Activity - Managing Eating Disorders in Custodial Settings by

Types of Learners

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Students are on placement and are Primary Care Graduate RNs

Program and Level

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2nd and 3rd Year nursing students
Bachelor of Nursing completers (New Grads and RNs)

Prerequisites

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Basic Understanding of healthcare centre, mental healthcare and correctional facility care frameworks.

1. Purpose of the Learning Activity?

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Ultimate purpose is to enhance and equip nurses with the knowledge, skills and clinical reasoning needed to adequately assess and provide evidence-based healthcare and support to individuals with a diagnosed eating disorder.

2. The Rationale

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The prevalence of eating disorders is rising within the Australian population. Eating disorders are a complex mental health condition that often co-exists in individuals with other mental health conditions, such as trauma and PTSD, who are over-represented within the custodial environment. Eating disorders have an increased risk, especially within the custodial environment, due to the restrictive measures and stigma. Nurses must be confident in recognising signs, making informed decisions and escalating appropriately.

3. Learning Outcomes

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Understand the main different types of eating disorders present within the custodial environment currently (Anorexia Nervosa, Bulimia Nervosa, Binge Eating Disorder and other specified feeding or eating disorder), as well as the signs and symptoms.
Apply nursing management and care strategies based on an individual's presentation
Demonstrate clinical reasoning in responding to a patient with an active eating disorder presentation through a case scenario.

Topic: Managing Eating Disorders in Custodial Settings

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Date: 30/06/2025

Time: 1400-1500

Duration: 60 Minutes

0-5 Minutes

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Content Outline: Introduction to the lesson - Scope and objectives of the session

Teacher Activity: Outline objectives, present scope

Learner Activity: Listen and contribute any prior knowledge

Resources: PowerPoint

Method of Assessment: Attendance

5-25 Minutes

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Content Outline: Understanding of eating disorders and their presentation (AN, BN, BED and OSFED)

Teacher Activity: Present DSM-V diagnostic criteria and challenges in detection

Learner Activity: Ask questions if needed clarification

Resources: PowerPoint and handouts

Method of Assessment: Attendance

25-45 Minutes

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Content Outline: Care-based clinical reasoning

Teacher Activity: Present two case studies, one physical health-focused and one mental health focused

Learner Activity: Small group decision, a different case study for each group. Present decision and findings

Resources: Case study prompt and poster paper

Method of Assessment: Decision making process

45-55 Minutes

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Content Outline: Escalation Protocols

Teacher Activity: Teach escalation protocols, policies and procedures

Learner Activity: Apply protocols to the scenario

Resources: Policies and Procedures

Method of Assessment: Expected outcomes for the patient

55-60 Minutes

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Content Outline: Conclusion and questions

Teacher Activity: Key messages and question time

Learner Activity: Reflect

Resources: Reflection sheet

Method of Assessment: Facilitator comments and feedback

Evaluation Strategies

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Pre and Post-Evaluative Survey

Reflective Practice

Scenario 1: Background

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Setting: Clinic within the prison

Patient: Helen, 24 year old female in custody

Background and health history: Diagnosed with bulimia nervosa at age 20, recent broken arm, no current engagement with mental health team, known history of self-harm and suicidal ideation.

Scenario 1: Presentation

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Visably upset and elevated, affect teary and restrictive. States mood as “horrible”. Insight provided “I was weighed by the GP yesterday during a consultation about my ongoing wrist pain and saw my weight, my buy-ups (personal shopping) arrived when I got back to my cell and I ate a weeks worth of food, my cellmate saw me and I was so ashamed I purged until only bile came out, I walked for 2 hours around the yard today”. Helen stated “i’m so pathetic everyone is going to see me stack on the weight, I didn’t deserve the food anyway”. Reports thoughts of self-harm but no current plan.

Scenario 1: Role of the RN

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Conduct initial assessment; discuss with your group which assessment method is indicated in this scenario e.g. DRSABCD, A-G assessment, MSE (mental state examination)
Use assessment to identify key concerns and acute risks
Implement next steps as based on satisfying key concerns and risks e.g. physical monitoring, RIT, transfer to external hospital, escalation or referrals.
Present findings and decision making process utilising the clinical reasoning cycle.
Reflect using Gibbs Reflective Cycle.

Scenario 2: Background

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Setting: Clinic within the prison

Patient: Ben, 21-year-old male in custody

Background and health history: Diagnosed with anorexia nervosa at age 19, previous hospitalisations and involuntary mental health admissions due to low BMI until weight restoration. Previous suicide attempts, previous deliberate self-harm.

Scenario 2: Presentation

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Officers present Ben to the clinic following a sudden syncope in the yard. Ben is alert and orientated to person, place and time and is now mobilising independently. Bens vital signs are as follows:

A - airways patent and clear, pt maintaining own

B - 16RR, 98%Sp02 on RA

C - 92/43 BP, HR 48BPM

D - A+O, mobilising independently

E - 36.6 temp, capillarry refil <3 seconds. Pt looks pale and quite clammy, pt reports feeling “cold”.

F - Pt reports eating and drinking ‘normally’ throughout the day, pt reports urinating and opening bowels normally.

Scenario 2: Role of the RN

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Conduct initial assessment; discuss with your group which assessment method is indicated in this scenario e.g. DRSABCD, A-G assessment, MSE (mental state examination)
Use assessment to identify key concerns and acute risks
Implement next steps as based on satisfying key concerns and risks e.g. physical monitoring, RIT, transfer to external hospital, escalation or referrals.
Present findings and decision making process utilising the clinical reasoning cycle.
Reflect using Gibbs Reflective Cycle.

Prompts for Reflection:

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What were your main concerns in this scenario?
How did you triage/ decide which actions to take first?
How/did you maintain patient autonomy and confidentiality?
What barriers could you face in these scenarios? How could you overcome them?
What did you find difficult?
What did you find interesting?