Table 1 Protocol of a stepwise approach: problem-oriented interventions: social-emotional, eating, motility
Day | Safety | Social-emotional | Eating | Motility | Autonomy |
|---|---|---|---|---|---|
1 | Bedside evaluation mental state antipsychotic medication | Crying, retching | Passive: infusion | Sits in bed if supported | |
2 | Build alliance with family, establish supportive relationship with patient | Nurse gets in contact with patient, offers contact, occupation at frequent short intervals | Infusion | Continued, able to sit alone in bed | Patient decides when to stop (some minutes) |
3 | Weight control, check caloric supply nasogastric tube | Breathing exercises by nurse, explore cognition: how does it feel in your stomach? Cognitive stimulation: school work at bedside | Sensory input, water in mouth without swallowing, mashed soup via tube, initially administered by nurse, then by father | Sensory input wash feet twice a day by father | Breathe slowly for self regulation reflection on inner state |
4 | Weight gain, antipsychotic medication stopped | Occupation continued, variety of tasks | Continued | Sits at bedside for a moment | Crying diminishes |
5 | Continued variety of tasks, longer attention span | Continued | Crying stops, is getting calm | ||
6 | Safe relationship to nurse | Praised by family and professionals | Active: able to swallow liquid | Active intake of food—very proud | |
7 | Takes part in group painting | Sits in group at table | |||
8 | Active: eats solid food nasogastric tube removed | Passive: massage of legs; active: guided movements, relaxation exercises | Expresses wish for favourite food, active movements of legs despite being anxious | ||
9 | Occupation for 1 h needle work fast, skilful | Able to sit in group for 1 h, stands with support | Able to ask for material, persists on own ideas in painting, able to say no, assertive behaviour, confident | ||
10 | Some steps on her own without support |