'Holding the line'—relationship building and challenges when nursing adults with a severe eating disorder

Abstract Background Eating disorders (EDs) are serious psychiatric disorders that may cause great suffering and reduced quality of life. Severe EDs often lead to somatic complications and have a high mortality rate. The most seriously ill patients need hospitalisation, with a need for highly trained nurses. Methods The aim of the study was to investigate challenges when nursing adults with a severe ED, and how to succeed in establishing a therapeutic relationship. A qualitative design was chosen, and individual qualitative interviews conducted with twelve nurses. The analytic method was Braun and Clarke's thematic analysis. Results Six main themes were developed: entering the patient’s world of experience (with the subthemes: understanding the patient’s anxiety, understanding the patient's rigidity and need for control and understanding the patient's ambivalence), providing somatic nursing, building relationships, ‘holding the line’ (with the subtheme: demanding and rewarding), manoeuvring between rules and frameworks and providing good nursing care during coercive treatment. Conclusion Nursing patients with a severe ED is demanding, requiring somatic as well as psychiatric expertise. The nurse must understand the patient's anxiety, rigidity and need for control, and ambivalence. Nursing patients with a severe ED requires clarity, and steadiness and the nurses must cope with resistance. To succeed, teamwork and support from colleagues are needed.