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