Research on the health consequences of criminal legal system contact has increasingly looked beyond imprisonment to understand how more routine forms of surveillance and punishment shape wellbeing. One of these sites is probation, the largest form of supervision in the U.S. Drawing on an interview study with 162 adults on probation in Hennepin County, MN, in 2019, we map how adults on probation understand the consequences of supervision for their health and how these self-reported health changes correlate with individual, social, and structural circumstances.Roughly half of participants described their health as having improved since starting probation, while the remainder were split between no change and worsened health. Examining both closed-ended survey questions and open-ended interview prompts, we find that the “gains” of supervision were correlated with substance use treatment (often mandated), reduced drug and alcohol use, increased housing and food security, and perceptions of support from their probation officer. However, these potentially health-promoting mechanisms were attenuated for many participants by the significant “pains” of supervision, including the threat of revocation, which sometimes impacted mental health. In addition, participants in the most precarious circumstances were often unable to meet the demands of supervision, resulting in further punishment.Moving beyond the “pains” and “gains” framework, we argue that this analysis provides empirical evidence for the importance of moving social services outside of punishing criminal legal system interventions. People with criminal legal contact often come from deeply marginalized socio-economic contexts and are then expected to meet the rigorous demands of supervision with little state aid for redressing structural barriers. Access to essential services, including healthcare, food, and housing, without the threat of further criminal legal sanctions, can better prevent and respond to many of the behaviors that are currently criminalized in the U.S. legal system, including substance use. Over the past two decades, scholars, policymakers, and the public have become increasingly aware of the harms of mass incarceration. Confinement in penal facilities is associated with a host of long-term impacts, including housing, employment, and family difficulties , but also imposes substantial “pains,” including material and psychological burdens  and mental health treatment programs, and avoiding contact with police and individuals with felonies  substance use treatment programs, mental health treatment, housing assistance, and employment resources McNeill, . As PhelAs a central location of both punishment and aid, probation has significant public health consequences. Yet scholars have focused most of their attention on the health consequences of imprisonment rather than probation or community supervision. Several recent papers address this gap, using the National Survey of Drug Use and Health (NSDUH), a national survey of the household population in the U.S. These studies find that adults who report being on probation in the past year are significantly more likely to experience a higher burden of chronic health conditions, mental health conditions, physical and cognitive disabilities, comorbid health conditions, substance use disorders, and greater levels of risk for serious illness or death from COVID-19, compared to the age-adjusted general population  employment, and avoid drug and alcohol use, supervision may provide coercive motivation to ameliorate living conditions that improve health. Perhaps most importantly, case management services through probation can connect adults on probation to services, programs, and government assistance. Adopting the risk-need-responsivity (RNR) model, many community corrections departments use risk-needs assessment tools to assess the kinds of assistance that might be helpful in reducing the risk of recidivism . As described in more detail below, our final sample includes 162 adults on probation, with varied backgrounds and experiences. Participants were compensated for their time with a $40 honorarium and told that participating (or not participating) in the study would have no impact on their supervision. The interviewers also made clear that participants’ identities would be kept confidential and that nothing shared in the interview would be relayed back to their PO.2Interviews were conducted by a team of undergraduate and graduate student research assistants (diverse across race/ethnicity and gender) who went through extensive training regarding confidentiality and consent, interview protocols, and data storage rules.Our analysis centers responses to the following question: “How do you think your current health compares to your health before you started probation?” with the response options: “Health is better now,” “Health is about the same,” and “Health was better before probation.” After the participant selected one of the options, the interviewer provided an open-ended qualitative prompt: “Please explain why you believe your health improved / worsened / stayed the same.” Out of a total of 166 participants who participated in the study, four participants did not answer this question. Therefore, we limit all analyses presented in this paper to the 162 participants with data on this question. Quantitative and qualitative analyses were completed simultaneously in a convergent mixed methods analysis  to indicate that there is a meaningful correlation between the two variables. For the key outcomes, we use stacked bar charts to visualize these correlations. Given the descriptive  nature of our study, and the fact that many of our variables are strongly correlated , we do not correct the p-value for multiple comparisons. Instead, we use significant results in an exploratory manner to highlight potential linkages between individual, social, and structural forces and individuals’ health.For the quantitative analyses (conducted in STATA 14), we examined the correlations between the health change variable and a range of other measures from the study, including demographic variables , health and healthcare-related variables , material stability , and experiences on probation . More detailed information about the quantitative variables included in the analysis can be found in For the qualitative analysis (conducted in NVivo 12), we followed Deterding and Waters’  flexibleThe findings section proceeds in four parts. First, we outline the demographic characteristics of our sample, variation in our key outcome variable , and relationships between demographic variables and the health. Next, we consider the three themes or central pathways that emerged from our analysis: health, health-related behaviors, and healthcare services; material stability; and supervision demands and relationships with POs. Although all three of these themes overlapped in participants’ lives, for analytical clarity, we describe each separately.Table p < .001) and aggregate physical health (p < .001) scores on the Short-Form Health Survey (SF-12), a validated measure of overall self-reported health . As displayed in Fig. p < .05); Among participants who reported participating in substance use treatment since starting probation, 62% reported improved health, compared to 40% among those who had not participated.One of the most consistent correlates of health across our sample, in both the quantitative and qualitative results, was sobriety, previous problems with drug and alcohol use, and substance use treatment. The majority of our sample reported a history of substance use problems (74%), which was associated with health changes during probation (p < .01). Similarly, as displayed in Fig. p < .05).Probation was also associated with a substantial reduction in substance use. In the 6 months leading to their arrest for their current term on probation, frequent illicit drug use (defined as twice a month or more) was reported by 51% of our sample for marijuana, 19% for cocaine/crack, 21% for methamphetamines, 11% for heroin, and 10% for prescription opioid misuse. In addition, 25% of participants reported drinking alcohol daily in the 6 months leading to their arrest. Rates of illicit drug use at the time of the interview were substantially lower, with more than half (64%) of the sample reporting zero use. By that point, only 15% reported frequent marijuana use; 12% frequent cocaine/crack, methamphetamine, heroin, or other opioid use; and only 2 participants reported daily alcohol use. Sobriety was associated with better health and, conversely, current substance use was associated with worse health. For example, participants who reported drinking any alcohol at the time of the interview were more than twice as likely to report worsening health, compared to those not drinking . Among people with a history of mental health diagnoses, 59% reported improved health, compared to 44% of those without such a diagnosis. However, people with a mental health diagnosis were also somewhat more likely to report worsening health (22% vs. 13%), suggesting a bi-modal distribution. Over half of participants (66%) had seen a mental health professional since starting probation, though having had these visits was not significantly associated with health outcomes. Most of our participants (68%) also had a history of chronic physical health conditions, including diabetes, high blood pressure, or asthma, and had seen a doctor since starting probation (85%). Yet having received physical health diagnoses in the past was not reliably correlated with improved or worsened health, nor was receiving medical care  since starting probation. Finally, somewhat surprisingly, whether or not participants consistently had health insurance coverage over the past year was not significantly correlated with improved or worsened health.In the quantitative results, other health-related characteristics mattered less than substance use and treatment for health outcomes during probation, but similarly documented the stark needs facing adults on supervision. At some point in their lives, most participants (71%) had been diagnosed with a mental health condition, a history associated with health outcomes  was the reduction in substance use we saw in the quantitative results. Sobriety was often, though not always, mentioned in conjunction with attending substance use treatment programs. In addition, most participants were subjected to random drug tests . Forced by the court and/or probation to end (or reduce) their substance use, many participants found themselves embracing other positive health behaviors. Leonard, a 52-year-old white man who started substance use treatment after beginning probation, told us how his new-found sobriety allowed him to meet basic needs:For Leonard, sobriety was tied to a bundle of changes in his ability to care for his body and mind, including a safe place to sleep.Like Leonard, many other participants credited substance use treatment and their new sobriety with improved health. Jessica, a 26-year-old white woman, had been struggling with substance use for years, with several convictions to prove it. She described: “I was an IV heroin and meth user, so my life was centered around my drugs … my health was not important and definitely wasn’t a priority like it is now … I was almost destroying myself.” Jessica was mandated to substance use treatment while on this term of probation, and felt that it was helpful: “I did and I do have a substance abuse issue, so treatment has helped me kind of get my life back together and have some, you know, structure.” Jessica reported that she is now scheduling health appointments and making her wellbeing a priority, which she attributed to her sobriety. Since the time of her arrest, Jessica had seen a healthcare professional a few times a week and accessed a variety of different health services. As a result, Jessica described her health as having improved since starting probation.For some participants, this new access to care included addressing long-standing health concerns, including depression and anxiety. Donna, a 43-year-old Black woman, attributed much of her recent strides towards good health to substance use treatment and counseling. While Donna had experienced many previous encounters with the criminal legal system, this was the first time she had been offered treatment. Donna was mandated to dual-diagnosis treatment to address her substance use and mental health conditions, which entailed attending substance use treatment programming, a trauma group, psychiatric care, and therapy. This was a pivotal experience for Donna, allowing her to address a lifetime of trauma and learn coping mechanisms: “I’m learning how to deal with it and talking about it versus not talking about it and doing drugs. It’s hard but it’s something I can do.” After years of criminal legal system contact, accessing treatment allowed Donna to address the causes of her substance use and gave her the support she needed to “want to change my life.” Additionally, after getting on Medicaid, Donna was able to supplement the health gains she made through treatment by accessing other healthcare services, including primary care and dental services.300 , declaring: “It’s like being on the front line of a hand-to-hand combat with swords and you know I gotta constantly be on guard.” Other respondents described how they had gotten sober in the past, only to relapse on substances. Marcus, a 27-year-old Black man, described how he had continued to have relapses with his substance use, which he characterized as an on-and-off cycle: “I try to be sober, it’s not like I don’t make an effort to be. I just continue to have relapses.” Like many others, Marcus was mandated to attend substance use treatment, but he was kicked out of this program after getting sober . As a result, Marcus lost his housing (which treatment was paying for), destabilizing his progress and precipitating another stint in jail. As Marcus recounted:“I lost my housing, and was back out on the street, so I just said fuck it and I got high for like five days… I got so high, and I came down, and I just couldn't get up to his office. It was just a bad deal. And I didn't know he wanted me to go, I had no phone. I knew I was in trouble, so I just didn't go check in at all for a couple weeks. And then I got picked up and that was it. So I was in jail for like 20 days.”This was one of many attempts at sobriety Marcus had made on probation and during previous stints in prison, each of which was eventually derailed.These gains, however, were hard-won and vulnerable to disruption. Leonard, for instance, still struggled with a desire for substances, describing staying drug-free as the most difficult part of supervision and calling it a “vicious battle.” Leonard compared “staying clean” with the movie For people like Marcus, testing and treatment mandates did not always produce sobriety—and, at times, could prompt worsening health. Among the 33 participants who reported worsening health since starting probation, answers to the open-ended “Why?” question again often invoked substance use, this time to say that continued use and the strains of supervision were negatively impacting their health. For example, Marcus described in detail how routine drug tests and treatment “have not been effective” in helping him manage his addiction and the costs of conviction and supervision on his wellbeing: “I used to exercise all the time. Like I said, I had my own shit and my own place, you know what I mean? I had my car, I had my shit, I had money, I had fucking whatever. I used to exercise all the time… all the time.” Now, Marcus continued, “I just haven’t had shit… it’s hard to stay in shape and I’m still doing drugs sometimes.” Marcus said he has not been able to stay drug and alcohol-free while on probation; he considered both supervision and his drug addiction to be significant barriers to his wellbeing.“When I was actively using drugs, I wasn't feeling the pain … Soon as I sobered up and went into recovery again, is when my symptoms start showing up more … when I was high, I could move around, I wasn't feeling the pain … So … it feels worse.”Probation had coerced Martin to get sober, but had not helped him address the chronic health condition underlying the drug use. Other participants also described how their fear of a positive drug test led to negative compensatory behavior, including drinking alcohol more frequently and smoking cigarettes. This was particularly true for people who previously used marijuana to self-medicate.For a small number of participants, coerced sobriety had worsened their health by removing a coping mechanism, including pain management and emotional regulation. Martin, a 51-year-old white man with an extensive list of health conditions, including a chronic pain condition, told us that although he had gotten sober, he felt his health had gotten worse as a result of not being able to self-medicate:In sum, participants who accessed healthcare, especially substance use treatment, and were able to change their health behaviors, experienced improved health on supervision. These gains were often attributed to supervision indirectly rather than directly—by mandating sobriety and referrals to services, probation provided coercive motivation to address this health issue. But the meaning of substance use (and abstinence) varied across participants, from a “risky” health behavior and potential criminal offense to a coping mechanism and/or treatment for a medical condition. As a result, for some participants (roughly 1 in 5), their health had worsened while on probation. In addition, as we describe below, participants without a minimum level of stability could not expect to complete treatment and probation requirements, putting them at risk of compounding punishment through revocation.As seen in the cases described above, sobriety and improved health was often connected to increased material security, including safe housing and access to healthy food, while precarity was associated with substance use and worsening health. Our sample faced substantial material insecurity, often despite the receipt of state aid. The majority of participants were not employed (61%), with just under half (46%) receiving public benefits . Nearly half (43%) reported that it was “slightly” to “very” difficult to provide themselves with food, a broad measure of food insecurity.p < .05). In addition, there was a strong coupling between housing status and health (p < .01). Only 9% of those with insecure housing reported improved health, a share drastically lower than the sample mean. In contrast, the highest percent of respondents reporting improved health (72%) was among participants living in supportive housing, followed by those living with friends, relatives, or partners (50%) and those living independently (46%).The social determinants of health framework posits that individuals’ health and wellbeing are tied to structural inequalities, including economic opportunities and the built environment. Among our participants, employment status and receipt of public assistance programs, however, were not significantly associated with differences in self-reported health. In contrast, food insecurity—perhaps a clearer measure of ongoing economic need—was strongly associated with participants’ perceptions. As displayed in Fig. Looking in more detail at respondents in supportive housing, most participants were living in in-patient drug treatment programs, sober living houses, and half-way homes. Most participants stated that they had received “support finding or obtaining” this housing. Some participants had been mandated to these facilities  or found housing through assistance from their PO, while in other cases, participants accessed housing through a social worker or referrals from treatment programs or jail and with support from government programs. As a result, the transition to probation was associated with a substantial reduction in experiencing homelessness: whereas a fifth of our sample was living on the streets, in hotels/motels, or “moving around a lot” at the time of arrest, only 7% were living insecurely at the time of the interview. More broadly, a quarter of our participants reported that their PO had helped connect them to assistance programs like housing vouchers, food stamps, and/or disability aid.Jasmine: “I don't want to say I was malnourished, but I definitely wasn't eating the way I was supposed to because I was homeless, like I was losing a lot of weight.”Interviewer: “So you see yourself eating better now that you have housing?”Jasmine: “Yeah.”Although Jasmine still faced many problems, including extremely low income and multiple chronic health conditions, housing had a large impact on improving her health overall.In the qualitative responses to “Why?” their health had improved, stayed the same, or worsened, participants often connected their material stability  with their current health. As described above, these discussions were often tied to sobriety or substance use. As Owen, a 29-year-old biracial man who was living at a sober living house, noted: “When you’re on the streets you worry about life; where your next meal going to come from, where you’re going to sleep at, especially if it rains or snows, you know the weather up here. Now I ain’t got to worry about that, I got a place to lay my head, eat, shower, everything.” Similarly, Jasmine, a 21-year-old Native and African American woman, felt that obtaining housing was vital in helping meet her basic needs (including food insecurity) and improve her health:Jasmine’s story also illustrates how mandates to treatment and coerced sobriety could backfire when people lack material stability. Jasmine was required to call in daily to learn whether she would be expected to come in for a drug test that day. Before finding the housing described above, Jasmine was living on the streets and did not have a phone so was not able to call in. Because of this, she missed UAs, which were counted as positive, which resulted in a probation violation. As a consequence, Jasmine was mandated to undergo substance use treatment. Despite feeling like she didn’t need treatment (the only substance she reported using was marijuana and Jasmine did not identify that use as a problem), Jasmine felt that this out-patient treatment program was helpful because they had food shelves and free clothing. However, Jasmine stopped attending this program in winter, when waiting for public transportation in extreme winter temperatures without an appropriate jacket became untenable. As a result, she was kicked out of the program and faced another violation. At the time of our interview, Jasmine had found housing through a voucher program and was awaiting a chemical dependency assessment. Without addressing the material instability that Jasmine faced, mandated treatment requirements were not sustainable.“I can't get a freaking job because of my probation and my criminal background … I don't have my own living situation anymore after years of my own living situation. I'm more broke … and then there's just like too much stress that's affecting everything … It's just all added up, and I don't have one area of my life where I really have freedom or like happiness associated with it because it's just like so much that I can't do.”For Jennifer, who had some stability before the arrest, her criminal conviction and probation sentence had prompted significant downward mobility, which in turn worsened her health.On the other end, for participants who had some measure of material security before probation, their arrest, conviction, and supervision could set off a cascade of consequences that worsened health. While most participants had very little income at the time of arrest, roughly 1 in 10 held a job with benefits. For these participants, their arrest, conviction, and supervision could trigger and/or exacerbate a downward spiral. Jennifer, a 36-year-old white woman, was a teacher before her arrest and lived in her own place. She had recently lost her father and was in an abusive relationship with a man with whom she had two children. Jennifer told us this boyfriend had PTSD from time in the military and had tried to kill her during one fight. By the time of the interview, Jennifer had been arrested and convicted of disorderly conduct . The arrest, legal processing, and transition onto probation led Jennifer to lose her job, eventually moving in with her mother. She noted that she had multiple health conditions  that had worsened since starting probation, and when asked why, expressed how her struggles to find both employment and housing with a criminal record impacted her:In addition, in-patient treatment programs, sober houses, and living with friends and relatives, were often temporary solutions to long-term problems. For example, Owen, the 29-year-old biracial man who above described the benefits of living at a sober living house, described the facility as “unsanitary” and stated that the neighborhood was an unsafe place to live. Owen also expressed concerns about having a roommate who drank heavily and was looking to get transferred as a result of these difficulties. At some point, people had to leave these contexts and find independent housing, often with little support and facing steep barriers, including housing discrimination against people with records and limited affordable housing in the metro area , the department had its own set of policies, including things like standard probation conditions and rules about how to identify which cases merited more intense supervision. In this final section, we turn to how participants described their relationships with POs and the conditions of supervision more broadly to unpack the relationships between these demands and self-reported health.p < .01). As displayed in Fig. p < .01), with 70% of participants who reported that probation had been “very helpful” reporting better health, compared to 37% of those who reported that probation had been “not at all” helpful. Notably, just over half of participants (55%) reported that their PO had asked about their health, an interaction that was associated with improved self-reported health (p < .001). A smaller share (16%) reported that their PO had helped connect them to health services, which similarly was associated with a higher likelihood of improved health (p < .05).We turn first to a battery of questions about participants’ perceptions of their POs. The vast majority (90%) of participants agreed that “My PO treats me fairly,” while 75% agreed with the statement “I receive support from my PO when I need it.” Respondents with more positive evaluations on both of these relationship indicators were more likely to say their health had improved since starting probation . As displayed in Fig. p < .05). Across our sample, 8% were not required to report regularly, 65% checked in once a month or less, 16% twice per month, and 10% once a week. As displayed in Fig. p < .0001); Those who rated it as “difficult” or “very difficult” to avoid a probation violation since starting probation were significantly more likely to agree that probation was stressful, while those who found it “not at all difficult” or “slightly difficult” to avoid violations were much more likely to disagree that probation had been stressful. In addition, these perceptions of the difficulty of avoiding violations and the stressfulness of probation were correlated with continued illicit substance use (p < .01).For some participants, these costs of supervision outweighed the benefits. More than half (57%) of participants agreed or strongly agreed with the statement “My experience of being on probation had been stressful.” These respondents were less likely to see health improve and more likely to see health declines  as being “held to a standard I can’t meet.” Similar to Ethan, Jessica reported that her mental health conditions had been exacerbated by probation: “There’s a lot of obligations to fulfill and things to do for drug court …I have a lot of anxiety just, you know, wanting to do good or do better and not let my probation officer down, cause they’re pretty strict.” She also mentioned that her anxiety has worsened due to a constant fear of revocation, which was the most difficult part of probation for her. Even though probation helped connect her with a healthcare provider, supportive housing, and substance use treatment, those benefits were tempered by stringent probation conditions, lofty expectations, and the constant threat of revocation, which drastically impacted Jessica’s quality of life and mental wellbeing. As Jessica described, “if you like miss a UA because you’re sick or something like that it’s like BOOM they can put you in custody.” Despite maintaining her sobriety, Jessica had recently faced a punishment of extra community service days after testing positive for marijuana three times, a result of her use of CBD oil she thought was legal for her to use, an error revealed to her only when her PO brought her in front of a judge for a violation hearing.Jessica’s ambivalence about supervision was common across our sample, with a majority reporting that supervision was both “helpful” and “stressful.” Where people benefited from supervision, it was as often less about the actual demands and “care” of supervision than it was about the services and resources their PO helped them to access. These resources, whether it be substance use treatment programs or housing assistance, allowed participants to begin to address the many barriers they faced to thriving in the community. In contrast, the harms of supervision for health came predominantly from supervision itself—and, more specifically, the threat of revocation. As Ethan aptly summarized: “I’m always worried about my freedom.” In addition, these costs were often born by people in deeply precarious socio-economic contexts, for whom probation was just one of many negative encounters with state authorities.In this article, we used an interview study with 162 adults on probation in Hennepin County in 2019 to ask: (1) How do adults on probation report their health has changed since starting probation? (2) What are the social and structural factors or mechanisms associated with improved or worsened health on probation? We found that roughly half of our participants described their health as improving since starting probation, with the other half split between no change and worsening health. Exploring the relationship between this health status change and individuals’ life circumstances quantitatively, we find that there were few statistically significant correlations between demographic characteristics  and self-reported health improvements. However, people with a history of substance use issues were more likely to report improved health, in large part mediated by access to treatment while on supervision. We also find strong associations between improved health and food security and supportive housing. Finally, participants who had more trusting and supportive relationships with their probation officers, and experienced supervision as less stressful, were more likely to report improved health. Conversely, those with poor relationships and greater stress from supervision were more likely to see their health deteriorate.Turning to the qualitative results from open-ended prompts, we find that when asked “why” their health had improved or deteriorated, participants often spoke of substance use treatment and sobriety, on the one hand, and stress from the fear of revocation, on the other. Sobriety or drug/alcohol use was rarely experienced in isolation–instead, struggles around substances were tied to other forms of precarity (including housing and food insecurity) and health challenges . This dominance of substance use talk among our sample is perhaps not surprising in a context where the majority of people on probation in the county had struggled with drug and alcohol use disorders . In addition, while we asked participants retrospective questions, the study was not longitudinal, preventing long-term follow-up and an opportunity to see how health changed prospectively over the period of probation. The most significant health impacts of probation may be long-term and/or concentrated amongst the people who fail on probation and wind up behind bars instead of in the community, dynamics we hope other scholars investigate. Nor was our study designed to disentangle the likely bi-directional relationships between health and supervision  or to provide causal impacts of probation on wellbeing. By centering the lived experiences of people on supervision, however, we have shown how any causal relationships between probation and health are likely to be difficult to estimate given the multiple and contradictory pathways.This paper also complements the growing body of literature on the experience of supervision by focusing attention on the potential health-related impacts of supervision. Consistent with Phelps and Ruhland , we findEvaluating the high mortality risk faced by adults on probation, Wildeman et al.  concludeoutside of the criminal legal system that mattered most. And yet, people understood that they had to put up with the coercion of the state in order to receive  assistance with basic needs like food, housing, and healthcare. Further, these services were often fragmented (Smith et al., Indeed, to the extent that participants found probation “helpful,” it was often the help In the context of the COVID-19 pandemic and the policy changes that emerged to respond to the risk of the virus, some of these changes perhaps seem easier to imagine. The pandemic substantially altered the experience of community supervision, prompting many departments to radically reduce in-person visits, drug testing, and revocations in an attempt to slow viral spread Kaeble, . In this


Anorexia nervosa is a paradoxical disorder, regarded across disciplines as a body project and yet also an illness of disembodied subjectivity. This overlooks the role that material environments—including objects and spaces—play in producing embodied experiences of anorexia both within and outside treatment. To address this gap, this paper draws together two ethnographic studies of anorexia to explore the shared themes unearthed by research participants’ engagements with objects that move across boundaries between treatment spaces and everyday lives. Demonstrating how the anorexic body is at once both phenomenologically lived and socio-medically constituted, we argue that an attention to materiality is crucial to understanding lived experiences. A materialist account of anorexia extends the literature on treatment resistance in eating disorders and offers a reconceptualisation of ‘the body in treatment’, showing how  objects and spaces shape, maintain, and even ‘trigger’ anorexia. Therefore, against the background of the high rates of relapse in eating disorders, this analysis calls for consideration of how interventions can better take account of eating disordered embodiment as shaped by material environments. Anorexia nervosa is a seemingly paradoxical disorder, framed in both sociological and clinical discussions as a body project and yet also as an ethereal illness of subjectivity. Across the many disciplines that engage with anorexia—psychiatry, psychology, sociology, anthropology, history, philosophy and neuroscience, among others—reflections on meaning, subjectivity and embodiment have tended to hinge upon the emaciated body. This has been held up as the focal ‘object’ of analysis as well as assumed to be the locus of desires and practices in anorexia.Yet, such a reification of emaciation as a ‘synecdoche’ of anorexia  and the UK (Lavis:2007–2008), the authors explore the materialities of anorexia by focusing on five objects that were, each in a different way, described by participants as core to their everyday experiences of anorexia: a photo album; a chair; a television set; biscuits; and paperback memoirs of anorexia. The authors decided to examine their datasets together due to this resonance of material objects in their respective field sites. Through discussing the role of materiality in their fieldwork observations, the authors recognised that, while different material objects emerged as prominent in each field site, reflecting local structures, practices, and concerns, when brought together, these objects spoke of broader experiences of anorexia as forged at the intersections of treatment and everyday life. As such, the authors recognised that analysing their data jointly could shed new light on anorexic embodiment.Positioning this analysis of anorexic embodiment both in and out of treatment is argued to be crucial to understanding lived experiences. In Israel and the UK, where the authors conducted their fieldwork, living with a diagnosis of anorexia almost always involves living with outpatient or inpatient treatment, however desired or resisted. This is due both to the local nationalised healthcare systems, and to the position of anorexia within these systems, i.e., as the eating disorder considered most pressing, due to the significant medical complications of starvation  were part of Eli’s doctoral research. The study, which has been described in detail elsewhere Eli , focusedThe ethnography from the English eating disorders inpatient unit (2007–2008) derives from Lavis’ doctoral research. 45 patients took part in the ethnography. Forty staff members also participated in the study; however, this paper does not refer to the data collected through interviews with or observations of staff members. From both groups, informed written consent to ‘hang around’ as an ethnographer was gained, as well as additional informed written consent for each interview. The focus of this research was to explore everyday experiences of anorexia and, specifically, to interrogate the desire amongst some individuals with anorexia to maintain their existing illness. Thematic analysis  self, growing to ‘contain multitudes’ Whitman .Grace had a photo album dedicated to her life on the ward. She began to take photographs three months after she was hospitalized, keeping a detailed record of the people, spaces, and objects that marked her stay. A typical stay in inpatient care entailed weeks or months of living in the ward. Patients who showed progress were allowed to go home for weekends or to spend a weekday afternoon away; for the most part, however, inpatient stays involved continuous living in the ward’s enclosed space, with the occasional supervised excursion to the ward’s front yard, or a guided walk at night to a nearby landmark. Life on the ward was marked by the strict schedules and regimens of diet and activity prescribed by the senior clinicians, under the observation of nursing staff.Early on during Eli’s fieldwork, and following several interview hours, Grace offered to show her the photo album—the object that materialized Grace’s stories about the eating disorders ward, providing a visible and tangible illustration of what she had described. This object served as Eli’s initiation into the ward, which, at that point, she had not yet visited. Guiding Eli through the album, Grace filled in the relational gaps in her photographs: identifying roommates, best friends, and favourite members of staff, telling Eli who had since given birth, and who was no longer in touch. Grace photographed and narrated the ward with a loving inflection, and as she turned the pages—in her kitchen, years after she had been discharged—she did so with a tinge of nostalgia. “It’s fun, nice, a sweet memory”, she reflected; “but I don’t miss it anymore… I used to miss it so much”.Grace’s photographs and stories, while positive, continued to highlight experiential moments that designated the ward as a space of surveillance and resistance: there was the common room , where patients were watched for two hours after every meal; there was the bathroom, where patients were followed by nurses, who stood watch; and there was Grace’s room, with her suitcase perpetually packed. “I was always with one foot out”, she explained. This image, however, did not conflict with her story of saying lingering goodbyes, on her last day at the ward, having been discharged but feeling unable to leave.a little lab like that, that you could be inside…. A lab in the sense that it was very sterile, it was – very very exact and measured conditions, and – you knew that you, it’s not like the real world, so it eased [our burden].2The ward, as it emerged in Grace’s account, was a haven. “It was,” she said,what is she in for? For bulimia. Okay, great”. Grace and Eli then began laughing, and Grace said that clarifying what each patient was ‘in for’ was part of every new arrival. The ward may have been a haven—a space away from “the real world”—but Grace kept records that testified to the authoritatively structured, carefully surveyed grids of sociality that the ward entailed. Her photo album, then, evoked ambivalence across time: both the ambivalence she had experienced as an inpatient, years ago, and the ambivalence she experienced in the present tense, when recollecting, narrating, and making sense of her past patienthood. Leafing and talking through the album’s pages, Grace opened up the co-existing tension and wistfulness she associated with her inpatient experiences, communicating her still-ambivalent relationship with the anorexic identity forged on the ward.But the ward, as Grace later explained, was also a prison. As she went through the album, and Eli observed that Grace had parenthetically noted the diagnosis of each fellow patient she had photographed, she explained that “it was so I’d remember”. Eli asked her why, and she said, her voice somewhat tense, “I defined the disease [each patient] was in, and she also didn’t have a problem defining the disease she got, it’s not—I didn’t define it judgmentally or divisively, I wrote it in the sense of noting a fact. She got in—Eli visited the ward for the first time in the summer of 2006, several months after being introduced to the eating disorders ward, and the ambivalence therein, through Grace’s photo album. Sara, a participant with whom Eli had been in contact since her fieldwork began, entered the ward as an inpatient, and Eli visited her regularly. Through these visits, she witnessed Sara’s everyday enactments of compliance and resistance. When Eli first visited, she met Sara in the common room, where most patients congregated (with or without visitors), and where the main features were a flat-screen television, a few desktop computers, and many upholstered chairs. With the guard at the door—a clinical social work or nursing student—keeping watch, patients  were engaged in the task of sitting still. It was the two-hour surveillance window after the patients’ mid-afternoon snack, and Sara, like other patients classified as anorexic, was not allowed to move around. Although the chair might have seemed incidental to Sara’s actions, it was, in fact, a crucial actor in the scene that unfolded. In the common room, the chair was transformed from a piece of furniture into a clinical object, used to confine Sara’s rebelling body after each meal. In conversation with Eli and her aunt, observed by the watchful guard, Sara made sure to stay seated. Occasionally, however, she pretended to yawn, stretching her arms at length while keeping her torso firmly within the confines of the chair. Each furtive stretch ended with an exchange of knowing smiles; she and Eli were acknowledging the resistance embodied in each subtle, and forbidden, stretch. But Sara complied with the rules, otherwise—eating every meal, drinking water only when allowed, and honouring her clinicians’ trust when they sent her for an afternoon away with the instruction to eat an ice cream bar (which she did).Sara’s resistance also took on less obvious shapes and targets. During a later visit, when Sara and Eli were engaged in conversation, another patient announced excitedly that her sister had just texted her to say that ‘Hunger Point’ Silver,  was beinall anorexic. Through mundane objects in the ward’s common room, Sara expressed a dual resistance: small subversions of the treatment regime, embodied in shifting and stretching on a chair meant to confine her movements after meals, alongside protests against fellow patients’ performances of eating disorders, embodied in switching off the television set where they played eating disordered media. With this dual resistance, Sara was continuously engaged in maintaining a fine balance—reasserting her anorexic self, while not losing herself to the patient group, and by extension, to anorexia.Sara’s resistance was directed at more than avoiding the triggering effects of anorexic talk and pro-anorexic images. On the ward, other patients were never fully ‘other’; ward life blurred the boundaries of selfhood, creating images of oneself—past, present, and future—that had equal power to inspire and to horrify Eli . As suchRather than highlighting the so-called pathology of the anorexic body or self, the engagements with materialities discussed so far have emplaced anorexic embodiment both within and beyond the logics of everyday clinical contexts, at intersections where illness and identity are continuously negotiated, parsing out relationships between self, others, objects, and spaces. Running through the participants’ narratives and practices are the constitutive elements of biomedical power in generating and reinforcing anorexic modes of being-in-the-world, whilst also showing the affordances of objects and spaces to disrupt these. Anorexia, thus, has emerged here as not simply the manifestation of a pathologized relationship between a person and her body but as shaped by material environments.Anorexic embodiment, then, is seen to be constantly created and recreated through engagements with multiple subjects and objects. The two vignettes so far have shown that it is through the relationships among the self, clinicians, other patients, as well as the spaces and material culture of the ward, that anorexic embodiment is lived, remembered, and defined. Exploring materialities has thereby begun to offer insights into anorexic embodiment as a continual process of drawing and redrawing relationships between illness, corporeality and subjectivity; it is these intersections that will now be drawn to the fore through Lavis’ analyses.Taking up the interrelated strands of ambivalence and resistance introduced by Eli’s explorations of the material dynamics of lived experiences of eating disorders treatment, and the porous boundaries of selfhood that these illuminate, Lavis now interrogates two objects that were framed by participants as core to their experiences of treatment and  to anorexia more widely: anorexia memoirs and food—in this case, biscuits. Woven through life within the Eating Disorders Unit (EDU) and beyond it, these emerge as at once utterly mundane and yet clinical, with their material exchange between spaces transacting and disrupting multiple meanings at once. Just as the objects that Eli discussed accrete into autobiographical reference points, biscuits and memoirs draw clinical spaces and categories into the forging of anorexic embodiment in ways that speak of the continual effort it involves both with and beyond treatment.In the English Eating Disorders Unit (EDU), it was during quiet moments in the patients’ lounge, as well as the fraught mealtimes of the dining room, that participants’ complex relationships with, and embodiment of, anorexia were made, articulated, and rendered visible. In relation to the very structures of the EDU’s spaces and times, various aspects of these relationships came to the fore or receded, and one moment at which this was most apparent was during the enforced ‘rest periods’ after mealtimes.the treatment for anorexia, thereby framing anorexia primarily as both in and about the body  nothing else at all. Whilst at home for the weekend she would always walk to the same Starbucks, a mile or so from her home, and order the same latte and small pre-sealed packet of biscuits. She would then sit with these for two hours, sipping and nibbling, slowly feeling her anorexia, as she put it, “rise up around [her]”. The mechanics of this rising are intriguing; Hadia described how the biscuits—as intermingled signifiers of both the agency of choosing and paying for food herself  and the messy materiality of butter and sugar—were utterly terrifying. By sitting in Starbucks every week Hadia drew too close to food to be comfortable, thereby echoing discussion above of participants’ experiences of the threat posed by food in the EDU. Yet, this discomfort played an important role in Hadia’s anorexic embodiment, or rather perhaps, her active embodiment of anorexia. She intentionally incited her terror of food precisely because, in leading her to fear for her anorexia, it ‘triggered’ an upsurge of the illness; it made, she felt, her anorexia stronger. In her adherence to the same latte and biscuits each week, Hadia mobilised anorexia in order to hold on to it, creating a “safe space” carved through the illness. As such, her biscuits might appear at first glance to transfer her treatment regimen to the home spaces of weekend leave, adhering to the rules of the EDU and honouring her clinicians’ trust, as Eli put it. Yet, through them Hadia resisted their clinical conceptualisations of anorexia and selfhood. She felt these moments in Starbucks to release her anorexia from the grip of the EDU, thereby symbolically also shifting herself from that unwanted enclosed space to the other space offered, perhaps ambivalently, by anorexia; biscuits afforded Hadia a modality of “stepping out” of clinical conceptualisations and spaces. This echoes Kate’s reading of memoirs, which created what she felt to be an “anorexic space” within the space of the EDU, carving her own sense of everyday embodiment into the fabric of the patients’ lounge. Extending that discussion -  that food emerges here as an object through which anorexia may be maintained both goes against habitual understandings of the illness and yet is also clearly shaped by Hadia’s experiences of treatment. The biscuits were imbued with multiple meanings that did not necessarily connect to or even disrupt one another. Rather, for this moment in Starbucks they came powerfully to afford Hadia’s anorexic embodiment, recreating and renewing the “safe space” that she felt her illness to signify.On the EDU every morning all the patients had to spend fifteen minutes in the dining room for morning snacks. The second of the highly regulated six meals and 4000 calories a day, morning snacks comprised milk with chocolate, strawberry or banana Across the vignettes, anorexic embodiment has been seen to be forged through the clinic’s ordering of space, time and materiality—an ordering which becomes absorbed into, but also reconfigured by, individuals’ experiences. As such, what Hadia’s biscuits draw to the fore is that all the material engagements in this paper have been about far more than the linearity of resisting treatment. In their mutability and movement across spaces and boundaries, the objects have shown how anorexic embodiment is forged through the fraught and mobile relationships between the clinical and the mundane. In both treatment and domestic spaces, these are carved into one another in ways that problematize medicalised understandings of the relationship between the body and anorexia. In so doing, these material engagements have challenged an arguably pervasive privileging of discourse over materiality, showing how bodies and the objects and spaces they encounter develop through mutually productive processes.To date little scholarly attention has been paid to how materialities shape intimate experiences of mental ill-health. In interrogating how material objects and spaces forge, frame and disrupt what we term ‘anorexic embodiment’, this paper has opened up a consideration of how material environments relate to eating disorders and mental health experiences more broadly. We have sought to ask what theoretical and therapeutic possibilities, trajectories, and limitations are engendered by exploring mental health, illness, and treatment through a critical lens of materiality.Specifically, the objects explored in this paper have elucidated the central, but previously-overlooked, role of materiality in forging lived experiences of anorexia. Ensuing directly from participants’ narratives, objects and spaces emerged from both datasets as central to embodied practices of “being anorexic”  possibilities for material interaction prescribed by the clinic, participants thereby creatively mobilized material engagements to assert modes of being in the world. As such, reflecting on anorexia through a lens of materiality has shown that objects and the spaces they move through are a crucial part of the production of anorexic embodiment as this comes into being, is threatened, and is remade within treatment.pas de deux, an enactment of compliance with ward rules (staying seated) and simultaneous resistance , communicating and embodying ambivalence. Likewise, the exchange of memoirs and calorie counting books between patients was not only disruptive but also productive; within a clinical space, this exchange enacted alternative regimes of care defined in specifically non-clinical terms.Crucially, these analyses have also shown that this movement of objects is bidirectional. Everyday household objects—such as televisions, books, and chairs—featured centrally in ward spaces and practices, turning intimacy inside out  or craft a personal response to macro-environmental changes, such as a global pandemic, which fundamentally alter both human and non-human relationality.This analysis has thereby shown how, using the lens of objects and spaces, it becomes possible to elucidate the anorexic body as both phenomenologically lived and socio-medically constituted. In so doing, our paper has sought to extend clinical discussions of anorexia and demonstrate that moving towards a materialist account of eating disorders has profound implications for treatment.


This study aimed to investigate the nurse-patient trust among in-patients in the context of the coronavirus disease (COVID-19) epidemic; it further analyzed the related influencing factors, which will provide a theoretical basis for developing corresponding measures.This study employed a mixed-method design and analyzed 149 patients at the Hongqi Hospital, affiliated with Mudanjiang Medical University, from December 2020 to February 2021. Quantitative analysis was carried out using the “Nurse Patient Trust Scale,” and qualitative analysis was performed using a semi-structured interview with in-patients.The average score on the scale was 46.65 ± 2.83, and the scores of the 2 dimensions were: 23.24 ± 1.51 for ability and peace of mind, and 23.32 ± 1.53 for attitude and care. According to the interview data, the factors included 3 aspects: a comfortable hospital environment and humane management measures; the nurse’s own competence; and effective communication with patients.During the COVID-19 epidemic, there are still many factors affecting patients’ trust in nurses that can be addressed by taking different measures. All these factors must be considered by the relevant managers and clinical nursing staff to maintain a better nurse-patient trust relationship. Good nurse-patient relationships are key to treatment progression. Trust as an essential part of nursing practice plays a vital role in building a good nurse-patient relationship. Especially in health care, a good nurse-patient relationship would help promote the treatment of patients, create a harmonious medical atmosphere, and enhance the nurses’ motivation. However, when a patient is ill or experiencing other risk factors, the trust between nurse and patient is very fragile and, once lost, is not easily restored, the consequences of which will directly impact nursing practice, education, and management. It is therefore important to establish a good nurse-patient trust relationship. Multiple factors influence the nurse-patient relationship. One study showed that the availability and accessibility of nurses and patients’ emotional and physical safety tend to influence patients’ trust in nurses. Also, the trust between nurses and patients is susceptible to environmental influences, including whether the nurse has enough time to communicate with patients to inform them about their illnesses, the effects of the medicines, and the timing of the review.Trust is the basis of cooperation; it means trusting the other person without fear, hesitation, doubt, observing ethical norms, and handling conflicts with dignity and goodwill without harming others. However, the severe prevention and control management of hospitals led to difficulties for patients’ family members in accompanying the patient to the hospital. This increased the psychological burden on in-patients and, somewhat, also affected the nurse-patient trust.To some extent, the epidemic outbreak raised nurses’ social position. In this pandemic, nurses have been on the front line, providing various important services to patients, families, and communities. Their contributions were acknowledged by all, especially by patients in the hospital. However, few studies have been conducted to investigate the factors that influence patients’ trust in the relationship with nurses during an epidemic. Therefore, the purpose of this study is to investigate the factors affecting in-patients’ trust in nurses during the COVID-19 pandemic and to provide practical coping strategies for hospital managers.Trust in nurses is seen as a very important factor in nurse-patient interaction. For the qualitative study, 4 points total were included through a semi-structured interview outline of our research team’s own design.This research used a mixed-method design, combining quantitative and qualitative aspects from December 2020 to February 2021 at Hongqi Hospital, Mudanjiang Medical University, China. For the quantitative study, we used the Nurse-Patient Trust Scale (NPTS), which was prepared by the Japanese scholar Gangguhuizi in 1995, and the Chinese scholars Zhao et al. Sinicized and modified it according to the Chinese context in 2018; Cronbach’s α of the scale was more than 0.8. We used the scale of NPTS developed by the Chinese scholars Zhao et al. According to this study, the number of questionnaire items should be 12, so the calculated sample size N = 12 × 10 = 120. Then, we added 20% to the sample size for non-response or for selection bias, thus, making the sample size 144. Finally, 149 patients were included for further analysis. For the qualitative study, 10 patients were finally included until the interview data were saturated.The sample size for quantitative studies is mostly based on the requirements of statistical variable analysis. The number of samples should be at least 5–10 times of the number of variables.A total of 149 patients hospitalized in Hongqi hospital affiliated with Mudanjiang Medical University, China, from December 2020 to February 2021, selected by convenient sampling, were investigated by the questionnaire (NPTS).(1) Age ≥ 18 years; (2) Patients admitted ≥ 3 days; (3) Patients with clear consciousness and independent judgment ability; (4) Patients who signed informed consent and voluntarily participated in this survey; and (5) Patients who are not infected with the new coronavirus.(1) Patients with consciousness, speech, mental, neurological, and other physical diseases; (2) Critically ill patients; (3) Patients who cannot actively cooperate in the study; and (4) Re-admitted patients who have been investigated.After collecting quantitative data, patients above and below the mean scores (mean scores = 46.65) were divided into 2 groups. Ten patients from each group were then selected by a nurse in our department. The semi-structured interviews were conducted with the sampled patients until the required information was collected  until no new items emerged. Finally, 10 patients were interviewed.A quantitative study was conducted using the NPTS. For the qualitative study, in-depth interviews were conducted with the participants, based on the analysis of the quantitative study, using semi-structured interview materials designed by the research team.The researchers designed the questionnaire, including gender, age, residence, sleep, hospitalization time, expenses, marriage, education level, occupation, medical insurance, and income. The scale was revised to include 12 entries with 2 dimensions, 6 entries for attitude and caring , and 6 entries for competence and reassurance . The 4-point Likert scale  was utilized, with no reverse scoring entries, and patients had to choose the appropriate content based on their feelings. The total score ranged from 12 to 48 points, with higher scores indicating higher nurse–patient trust. According to the results of this study, Cronbach’s α and half coefficients for the total scale and the 2 dimensions were above 0.86, indicating good reliability and validity.This study adopted the NPTS after cultural adaptation by Zhao et al., related to the Chinese national context.The interview outline, designed by researchers, revolves around the experiences and feelings of patients in contact with nurses in the context of the COVID-19 epidemic. The interview questions were the 4 that followed: (1) Do you trust nurses or nursing operations? (2) Have you ever been touched or seen anything in a way that affects your trust in nursing? (3) How do you handle the relationship with nurses? (4) Is there any particular reason for hospitalization that affects your relationship with nurses?The investigators received uniform training involving how to communicate with patients, motivate them to fill in questionnaires effectively, and ensure the authenticity of the questionnaires to prevent the surveyors from influencing the study. The respondents were introduced to the purpose, precautions, and confidentiality prior to the survey. After the patients’ consent was obtained, questionnaires were distributed and collected after completion. The collected data were numbered and counted. About 160 questionnaires were distributed, and 149 were collected, with an overall response rate of 93.1%.Before the interview, patients were informed of the purpose of the interview. During the interview, the recording and data were kept confidential and replaced by numbers. The interview was conducted for about 30–40 minutes. Ten patients were interviewed, and the data were collated and recorded within 24 hours.SPSS 26.0 software  was used for the statistical analysis. General data of the research objects were presented using frequency. The measurement data were expressed as mean and standard deviation, and the influencing factors were tested by T-test/F-test, with a significant level of α = 0.05. NVivo12 (US) was used to organize materials and memos in time, concepts and themes were gradually formed, and the preliminary theme framework was subsequently sorted out. In addition, expressions relevant to this study were refined, coded sentence by sentence, and continually compared and categorized with existing thematic frameworks until no new themes and subthemes emerged.The descriptive qualitative study was used to analyze the interview data by content analysis.The data of 149 patients were collected. There were 85 (57%) males and 64 (43%) females. The vast majority of the participants (85.9%) were married, and the rest were unmarried, divorced, or widowed. In terms of education, 38.9% received a senior high school education or above. Among respondents, 8.7% had a monthly household income of $5000 CNY or more .The total score of the questionnaire was 46.64 ± 2.83 points. The top 3 scores were: “When I have an emergency, the nurse can handle it correctly (3.93 ± 0.26),” “After listening to the nurse’s explanation, I feel much better (3.93 ± 0.26),” and “The nurse encourages me to overcome the disease (3.92 ± 0.30).” The score of each item is shown in P < 0.05)   in the uThe general demographic information of the interviewees is shown in (1) Patients do not recognize the expertise of nurses—P3: “I just got admitted to the hospital with many questions, and I think the doctors are too busy, so I want to talk to the nurses, but I always feel that what the nurses say may not be very clear”; P3: “I don’t usually ask the nurse if I have a problem. Should I not ask the doctor about treatment? If the infusion does not work, then, of course, you should ask the nurse”; P7: “It is the nurse who gives the injections, but it is better to ask the doctor. Doctors have more experience than nurses.” (2) Patients have high expectations. Patients hope for a good outcome, but the variability of their condition leads to physical and mental exhaustion and emotional sensitivity—P4: “If the test results are good, I hope someone will let me know because I am prone to overthink, and I will be too worried and afraid to ask”; P8: “I spend a lot of money, but I think the curative effect is too slow, the disease repeats itself, my wound is not easy to heal, and now it is still expanding.”(1) Nurses are often reluctant or unable to interact much with patients because they are overwhelmed by their work in nursing—P6: “Nursing was not well versed in some knowledge of the disease, they do not explain things enough and may also care for many patients, like when I want to ask them a question, they can be called away by something else before they make it clear”; P8: “I didn’t know anything when I was first admitted; I was dazed and confused, I had to undergo a lot of tests and treatments, and the nurses gave me notes, some of which I probably did not understand the technicality, I felt confused about what I was doing, and the nurses did not provide a detailed briefing.” (2) In a university hospital, many nursing students will come here to learn clinical knowledge—P3: “I do not want trainee nurses to perform operations on me; they are just practicing.”(1) Hospital prevention and control management restrict access to patients, especially their families—P5: “We need to do many tests before I have to be hospitalized. My wife and I are getting older, and we want our children to go to the hospital to take care of us, but they cannot enter or leave once they are in but have to go to work, so it’s not convenient.” (2) Hospitalization costs are relatively high—P1: “We need to live in an isolation room with higher costs, and some tests are now added. For example, accompanying relatives also need nucleic acid tests. We can only eat the food distributed by the hospital canteen, which increases the cost and is not convenient. The overall cost of hospitalization is higher than before.” (3) Lack of waiting rooms—P10: “There are too many people on the ward, which I think is not conducive to the management of epidemic prevention and control. With several patients in one room, the air is not good, and masks cannot fully achieve the isolation effect. The greatest worry is that we will all be quarantined if there are such patients or suspected patients in the hospital.”(1) Patients have empathy and can understand the difficulties of nursing workers from a nursing point of view—P1: “There are few nurses on the ward that need to take care of patients and the families of the patients. Moreover, they not only need to measure our temperature frequently but also help us pick up and deliver our daily necessities. I heard that some nurses still need to go to places with epidemic outbreaks, so it is necessary to understand their hard work”; P4: “It is not easy for a nurse. I am a patient with a stoma. I once burst into my pocket when I fell asleep at 1 am and filled the bed with stools. I was in a terrible mood at that time, and the night nurse saw my condition and took care of it immediately, changed my quilt, clothes, and made pockets, which helped me deal with it very well. They not only had good skills on their hands but also made me feel particularly warm”; P10: “Nurse are very busy every day. I usually do not ask them questions. I am afraid of increasing their workload. Anyway, I don’t understand medicine, but I trust them.”(1) Excellent professional skills: Nurses with professional skills are the basis to gain the trust of patients and enable them to better cooperate with treatment—P5: “The nurse in this department is exemplary. I am often hospitalized. The nurses here are diligent. Although they wear masks and I cannot see their faces, they often encourage me.” (2) Good professionalism: Exemplary professionalism can establish a harmonious atmosphere for medical treatment—P6: “I find that nurses are neatly dressed, energetic, meticulous, patient, and responsible every day. Every time they come in and out of the door, they keep their voice to a minimum”; P9: “My nurse asks me about my meals, sleep quality, and if I need help every day. I like to chat with her.”(1) The hospital must strictly prevent and control the management system to avoid cross-infection in the hospital and ensure the safety of the patient—P1: “It is difficult to accompany family members now; there are many requirements, but, understandably, we have done an excellent job for our safety”; P2: “I saw nurses guarding the stairs”; P3: “The hospital is disinfected many times a day, and everyone has been tested. I am relieved.” (2) Media report on the outstanding contribution of nurses during the epidemic—P6: “I have been seeing nurse news lately, like the most beautiful nurses. I was touched by the nurses with whom I came in contact”; P7: “Nurse are very brave; I can see from TV news that many nurses went to Wuhan during the outbreak of the epidemic.”The results of the NPTS showed that patients’ overall trust in nursing care was high at 46.64 ± 2.83 points. The results of the combined interviews indicated that various favorable factors had a positive effect on maintaining a good nurse-patient relationship. This may be because the value of nurses in the epidemic was highlighted through meticulous nursing measures, which greatly met the humanistic needs of patients during their hospitalization and promoted their affirmation of nursing care. Moreover, positive social media coverage contributed to a certain extent to patients’ understanding of nursing care, their trust in nursing workers, and their willingness to cooperate with treatment. However, there are still some factors that need our attention, including the patient’s sleep, the effectiveness of treatment of their own illness, the social context of the epidemic, and the nurses’ expertise. Three nursing measures are proposed to address these factors, including a comfortable hospital environment and humane management measures, the nurses’ own competence, and effective communication with patients. This may have been due to the lack of sleep for patients and the special in-patient environment of the hospital during the COVID-19 pandemic, whose complex admission procedures and strict hospital management processes further affected patients’ mental health status, leading to dissatisfaction with care and distrust of nurses. Meanwhile, some interviews showed that patients’ distrust of the hospital also led to patients’ distrust of their nursing work. During the COVID-19 pandemic, hospitals, as special places, are subject to strict requirements in different countries in order to mitigate the infectious disease hazards, protect health, and prevent the viral spread. Strict management may, to some extent, lead to cumbersome hospitalization, restrictions on prevention and control management, and increased costs, all of which can affect patients’ trust in their care.Previous research showed that there is a direct relationship between the patient’s sleep status and the level of nurse–patient trust, with environmental factors recognized as the most influencing. It is also possible to classify hospitals into different levels according to their capacity so that they can receive and sort patients with different conditions. Establishment of a regional coordination unit for admissions is responsible for collecting daily data on the number of empty beds and reallocating the number of patients to facilitate rapid admissions wherever possible. We can also promote patient understanding by giving hospital management brochures to in-patients, by informing them about epidemic preparedness, and answering their questions in a timely manner. At the same time, the results of the study also showed a positive effect of news media for positive public guidance, but social media have the characteristics of complex information and fast dissemination and should be adopted in an appropriate way to promote the spreading of effective health knowledge. The mentioned methods were used to promote patients’ understanding and support of hospital work and nursing care and to increase the level of patients’ trust in nursing care.Even considering the need to adopt preventive and control measures in hospitals, health care professionals can create as comfortable an environment as possible for patients to sleep well while taking targeted measures for hospital management to ensure the overall safety as far as possible and reduce difficulties in admitting patients—for example, recruiting and training staff to help and guide patients through the admission process. As people’s quality of life improves, in-patients have higher demands for basic hospital and nursing care, health education, and psychological support. According to the study of Jing et al., the current competencies of clinical nurses are still at an intermediate level. Since the 21st century, there has been a gradual emergence of nurses of various specialties to develop higher nursing skills and possess higher clinical practice, teaching guidance, consultation, and research and information skills. By further developing the advanced practice roles such as Clinical Nurse Specialist (CNS) developed by the nursing workforce, the professional nursing skills and knowledge they possess will not only enhance the nursing experience and meet the needs of the patient, but also improve the voluntary utilization of health care. According to a study by Leslie et al., advanced practice nurses can promote patient trust and prompt patients to demonstrate good resilience and collaborative skills. Clinical managers should increase the training of nurses and improve their professional knowledge to assume the role of a health consultant to meet patients’ needs for health and disease-related knowledge.Both the individual items of the NPTS questionnaire and the results of the interviews showed that patients felt that the nurses’ knowledge was incomplete. Similar results were reported by Zhang et al. They used the Newcastle Satisfaction with Nursing Care Scale, which is different from this study’s scale. Still, the survey population was the same as this study with Chinese patients. Owing to the continuous reform of the medical system and the gradual improvement of medical technology, patients have excessively high expectations for the treatment effect while seeking medical treatment, which tends to produce discrepancies between expectations and reality, thus, affecting nurse-patient trust. In addition, with the improvement of patients’ legal consciousness, their requirements for medical service quality and awareness of their medical rights are also constantly increasing. If they are not satisfied with the results, they usually seek legal help, which exacerbates a conflict. Good communication helps improve patients’ satisfaction and increase trust in nurses.The results of this study and the other 2 interview-based studies showed that most patients had high requirements for treatment results, especially the patients with incurable malignant diseases. Interns are encouraged to communicate with patients regularly to get patients’ understanding and recognition. The results of Lorena et al. showed that after training, interns could flexibly master communication in conversation methods, and their communication skills improved to a great extent, which is conducive to the coordinated development of the nurse–patient relationship.At the same time, to meet the clinical learning of interns during the epidemic, the interns’ ability for nurse–patient communication should be strengthened. Effective communication strategies are an essential determinant of the positive nurse–patient relationship.For qualitative studies, researchers may be influenced by education and experience, which may result in bias. The interview about the trust in the nurse–patient relationship depends on the patients’ own experiences, and they might have shown a more positive attitude to answer questions when the investigators were nearby. This may become a source of information bias, which should be systematically considered in research. Furthermore, this study was conducted in only 1 hospital. The next step could be to expand hospitals for research and analysis.Patients’ trust in nurses not only promotes recovery and motivation, but also goes a long way to maintaining a stable in-patient environment. The multiple factors arising from the outbreak not only affected patients’ trust in nursing staff, but also exposed some of the problems that nurses might have in their work. Under the premise of ensuring medical safety, we can reduce the difficulties of patient admission through a variety of measures such as recruitment, and we can also use the news media to raise patients’ awareness of epidemic prevention and control. While the health care industry is developing at a rapid pace, health care managers should also increase the training of clinical nurses to improve the overall standard of care to help nursing staff better cope with the challenges of the nurse–patient trust relationship in the event of a public health emergency. In addition to this, we should actively communicate with patients to improve their trust in nursing care, which will help us greatly in our work.