill Hospital are numbers 5, 10, 12 and 59.
  • Travelling by car
  • Free parking is available in the grounds of the
    hospital but spaces are limited and you may have
    to park a short distance from the Unit. There are
    Pay and display regulations in force on
    neighbouring streets.
  • There are also a number of taxis available at
    taxi stances in the city centre or companies to
    telephone. There is a free-phone taxi telephone
    available at the main reception of hospital.
  • More information on nearby facilities can be
    given by staff.
  • (please insert maps plan of RCH and google map
    of local area)

12
Looking after your property
  • Cornhill Hospitals policy is that
    personal property is brought in at the owners
    risk, so it would be unwise to bring items of
    high or sentimental value into the Unit. If you
    do bring things that are valuable, fragile or not
    permitted in your room, you may prefer to hand
    these to staff for safekeeping. Handbags,
    diaries and so on should not be left lying around
    even though obviously we hope most people will be
    trustworthy and respectful of all property, both
    private and that of the Hospital.
  • You will not need too many changes of
    clothing dress is fairly informal and there is
    a laundry room for patients use.
  • We ask that neither patients nor their
    visitors bring in any of the following
  • -Drugs, alcohol, food, and drink, sweets,
    laxatives, chewing gum
  • Any items that people may use to hurt
    themselves should be handed in to staff who can
    them let you have them back for appropriate use.
    These would include
  • -Razor blades, knives, scissors, tweezers,
    mirrors and other glass objects, matches and
    lighters.
  • If you bring in personal
    electrical items, e.g. Hairdryers and mobile
    phone chargers, these may need to be checked by
    hospital electrician prior to use.
  • Dont forget to collect your
    belongings when you leave the ward again!

13
THE DAILY ROUTINE ON EDEN
  • The day starts with breakfast unless you are
    weighed that day. Most people will be weighed 3
    times a week or even more often at first.
    Sometimes staff will ask you to be weighed
    unexpectedly, because anorexia can make people
    fake their weight. We ask you not to have
    anything to eat or drink on the morning you
    expect to be weighed, but to go to the treatment
    room in pyjamas. You are asked you to empty your
    bladder and you may be asked to provide a urine
    sample too. This can be checked for signs of
    infection or other problems, and can also be used
    to assess whether you are under- or
    over-hydrated. First thing in the morning we
    would expect most people to have concentrated
    urine, and if this is not the case then its
    likely that your weight is an over-estimate of
    the true value.
  • Of course, you may also have medication dispensed
    first thing too.
  • Breakfast is at 8am . It is courteous to wear
    day clothes dress is casual but you are
    expected to wear clothes that express
    consideration of other peoples feelings and that
    are appropriate to the time of year and
    temperature. Patients are expected to be
    punctual for all meals and snacks..
  • Most of the rest of the days events are
    described in the account of eating for recovery
    or in the weekly timetable. Do ask staff to
    explain anything we have not made clear.

14
Our Weekly Timetable
  • Each week the day starts with a 15 minute
    community meeting except on Tuesdays when the
    Staff meet for the morning Ward Round at which
    patients care is reviewed and developed.
    Patients themselves prepare a report for the
    staff to consider, and feedback is provided the
    next day (Wednesday)
  • The rest of the week is structured by a series of
    meetings and groups between meal and snack times,
    and by the increasing number of individual
    appointments that will be provided for you as you
    become able to engage in therapy. We enclose a
    copy of the current timetable this changes from
    month to month in accordance with the needs of
    the patient group and the availability of
    different opportunities.
  • Weekends are quieter times on the ward, but
    still involve the hard work of tolerating
    renutrition and rest and their physical and
    psychological side-effects. They are also
    opportunities to practise re-engaging in
    interpersonal contacts and relationships without
    using eating disordered ways of coping with the
    stresses involved.

15

Eating for RecoveryEveryone eats three meals
and three small snacks each day in the Dining
Room.WHAT DO WE EAT? Tina, the dietician,
prescribes what you are to eat. Nursing staff
decide on the portion size and serve it to you.
Your job is to eat all of what you are given.HOW
DO WE EAT IT? Most patients need guidance to
learn the etiquette expected in the dining room.
This is unlikely to be what you have been used to
at home. It is not the only way for healthy
people to eat, but we use this approach because
it is a way you can learn how to eat healthily
again. Some members of staff ask you to do
things differently from others, and you may also
notice that not all patients are expected to
follow the same guidance. Patients will be at
different stages of recovery and not all will
have the same difficulties. Its not helpful to
compare yourself with others but to accept staff
guidance. On the other hand, if you are asked to
do something that mystifies you (for instance not
to wear loose sleeves or scarves) it may be that
staff are taking precautions against behaviours
that have undermined other peoples recovery
please cooperate rather than quibble!WHAT HELPS?
Of course many people are terribly anxious and
sometimes this takes the form of anger and
stubbornness. Part of recovery involves trying
to make the atmosphere as pleasant and normal
as possible, however hard this may feel. You are
asked to save complaints or questions about the
food or portions until you are alone with a
member of staff, not to raise these at the table.
We make conversation about intersting things -
not about food, diets , weight or appearance.
Everyone eats three meals and three small snacks
each day in the Dining Room.WHAT DO WE EAT?
Tina, the dietician, prescribes what you are to
eat. Nursing staff decide on the portion size
and serve it to you. Your job is to eat all of
what you are given without any negociation.HOW
DO WE EAT IT? Most patients need guidance from
staff to learn the etiquette expected in the
dining room. This is unlikely to be what you
have been used to at home. It is not the only
way for healthy people to eat, but because it is
a way you can learn how to eat healthily again.
Some members of staff will ask you to do things
differently from others, and you may also notice
that not al patients will be expected to follow
the same guidance. Patients will be at different
stages of recovery and not all will have the same
difficulties. Its not helpful to compare
yourself with others but to accept the guidance
of staff supporting you. On the other hand, if
you are asked to do something that mystifies you
it may be that staff are taking precautions
against behaviours that have undermined other
peoples recovery please cooperate rather than
quibble!HOW CAN WE HELP? Of course many people
are terribly anxious and sometimes this takes the
form of anger and stubbornness. Part of recovery
involves trying to make the atmosphere as
pleasant and normal as possible, however hard
this may feel. You are asked to save complaints
or questions about the food or portions until you
are alone with a member of staff, not to raise
these at the table.
  • ex

16
The thinking behind the way we eat
  • Tina, our dietician, will explain more
    about this
  • but in
    essence the aims of the eating programme are
  • To make eating as manageable as possible rather
    than frightening.
  • To gradually set you free from the physical and
    psychological effects of starvation
  • To help you cope with the physical and
    psychological effects of refeeding
  • To help you to establish a regular eating pattern
    and eat a healthy variety of foods so that you
    get the best health benefits from a slim body.
  • To accustom you to healthy new eating habits that
    you follow regardless of the way you feel or what
    is going on around you
  • To support you to take back the responsibility
    for caring for yourself, including feeding
    yourself , digesting what you have eaten, and
    resting your body.
  • Vitamin and mineral supplements are
    prescribed to restore deficiencies and prevent
    imbalances . Your meal plans need to be
    gradually increased as your body functions
    better, speeds up the rate of metabolism and
    repairs the damage done by starvation. At first
    your weight may oscillate a lot, then it is
    likely that you will gain an average of 0.5 to
    1.0kg per week, usually a little faster at start,
    then slowing down as you body begins to work
    normally.
  • Much of what the public hears about a
    healthy diet is what is aimed at an
    increasingly overweight population. We are not
    taught about the importance of fats, for
    instance, because most people eat too much of
    such food, but they are essential to good health.
  • Whilst your brain and heart, in particular,
    recover from starvation, its as important as
    when you were a growing child to take in food
    rich in phosphate, such a milk.

17
  • WHAT HAPPENS IF WE ARE TOO ILL TO EAT ENOUGH?
  • All of us have to eat human beings, like
    other animals, dont have any choice in the
    matter if they are to live. The only choices we
    do have are about how and what we eat, and how
    much is enough. People with severe eating
    disorders become too anxious to make these
    choices wisely and need to be guided by experts
    to master the fear and learn new eating skills.
    The staff on the Eden Unit have experience
    skills to help you eat as normally and healthily
    as possible.
  • Very occasionally people dont manage to eat
    enough of the food on their plan so will be
    prescribed a nutritional drink instead (usually
    Fortisip or equivalent). More rarely still,
    patients cannot manage to take in what is
    prescribed at all and then, after careful
    discussions between staff and with the Scottish
    Mental Welfare Commission, people may need to be
    fed by means of a soft plastic tube. Sometimes
    this is also used to start the refeeding process
    where a person is so fragile that a normal diet
    could be physically dangerous.

18
Coping after mealtimes
  • It is rather misleading to talk about eating
    disorders, since most patients struggle not only
    to eat but also to allow the nutrients to stay in
    their body. For many people there is terrible
    discomfort leading to urges to be sick or to
    burn off calories which leads people to purge
    or engage in obsessive physical activity, usually
    in secret.
  • We therefore ask people to stay together in the
    sitting room for a period of about half an hour
    after each meal, for a period of supervision.
    This is of course a time of tension and anxiety
    for many people, and it is helpful if you can
    discuss with the group and with the supervising
    nurses how best to create a supportive
    atmosphere. Some people manage best by playing
    board games or cards, whilst others like to read,
    watch TV, knit or sew, or converse quietly.
    Please do be open minded about other peoples
    ways of coping and experiment with different ways
    to distract yourself.
  • For patients who struggle particularly with
    compulsions to purge or overexercise, or who are
    so starved that they are in danger of losing
    control of their appetite, there may be extra
    supervision arrangements involving accompanying
    patients even in bathrooms or at periods other
    than after mealtimes. These will be carried out
    with maximum dignity and compassion.

19
  •  VISITORS
  • Visiting times are 7-8.55pm during the week and 2
    3.15, 3.30 4.55 and 7 8.55pm at weekends..
    At other times visiting may be arranged with
    special agreement of the staff team, particularly
    if visitors have long distances to travel or work
    shifts. During normal working hours patients
    have to concentrate on groups, activities and
    therapy so we ask visitors to respect the ward
    timetable. Obviously you need not receive a
    visitor unless you want to be visited!
  •  Sometimes its not helpful for patients if there
    are too many visitors on the Unit - they may
    feel terribly exposed when they dont feel well.
    Occasionally patients become distressed or
    confused and when they are well again feel
    embarrassed to think they had been visited by any
    people except the very closest. Patients may
    entertain visitors in their own rooms or in the
    shared spaces, but should always respect other
    peoples peace and privacy.
  • Friends, family and other carers deserve some
    rest and respite from caring. Children
    particularly young ones may be upset to see
    their relative so ill, and may be frightened by
    the hospital or resentful of the time taken up by
    the illness. We can arrange a
  • meeting to explain things to them if you feel
    this would be helpful

20
  • Confidentiality
  • Please check out your expectations of
    confidentiality and privacy with staff members.
    The members of the team treating you do not make
    private information about you available to the
    public without your express permission. Indeed
    your medical records are only released if there
    is a sub poena by a court of law. The staff
    team do share information with each other and
    to some extent with your GP and outpatient staff
    in order to maintain helpful communication.
    The balance between good and important
    communication on one side and privacy and
    confidentiality on the other is extremely
    difficult and sensitive.
  • On the other hand , family, friends and other
    carers do not have an automatic right to have
    information about you without your permission.
    People who care for you do have a right to
    general information about the disorder from which
    you have been diagnosed to suffer. They may also
    be provided with information needed to care for
    you when on pass. They do not have automatic
    rights to staff confidentiality. Staff dont
    pass on sensitive personal material unless they
    believe this is crucial, but in general they
    assume that communication from relatives can be
    made known to the patient involved.

21
Going on pass
  • Once people are well enough to safely go for
    walks in the hospital grounds or beyond, we
    negotiate this together. We do need to know at
    all times where the patient is, and who is with
    them. We may insist that patients go out only
    with nurses, or with family, and we often ask
    them to stay indoors when it is dark or cold .
    We have to bear in mind that we are part of a
    Psychiatric Hospital, where other people may at
    times inadvertently pose a risk of infection to
    underweight patients . We often offer drives or
    outings in wheelchairs to provide fresh air and a
    change of scene.
  •  Weekend or indeed any other home pass is not
    supposed to be simply a break from treatment!
    In fact it is likely to be very hard work for
    everyone involved. The aim is to see whether
    the treatment set up in the Unit can continue at
    home. For instance, prescribed medication should
    be taken, food and exercise plans followed, and
    planned behaviours practised. Patients are
    expected to refrain from using alcohol, cannabis
    and other substances during pass, just as on the
    Unit. Much as you want to be back in the normal
    world, it is important to remember that
    unprepared passes can set back the treatment
    badly. Please help us all to plan and practice
    the work with you.

22
Whos who in Eden?
  • Consultant Psychiatrist
  • Dr Jane Morris
  • Trained in both Adult Medical Psychotherapy
    and Child Adolescent Psychiatry, she is Chair
    of the Scottish Eating Disorders Eating Disorders
    Interest Group, and leads a Research Group
    adopted by the Scottish Mental Health Research
    Network. She has published papers and books in
    the fields of Eating Disorders and
    Psychotherapies
  • Medical Doctor
  • Dr Lesley Pillans
  • (insert photo and short bio)
  • Consultant Physician
  • Dr Alastair McKinlay
  • Ward Manager
  • Pauline Milne
  • (insert photo and short bio)
  • Deputy Ward Manager
  • Lindsey Money
  • (insert photo and short bio)

23
Whos who in Eden?
  • Art Therapist
  • Leslie Spillman
  • Cognitive Behavioural Therapist
  • Jan Templeton
  • Pharmacist
  • Dietitian
  • Tina McGilton
  • Occupational Therapist
  • Shona McCulloch
  • Physiotherapist
  • Sandra Philip-Rafferty

24
Whos who in Eden?
  • Secretarial/Admin Staff
  • Wendy Pawlik and
  • Rona Walker
  • worked in the field of Eating Disorders
    even before the Eden Unit opened and have worked
    here from its inception. Rona is also
    administrator for the EEATS organisation
  • Ward Cleaner
  • Sangit leads the cleaning of our Unit
  • Chaplains
  • The Rev Muriel Knox and the Rev Jim Simpson
    lead the non-denominational Chaplaincy
    neighbouring the Eden Unit in the prefabricated
    building
  • At present we have vacancies for a Social Worker
    and for a Psychotherapist

25
The Nursing Team
  • The Eden Unit is staffed by both formally
    trained nurses and by nursing assistants who,
    though they may not have a Nursing Degree, will
    have undertaken specialist Eating Disorders
    Training and in some cases other paramedical
    skills, such as phlebotomy (taking blood
    samples). The team is led by our two most senior
    nurses, Ward Manager Pauline Milne and her Deputy
    Lynsey Money.
  • Our most experienced Staff Nurses are
    frequently entrusted with the role of Mentor to
    the Student Nurses who undertake work placements
    on our Unit. The teaching and learning roles
    allow our whole Team to engage in the continuing
    learning process that maintains the quality of
    the service we offer and often provides creative
    advances in the treatment of anorexia and related
    disorders.
  • At times of intensive demand on the
    nursing team our regular staff may be joined by
    members of Cornhill Hospitals Nurse Bank. These
    nurses may not have training specific to the care
    of people with eating disorders and are guided by
    our permanent staff.

26
  • TRAINED NURSES
  • NURSING ASSISTANTS
  • Angie Milne Day Programme Nurse (insert photo)
  • Bernadette Laidlaw (insert photo)
  • Debbie MacDonald (insert photo)
  • Claire McFarlane (insert photo)
  • Elaine Ross (insert photo)
  • Emma Stephens (insert photo)
  • Dawn Watt (insert photo)
  • Kerri-Lee Watt
  • Rose Amos (insert photo)
  • Donna Campbell (insert photo)
  • Jacqui Holmes (insert photo)
  • Christine Leonard (insert photo)
  • Emma Riley (insert photo)
  • Kerry Robson (insert photo)
  • Jenny Swankie (insert photo)
  • Irene Thomson

27
The Key Worker Role
  • Your individual care will be entrusted to a
    Key Worker identified from among the trained
    nurses. Your key worker takes a leading role in
    discussing, planning, implementing and monitoring
    your individual care plan. This may involve
    looking at past experiences to learn from which
    solutions and skills have worked well, which have
    not so far helped you and which may not have yet
    been tried.
  • The Key worker may also act as your
    particular advocate with the team, for instance
    at Ward Rounds and other meetings, and will
    encourage you to complete questionnaires and
    assessments. However, you are encouraged to work
    with several different members of staff it is
    not the case that you must put your entire trust
    in this one member of staff! When your own Key
    Worker is not on shift it is important to
    identify someone else who can take time to catch
    up with your progress and feelings

28
Treatments for weight-losing disorders
  • Members of the Eden and Aberdeen Eating Disorders
    teams were part of the group which met in 2006 to
    review the 2004 NICE Guideline on Eating
    Disorders, to update the evidence base and make
    recommendations specific to the Scottish context.
    These were published by QIS (Quality Improvement
    Scotland) and form the basis for treatment here.
  • We are guided by evidence from other Eating
    Disorders and Medical Units to keep people alive
    and healthy in terms of warmth, rest, body
    chemistry, protection from infection and other
    aspects of health planning, and use dietetic
    expertise to inform nutrition.
  • Unfortunately, there is very little research
    evidence for management of severe low weight
    anorexia nervosa and of complicated disorders.
    The best available evidence suggests positive
    results for the use of the drug Olanzapine.
    Younger patients and those living
  • at home also benefit from Family
    treatments. The Eden Unit therefore offers these
    whenever possible but also returns to first
    principles in using individual formulations to
    map out personalised care plans for each patient.
  • Formulation is a way of integrating the
    physical, emotional and psychosocial interactions
    of peoples strengths and vulnerabilities into a
    design for working towards recovery. Our
    multi-disciplinary team uses the 24/7 inpatient
    experience to build up a picture of each patient.
    We also incorporate the information provided by
    each patient, by families, and the results of
    questionnaires.
  • Finally, we are proud to be part of several
    research initiatives exploring and developing
    best practice, and hope you will be interested in
    participating if invited.

29
Working with families and other carers
  • Family work is the most strongly evidenced
    treatment for Anorexia nervosa. We therefore
    include relatives and carers wherever possible.
  • For many patients this will mean parents or
    partners are asked to take over the same sort of
    responsibilities at home as taken by the staff
    team here in the hospital. This is of course
    MUCH harder to do if you are emotionally involved
    with the patient and if you have already built up
    expectations of the way the relationship works.
    For patients, accepting a change in the
    relationship to help with earlier discharge home
    is an important part of progress.
  • Its also important to acknowledge that several
    studies have shown that the burden of stress
    involved in living with someone with anorexia
    nervosa is even greater than living with someone
    suffering from the most severe mental illnesses
    such as schizophrenia. It is helpful for carers
    to learn skills to deal with the extreme tension
    and often aggression that the illness can cause
    unless it gets its own way.
  • The NEEDS groups are self-help monthly meetings
    for both patients and carers which we would
    encourage carers of our patients to attend.
    Staff can let you know of the dates, and the
    meetings are held just around the corner, in the
    Fulton Clinic.

30
What are the treatments offered?
  • Patients are given an individual dietary plan
    prescribed by the dietitian, and will be offered
    nutritional supplements such as vitamins and
    minerals to repair deficiencies.
  • The physiotherapist offers programmes for the
    appropriate levels of physical activity for each
    patients physical and psychological needs
  • Medical management may include medication for
    pre-existing medical or psychiatric disorders as
    well as symptomatic treatment and medications
    known to be helpful in the management of anorexia
    or other eating disorders
  • Eden offers a variety of individual and group
    treatments including Body Image therapy, Self
    Esteem enhancement, Nutritional Education,
    Cognitive Behavioural Therapy, Art Psychotherapy,
    Occupational Therapy and Physiotherapy. The
    programme varies from time to time to reflect the
    needs of the current group of patients
  • With your permission, family and other carers
    will be invited to participate in supporting your
    recovery
  • Individual key worker sessions will occur
    whenever your key worker is available. Other
    nurses will offer input too, particularly if your
    key nurse is not about. Our trained nursing
    staff have experience of counselling techniques
    and use the underlying principles of the
    therapeutic approach to inform their support of
    your needs as well as to contribute to an
    assessment of your readiness for...
  • More formal individual psychotherapy, carefully
    matched to your stage of recovery. Please note
    that psychotherapy can be a stressful experience
    so that if this occurs whilst your automatic
    response to stress is to lose more weight, it can
    hinder rather than help your recovery.

31
Arrangements for discharge
  • Most patients stay for a few months rather
    than weeks, although very short admissions can
    sometimes be planned. There are no no hard and
    fast criteria for discharge it happens when you
    are able to continue recovery without the support
    of the inpatient unit, so it depends on your own
    levels of motivation, the skills you have learned
    and the support available to you outside the unit
    both in your home and at the local Eating
    Disorders service. Social workers and Out Patient
    team may be involved in your discharge planning
    meeting, which takes the same form as the 6
    weekly review meetings you have been used to
    holding throughout your stay.
  • Sometimes patients are discharged sooner
    than they expected, or decide to leave before the
    original date planned for discharge. The Team
    will usually host or attend a Discharge Planning
    meeting even after you have left, because of the
    importance of communicating what has been learned
    from your admission and the need to assess the
    follow up care you need.
  • It is often the case that in-patients move
    over to join the Day Patient programme as a
    stepping stone to full discharge to out patient
    care. The Day Programme expects people to commit
    to a minimum of a 12-week session, with 6 weekly
    reviews. Some patients will need substantially
    longer to consolidate recovery. The Day
    Programme is unique in Scotland in offering
    intensive support to translate the new skills
    learnt in the inpatient unit to your home
    setting.

32
Day ProgrammeThe Day Programme attached to
the Eden Inpatient Unit provides suitable
patients with an opportunity to generalise
progress made in IPU or to avoid requiring
admission altogether in some cases. Some patients
may be treated for more than 12 weeks. All
patients are asked to prioritise attendance on a
Tuesday, as this is currently the day on which
the Day Programme weekly Community Support Group
is held. In addition to this, Day Patients will
meet for individual sessions, therapy on an
individual, couple or family basis, and groups
which may be shared with Inpatients or may be
pitched to a more advanced level of motivation.
Some patients may attend on 5 weekdays plus
weekends, whereas others may need only one or two
days. This will vary, usually decreasing during
the admission.Not all inpatients benefit from
Day Programme attendance. In some cases it is
preferable to resume links with a well known
outpatient therapist as soon as possible. Other
patients may have to travel too far for
attendance to be feasible. In these cases we
hope to have offered opportunities for extensive
home passes to allow patients to test out their
capacity to live independently and still continue
to progress.All patients are reviewed after 6
weeks. The Outpatient worker or their
representative attends reviews as well as the
discharge planning meeting
33
COMMUNICATING WITH US AND MAKING YOUR VIEWS KNOWN
  • The Eden Unit telephone numbers are as follows
  • Nurses Office 01224 557586
  • Nurses Station 01224 557521/557699
  • Ward Secretaries 01224 557769/557758
  • There is a cordless phone available for your
    incoming calls and if you are available a member
    of staff will bring this to you. The number for
    this phone is 01224 557440 calls to be limited
    in length.
  • If you or your carers wish to communicate by
    email, the Units email address is
    grampian.edenunit_at_nhs.net. Emails are receievd
    and accessed by our secretaries who then forward
    them to the individual member of staff to whom
    they are addressed. They may also be printed and
    stored in patients medical records where,
    theoretically they may be accessed by other
    medical staff.
  • We welcome any comments you have regarding your
    stay in hospital. If you would like to comment on
    the care you have received or on any aspect of
    your stay in hospital please let us know by
    completing one of the Grampian NHS Feedback
    Cards. These are available from any member of
    nursing staff.
  • If you are unhappy with any aspect of the service
    you receive, please speak to the Unit Manager,
    Pauline Milne (or in her absence to the Nurse in
    charge).
  • If you have any suggestions or complaints and
    for any reason you would prefer not to speak to a
    member of staff, you may wish to complete a
    Feedback Card.
  • The Hospital Advocacy Service is also available
    to help represent your expressed views. Their
    office is next to the canteen, opposite the WRVS
    hospital shop.
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