Nurses can encourage patients to eat and drink in several ways, including providing a variety of practical support and working with other professionals

    Abstract

    Nurses have a key role in ensuring that inpatients receive adequate nutrition and hydration. This article gives practical advice on helping patients during mealtimes.

    Citation: Wilson N et al (2012) Feeding patients: a multiprofessional approach. Nursing Times; 108: 25, 17-18.

    Author: Neil Wilson is senior lecturer and admissions tutor, pre-registration adult nursing, Faculty of Health, Psychology and Social Care, Manchester Metropolitan University and secretary, National Nurses Nutrition Group; Carolyn Best is nutrition nurse specialist, Hampshire Hospitals Foundation Trust and communications officer, NNNG.

    • This article has been double-blind peer reviewed
    • Scroll down to read the article or download a print-friendly PDF including any tables and figures

    All health professionals who are providing direct care should receive theoretical and practical training on nutrition. This should cover the implications of malnutrition, the role of nutrition screening and practical techniques for providing adequate nutritional care (Bjerrum and Tewes, 2011). Education should aim to ensure patients who can safely eat and drink receive adequate and suitable support to do so. If all staff appreciated the vital role nutrition plays in patients’ recovery (Brogden, 2004), attitudes towards and standards of nutritional care should improve.

    Neither nutritional screening nor assessment will be of any benefit unless patients can eat or are helped to eat (British Dietetic Association, 2006). Although responsibility for nutritional care involves many practitioners, nurses have the most central role in ensuring patients receive food and fluid. This role includes providing encouragement or help to enable patients to eat.

    The Nursing and Midwifery Council’s (2008) code of conduct states: “Work with others to protect and promote the health and wellbeing of those in your care, their families and carers, and the wider community.” Interpreting this for nutritional care can mean that, even if this aspect of care is delegated to a healthcare assistant, responsibility for the outcome remains with the nurse. It is essential that nurses are aware of how effective any intervention may be and ensure progress is documented.

    There are many reasons why patients may not eat in hospital; the most common relate to disease and treatment. Some systemic issues may also inhibit intake, including those outlined in Box 1.

    Assessment

    Patients should have a full nursing assessment of needs on admission, which should be undertaken within a framework such as the Roper, Logan and Tierney model of nursing (Holland et al, 2008).

    The assessment should help nurses to undertake a “head to toe” patient review and include nutrition screening, which helps to highlight the risk of malnutrition. A validated screening tool such as the Malnutrition Universal Screening Tool (MUST) should be used (National Institute for Health and Clinical Excellence, 2006).

    On completion, the action plan recorded on the screening tool should be implemented, appropriate to the patient’s risk score, and nutritional care started. Referrals to health professionals such as dietitians should be made in line with this plan.

    Ensuring adequate nutrition

    In many cases, patients’ nutritional risk in hospital is exacerbated by their dependence on the healthcare team, for example, from simple things such as making choices over food to the provision of intensive support with feeding at mealtimes.

    The provision of food and fluid for patients in hospital has generated much debate over recent years, with reports highlighting inadequacies contributing to patients’ poor nutritional status (Care Quality Commission, 2011; Age UK, 2010).

    With initiatives such as protected mealtimes, nutritional screening, better hospital food projects and red trays, one would assume patients were now being fed. However, these initiatives are only effective if food reaches patients’ mouths.

    There are a number of methods, which, if considered and adapted to the local setting, may help to increase the amount of food patients can consume. This may only be possible with the support of nurses or other staff to help patients. Practitioners should consider the following when supporting inpatients in eating meals:

    • Where possible, support patients to eat as close to mealtimes as possible. Dietetic departments may have a dietetic assistant or mealtime volunteers to help with this;
    • Encourage choice, preferably from a menu;
    • Document where the following patient information can be accessed:
    • Preferences, dietary requirements and food and fluid consistency;
    • The level of help that may be needed;
    • Provide, where appropriate, access to fresh drinking water regularly throughout the day.

    Nursing staff should know how best to help patients with meals without taking over or undermining their ability or confidence. Where patients need help to eat and drink, nurses should provide support in a manner that encourages but promotes or maintains independence (Reimer and Keller, 2009). The level of assistance may vary; some patients may need help to prepare to eat, while others may initially manage independently but tire as the meal progresses. Often, if patients are prepared before their meal is delivered, less support will be needed during mealtimes (Box 2).

    Dietitians, speech and language therapists, occupational therapists and physiotherapists play a valuable role in supporting patients and staff over issues relating to dietary requirements, textures, positioning and adaptations to support eating and drinking. These practitioners may not be directly involved in feeding patients but they can assist with preparing patients and provide guidance. This collaborative approach could minimise the need for complex initiatives and promote greater interdisciplinary working.

    Final considerations to improve patient nutrition at mealtimes may include some or all of the points in Box 3.

    After mealtimes

    To ensure effective communication and improve patients’ nutritional state, on completing a meal it is essential to: leave the patient in an upright position; complete food intake charts; and report and record difficulties with food consistency.

    Conclusion

    While acknowledging that the above measures will not suit all environments, with clinical judgement and common sense they can support nurses striving to deliver the best standards of care.

    Key points

    • Health professionals need to appreciate the important role nutrition plays in patients’ recovery
    • Nurses have a key role in ensuring patients receive adequate food and fluid
    • Nutritional screening helps to highlight the risk of malnutrition
    • Nursing staff should know how best to help patients with meals without taking over or undermining their ability
    • If patients are prepared appropriately before meals, the support needed during the5 key pointsm may be reduced

     

    References

    Age UK (2010) Still Hungry to be Heard: The Scandal of People in Later Life Becoming Malnourished in Hospital. London: AGE UK.

    Best C (2008) Nutrition: A Handbook for Nurses. Oxford: Wiley-Blackwell.

    Bjerrum M, Tewes M (2011) Nurses’ self-reported knowledge about and attitude to nutrition - before and after a training programme. Scandinavian Journal of Health Sciences; 26: 1, 81-89.

    British Dietetic Association (2006) Delivering Nutritional Care Through Food and Beverage Services. Birmingham: BDA.

    Brogden B (2004) Clinical skills: importance of nutrition for acutely ill hospital patients. British Journal of Nursing; 13: 15, 914-920.

    Care Quality Commission (2011) Dignity and Nutrition Inspection Programme. National Overview.

    Hiesmayr M et al (2009) Decreased food intake is a risk factor for mortality in hospitalised patients: the Nutrition Day Survey 2006. Clinical Nutrition; 28: 484-491.

    Holland K et al (2008) Applying the Roper-Logan-Tierney Model in Practice. Edinburgh: Churchill Livingstone.

    National Institute for Health and Clinical Excellence (2006) Nutrition Support in Adults: Oral Nutrition Support, Enteral Tube Feeding and Parenteral Nutrition . London: NICE.

    Nursing and Midwifery Council (2008) The Code: Standards of Conduct, Performance and Ethics for Nurses and Midwives . London: NMC.

    Reimer HD, Keller HH (2009) Mealtimes in nursing homes: striving for person centred care. Journal of Nutrition for the Elderly; 28: 4, 327-347.

    Thibault R et al (2011) Assessment of food intake in hospitalised patients: a 10-year comparative study of a prospective hospital survey. Clinical Nutrition; 30: 289-296.

    Can nurses force-feed patients?
    The hospital's duty is to intervene, and the court's responsibility is to allow such intervention. The most compassionate way in which the hospital can help is to force-feed the patient. If a patient is mentally competent, the refusal to eat is morally wrong. more
    What do you feed a bedridden patient?
    Feeding Someone Who Is Bedridden
    1. Steaming. You can quickly steam most vegetables.
    2. Stewing. Pot roast has to be one of the most comforting dishes known to humans, and if you do it right, the meat will be fall-off-the-bone tender, and your vegetables will be both soft and flavorful.
    3. Soups.
    more
    Should you force feed a dementia patient?
    A study by Finucane and colleagues (JAMA 1999) reviewed the literature on feeding tubes from 1966 through March 1999, and found no data to suggest that tube feedings improve clinical outcomes. They concluded that tube feedings should be discouraged for patients with severe dementia. Dr. more
    Which patient benefit is gained through the use of the patient-centered medical home?
    (8.21) Patient-centered medical homes (PCMH) effectively integrate information technology with a focus on primary care, which have resulted in cost containment and improved quality of healthcare delivery. more
    When is a patient no longer a patient?
    Patient abandonment is a form of medical malpractice that occurs when a physician terminates the doctor-patient relationship without reasonable notice or a reasonable excuse, and fails to provide the patient with an opportunity to find a qualified replacement care provider. more
    Can you force feed a patient?
    Hospitalization itself can be the first step in involuntary treatment. In some cases β€” as with S.A. β€” guardianship, or conservatorship, is required. Once admitted to a hospital, patients may be fed additional snacks, liquid meal replacements, or servings at meals to increase caloric intake. more
    What should a health care worker do first if a patient starts falling scream at the patient lower patient to closest flat surface call for help fall with the patient?
    What should you do if a patient starts falling? You should lower them to the closest flat surface to avoid any injury to yourself or the patient. Then call for help. more
    When can an established patient be treated as a new patient?
    three years By CPT definition, a new patient is β€œone who has not received any professional services from the physician, or another physician of the same specialty who belongs to the same group practice, within the past three years.” By contrast, an established patient has received professional services from the physician or more
    What is provided by a patient care assistant to a patient?
    Patient care assistants help with providing care, support and services to patients in a hospital or health care environment. They assist patients with their personal care needs such as showering, dressing and eating. They help patients move around the facility by pushing them in wheelchairs or in mobile beds. more
    When is a patient no longer considered a patient?
    Patient abandonment is a form of medical malpractice that occurs when a physician terminates the doctor-patient relationship without reasonable notice or a reasonable excuse, and fails to provide the patient with an opportunity to find a qualified replacement care provider. more
    Should you feed a dying patient?
    It's simply part of the dying process. A person's need for food and water are significantly less than those of an active, healthy person. Hospice care does not deny a patient food or drink. If someone has the desire to eat or drink, there are no restrictions on doing so. more

    Source: www.nursingtimes.net

    You may be interested in...

    Does Costco limit the amount of gas?

    What jobs can only a man do?

    What is 1 year degree called?

    Is caviar halal Sistani?

    Why is Bollywood popular in Pakistan?

    What happened to the kitten born with two faces?

    Do sharks like to cuddle?

    Do Golden Retrievers like to be hugged?

    What can only be found in the Philippines?

    Why do I feel exhausted all the time?

    Can you trim squash vines?

    Why do you put milk in a cake?

    What is the monthly income limit for food stamps in Texas?

    Is Blood and Honey appropriate?

    Can you breathe on your own during general anesthesia?

    About Privacy Contact
    ©2022 REPOKIT