Students with eating disorders

[KelRN215, BSN, RN]

Hi everyone,

I'm hoping those of you who've worked in schools longer than I have might have experience with this or ideas to share.

I recently started working 2 days/week at a boarding school (high school). The full-time nurse has asked me for my input in establishing a protocol for students with eating disorders- how they need to be monitored/managed, when they are safe to be at school, at what point do they need to be removed from school, etc.

We currently have a student diagnosed with bulimia who was removed from the boarding environment for several weeks with the understanding that she would pursue more intensive treatment. She returned unexpectedly after spring break with no prior notice and I guess the problem is that because her family removed her from the boarding environment before they were told she was going to be removed, there was no specific criteria for her return/no expectations that had to be met before she could return.

The school does not have 24/7 nursing and it seems like it may not be possible for someone with an active eating disorder to be safe as a boarding student.

Do your schools have specific guidelines for dealing with students with eating disorders? I know that eating disorders are quite common in boarding schools. There is a doctor who is at the school 1 day/week but from what I can tell, this girl is being mismanaged by her outpatient provider as she only has a psychopharmacologist and the treatment approach I am familiar with for eating disorders involves medical, nutrition and psychological approaches to treatment. My inclination is that this girl needs better medical management outside of the school, that her teams needs to come up with a concrete plan (meals, coping strategies, etc) and that the plan needs to be communicated with the school so we can appropriately monitor her.

Thanks for any input.

Kel

[Flare, ASN, BSN]

It sounds to me like you are on the right track. I have never worked in a boarding school, so as far as that piece of the puzzle goes, i cannot provide too much commentary, but when considering a typical student, the biggest help is having a well laid out plan and being consistent.

This may include regular weigh ins and dental checks or sending her out for regular blood work. This may include her being monitored for a period of time after eating and having meals in front of staff only. Obviously there needs to be a counseling portion here- so that would need to be worked in as well.

I don't think there is necessarily a boiler plate protocol that can be in place beyond frequent checks with the student, medical clearance to return to school and requiring the outpatient case manager or physicain to provide the school with a written plan of intervention. Perhaps it would be beneficial, however for the school to have timeframes for followup and reanalysis of plans in place to check that they are adequate.

[canned_bread]

I am not a school nurse, however have worked in an eating disorders unit/outpatient clinic at a children's hospital (as a nurse). Part of the plan for each child was to be buddied up with the school and family with a management plan, and this on a few occasions was with a boarding school. I would suggest your student attend a hospital outpatient ED program, if one of them is available. They will co-ordinate counselling, dietetics, and medical monitoring such as weight and blood work on an outpatient basis. For the boarding school students it usually also involved the year boarding advisor who would monitor behaviour that was reported weekly or monthly depending on severity to family and treatment team. So, perhaps some research on community options would be helpful.