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The COVID-19 pandemic has impacted the lives of very many people in different ways around the world. The impact of the pandemic on delaying cancer diagnosis and subsequent treatment has been well-documented but the pandemic has also had significant consequences for many other patient groups experiencing a wide variety of life-changing and potentially life-ending conditions. In this editorial, the focus will be on the pandemic's impact on individuals experiencing Eating Disorders and Other Specified Feeding or Eating Disorders (OSFED). This is an important issue for all nurses because eating disorders are currently the leading cause of death amongst individuals experiencing mental ill-health.

An eating disorder is a diagnosable mental illness characterised by an obsession with food, either eating too little or too much. Individuals experiencing an eating disorder often use food as a response to intrusive thoughts, which might be around size and shape of food or could be about fear of some types of food, such as carbohydrates or fats. Some individuals might even experience hallucinations and reduced cognitive function related to their eating disorder. OSFED sits on a spectrum somewhere between ‘normal eating’ and an ‘eating disorder’ and can be characterised by behaviours such as restrictive eating, binge eating, skipping meals, avoiding food groups, use of diet pills or laxatives and self-induced vomiting. The consequences of OSFED eating can be as serious as eating disorders. Eating disorders and OSFED can lead to serious and life-threatening physical and psychological side effects and, in a significant number of cases, to death.

During and after the COVID-19 pandemic, the prevalence of eating disorders and OSFED eating have grown substantially. This has resulted in increasing demands on many health services in mental health care, primary health care and in general hospital services. Perhaps the biggest challenge is outside mental health where there might already be a significant lack of focus on mental health or where there might be a lack of knowledge and experience around the presentation and management of eating disorders, or the communication skills required to support individuals presenting with eating disorders. Emergency departments, acute medical wards and paediatric wards are examples of extremely busy clinical areas where the multiple demands on nurses, lack of knowledge and experience of caring for people with eating disorders and lack of resources can increase the demands placed in nurses and can result in inadequate care for individuals seeking support for eating disorders (Rodgers et al., 2020).

There needs to be a shift in thinking about how individuals presenting with eating disorders are supported in hospital settings. It is important that all nurses have an understanding of eating disorders, so they are able to provide appropriate care and support to the growing number of individuals requiring this support, wherever it is needed.

The nursing care provided for individuals with eating disorders is highly specialised and draws on unique knowledge and understanding. Individuals with eating disorders might need to have their food intake carefully monitored, which can create challenges if they are being cared for in the wrong environment or are being cared for by nurses who lack the necessary knowledge and experience. Individuals with eating disorders may also undertake compensatory behaviours, such as over-exercising, purging or using laxatives, if they feel guilty about the food they have consumed. Again, ensuring adequate and accurate monitoring can be challenging.

Nurses familiar with caring for individuals with eating disorders will be aware of the need to maintain clear and consistent boundaries. Establishing and maintaining these boundaries can be difficult in acute care settings. Clear communication between all those involved in providing care for people with eating disorders, including their families, can also be challenging in the wrong clinical area or where those providing support lack knowledge and experience.

Nurses unfamiliar with caring for individuals with eating disorders might unintentionally use inappropriate terminology, such as ‘you are looking healthier’, which can have a detrimental impact on future behaviour (Beat Eating Disorders, 2022). It is important to remember that individuals who are recovering from an eating disorder are continuously battling intrusive thoughts about their intake, body image and self-esteem. A one seemingly positive comment from a healthcare practitioner can have negative implications for the individual involved.

Without knowledgeable and experienced support in an appropriate clinical environment, efforts to support individuals with eating disorders may not be as effective as they might otherwise be. The consequences of inadequate support can be devastating, including serious mental and physical health complications and even death. It is important, therefore, that all nurses, regardless of area of practice, acquire some knowledge and understanding of eating disorders and OSFED. This could be achieved through e-learning, in-house training and annual updates. Nurses will already be familiar with multiple annual training activities but, with the possible exception of resuscitation training, it is unlikely that any other annual training might have a positive impact on so many lives. As the number of individuals needing this support increases, so does the imperative to ensure that nurses everywhere have the knowledge and skills required.

The COVID-19 pandemic had an immense impact on all aspects of everyday life with many people having to drastically change their usual daily routines. The impact of making such changes to everyday life was felt not only by those with existing mental health illnesses but also by those without existing mental health challenges, many of whom adopted maladaptive coping mechanisms around eating in an attempt to retain a sense of control.

Throughout the United Kingdom (UK) those most affected were children, young people, those already experiencing emotional dysregulation and those with a known eating disorder. These individuals appear to have been most affected because of the high levels of stress and uncertainty caused by the pandemic and limitations imposed on them (Sideli et al., 2021). One of the most important limitations faced by children and young people was the immediate shift to online learning in schools, colleges and universities. Overnight, many children and young people were deprived of important support networks and contact with friends. This impact has also been seen in similar groups around the world but most obviously in higher income countries.

As health services around the world responded to new and significant challenges in delivering healthcare, many hospital appointments were cancelled or moved online. For some, this meant that opportunities for early intervention were missed and for others ongoing support was restricted and less effective. In the UK, referrals have increased as COVID-19 restrictions were lifted, with 10,000 children and young people starting interventions for eating disorders between April and December 2021 (Solmi et al., 2021). This is an increase of two-thirds since COVID-19 restrictions were in place.

A further complication is that many eating disorders and OSFED service users, including children, young people and adults, are being managed in physical health teams and settings. This is not the right environment because there is a danger that a lack of experienced mental health input could result in a further decline in an individual's mental health. As part of the NHS Implementation Plan in the UK, there will be an opportunity to review the current provision of mental health care outside mental health care settings and how such services are resourced (National Health Service, 2019). People needing support and intervention for eating disorders need specialised support from knowledgeable practitioners that might not always be available in general hospital settings.

The COVID-19 pandemic has resulted in an increase in eating disorders and OSFED around the world. As a consequence, there has also been an increase in critical and life-threatening illnesses in people with eating disorders in different clinical settings. It is, therefore, important that all nurses have an understanding of eating disorders, so they can provide the best care possible in any healthcare setting.

全文翻譯（僅供參考）

新冠肺炎大流行以不同方式影響了世界各地許多人的生活。大流行對(duì)延遲癌癥診斷和后續(xù)治療的影響已得到充分記錄，但大流行也對(duì)許多其他患者群體產(chǎn)生了重大影響，這些患者群體經(jīng)歷了各種各樣的改變生命和可能導(dǎo)致生命終結(jié)的疾病。在這篇社論中，重點(diǎn)將是大流行對(duì)飲食失調(diào)和其他特定飲食或飲食失調(diào)（OSFED）患者的影響。這對(duì)所有護(hù)士來說都是一個(gè)重要的問題，因?yàn)轱嬍呈д{(diào)目前是精神病患者死亡的主要原因。

飲食失調(diào)是一種可診斷的精神疾病，其特征是對(duì)食物的癡迷，要么吃得太少，要么吃太多?；加酗嬍痴系K的人通常會(huì)用食物作為對(duì)侵入性想法的回應(yīng)，這些想法可能與食物的大小和形狀有關(guān)，也可能與對(duì)某些類型食物的恐懼有關(guān)，例如碳水化合物或脂肪。有些人甚至可能會(huì)出現(xiàn)幻覺和與飲食失調(diào)相關(guān)的認(rèn)知功能下降。OSFED介于“正常飲食”和“飲食失調(diào)”之間，其特征可能是限制性飲食、暴飲暴食、不吃飯、避開食物組、使用減肥藥或?yàn)a藥以及自我誘導(dǎo)嘔吐等行為。OSFED飲食的后果可能與飲食失調(diào)一樣嚴(yán)重。飲食失調(diào)和OSFED會(huì)導(dǎo)致嚴(yán)重的、危及生命的身體和心理副作用，在很多情況下，還會(huì)導(dǎo)致死亡。

在新冠肺炎大流行期間和之后，飲食障礙和OSFED飲食的流行率大幅上升。這導(dǎo)致對(duì)精神衛(wèi)生保健、初級(jí)衛(wèi)生保健和綜合醫(yī)院服務(wù)中許多保健服務(wù)的需求增加。也許最大的挑戰(zhàn)是在心理健康之外，可能已經(jīng)嚴(yán)重缺乏對(duì)心理健康的關(guān)注，或者可能缺乏關(guān)于飲食失調(diào)的表現(xiàn)和管理的知識(shí)和經(jīng)驗(yàn)，或者缺乏支持飲食失調(diào)患者所需的溝通技能。急診室、急癥病房和兒科病房是非常繁忙的臨床區(qū)域的例子，在這些區(qū)域，對(duì)護(hù)士的多重需求、缺乏照顧飲食失調(diào)患者的知識(shí)和經(jīng)驗(yàn)以及缺乏資源可能會(huì)增加對(duì)護(hù)士的需求，并可能導(dǎo)致對(duì)尋求飲食失調(diào)支持的個(gè)人的護(hù)理不足（Rodgers等人，2020年）。

對(duì)于在醫(yī)院環(huán)境中如何支持患有飲食障礙的個(gè)人，需要改變想法。重要的是，所有護(hù)士都要了解飲食失調(diào)，以便能夠在需要時(shí)為越來越多需要這種支持的人提供適當(dāng)?shù)淖o(hù)理和支持。

為飲食失調(diào)患者提供的護(hù)理是高度專業(yè)化的，并利用獨(dú)特的知識(shí)和理解?；加酗嬍痴系K的個(gè)人可能需要對(duì)其食物攝入進(jìn)行仔細(xì)監(jiān)測(cè)，如果他們?cè)阱e(cuò)誤的環(huán)境中被照顧，或者由缺乏必要知識(shí)和經(jīng)驗(yàn)的護(hù)士照顧，這可能會(huì)帶來挑戰(zhàn)。患有飲食障礙的人如果對(duì)自己吃的食物感到內(nèi)疚，也可能會(huì)采取補(bǔ)償行為，如過度鍛煉、清洗或使用瀉藥。同樣，確保充分和準(zhǔn)確的監(jiān)測(cè)可能具有挑戰(zhàn)性。

熟悉照顧飲食失調(diào)患者的護(hù)士將意識(shí)到需要保持清晰一致的界限。在急性護(hù)理環(huán)境中，建立和維持這些界限可能很困難。在錯(cuò)誤的臨床領(lǐng)域或提供支持的人員缺乏知識(shí)和經(jīng)驗(yàn)的情況下，所有參與為飲食失調(diào)患者提供護(hù)理的人員（包括他們的家人）之間的清晰溝通也可能具有挑戰(zhàn)性。

不熟悉照顧飲食失調(diào)患者的護(hù)士可能會(huì)無意中使用不恰當(dāng)?shù)男g(shù)語(yǔ)，例如“你看起來更健康”，這可能會(huì)對(duì)未來的行為產(chǎn)生不利影響（Beat eating disorders，2022）。重要的是要記住，那些正在從飲食失調(diào)中恢復(fù)的人，正在不斷地與關(guān)于他們的攝入量、身體形象和自尊的侵?jǐn)_性思想作斗爭(zhēng)。醫(yī)療從業(yè)者的一個(gè)看似正面的評(píng)論可能會(huì)對(duì)相關(guān)個(gè)人產(chǎn)生負(fù)面影響。

如果在適當(dāng)?shù)呐R床環(huán)境中沒有知識(shí)和經(jīng)驗(yàn)豐富的支持，支持進(jìn)食障礙患者的努力可能不會(huì)像其他情況那樣有效。支持不足的后果可能是毀滅性的，包括嚴(yán)重的心理和身體健康并發(fā)癥，甚至死亡。因此，重要的是，所有護(hù)士，無論執(zhí)業(yè)領(lǐng)域如何，都要對(duì)飲食失調(diào)和OSFED有一定的了解和了解。這可以通過電子學(xué)習(xí)、內(nèi)部培訓(xùn)和年度更新來實(shí)現(xiàn)。護(hù)士們已經(jīng)熟悉多個(gè)年度培訓(xùn)活動(dòng)，但除了復(fù)蘇培訓(xùn)之外，其他年度培訓(xùn)不太可能對(duì)這么多人的生活產(chǎn)生積極影響。隨著需要這種支持的人數(shù)增加，確保各地護(hù)士具備所需知識(shí)和技能的必要性也隨之增加。

新冠肺炎大流行對(duì)日常生活的各個(gè)方面都產(chǎn)生了巨大影響，許多人不得不徹底改變他們的日常生活。對(duì)日常生活做出這種改變的影響不僅存在于患有心理健康疾病的人身上，也存在于那些沒有心理健康挑戰(zhàn)的人身，他們中的許多人在飲食方面采取了不適應(yīng)的應(yīng)對(duì)機(jī)制，試圖保持控制感。

在整個(gè)英國(guó)（UK），受影響最大的是兒童、年輕人、已經(jīng)經(jīng)歷情緒失調(diào)的人和已知飲食失調(diào)的人。這些人似乎受到了最嚴(yán)重的影響，因?yàn)榇罅餍泻蛯?duì)他們施加的限制造成了高度的壓力和不確定性（Sideli等人，2021）。兒童和年輕人面臨的最重要的限制之一是學(xué)校、學(xué)院和大學(xué)立即轉(zhuǎn)向在線學(xué)習(xí)。一夜之間，許多兒童和年輕人被剝奪了重要的支持網(wǎng)絡(luò)和與朋友的聯(lián)系。這種影響也見于世界各地的類似群體，但最明顯的是高收入國(guó)家。

隨著世界各地的醫(yī)療服務(wù)部門在提供醫(yī)療服務(wù)方面應(yīng)對(duì)新的重大挑戰(zhàn)，許多醫(yī)院預(yù)約被取消或在線轉(zhuǎn)移。對(duì)一些人來說，這意味著錯(cuò)過了早期干預(yù)的機(jī)會(huì)，而對(duì)其他人來說，持續(xù)的支持受到限制，效果較差。在英國(guó)，隨著新冠肺炎限制的解除，轉(zhuǎn)診人數(shù)增加，2021 4月至12月期間，有10000名兒童和年輕人開始對(duì)飲食障礙進(jìn)行干預(yù)（Solmi等人，2021）。自新冠肺炎限制實(shí)施以來，這一數(shù)字增加了三分之二。

更復(fù)雜的是，許多飲食失調(diào)和OSFED服務(wù)用戶，包括兒童、年輕人和成年人，都在身體健康團(tuán)隊(duì)和環(huán)境中進(jìn)行管理。這不是一個(gè)合適的環(huán)境，因?yàn)槿狈?jīng)驗(yàn)豐富的心理健康投入可能會(huì)導(dǎo)致個(gè)人心理健康進(jìn)一步下降。作為英國(guó)NHS實(shí)施計(jì)劃的一部分，將有機(jī)會(huì)審查目前在心理健康護(hù)理機(jī)構(gòu)之外提供的心理健康護(hù)理，以及這些服務(wù)的資源配置情況（國(guó)家健康服務(wù)局，2019年）。需要飲食失調(diào)支持和干預(yù)的人需要來自知識(shí)淵博的從業(yè)者的專業(yè)支持，而在普通醫(yī)院環(huán)境中，這可能并不總是可用的。

新冠肺炎大流行導(dǎo)致全世界飲食失調(diào)和OSFED的增加。因此，在不同的臨床環(huán)境中，患有飲食障礙的人中，危重和危及生命的疾病也有所增加。因此，重要的是，所有護(hù)士都要了解飲食失調(diào)，這樣他們才能在任何醫(yī)療環(huán)境中提供最好的護(hù)理。

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