List Four Things You Need to Know From the Nurse or Care Plan Before Serving Meal Trays

This article outlines the procedure for helping patients to consume at mealtimes. It highlights the importance of monitoring food and fluid intake and the need for authentic documentation

Citation: Anderson 50 (2017) Assisting patients with eating and drinking to prevent malnutrition. Nursing Times [online]; 113, 11, 23-25.

Author: Liz Anderson is nutrition nurse specialist at Buckinghamshire Healthcare Trust.

• This article has been double-bullheaded peer reviewed
• Scroll downward to read the article or download a print-friendly PDF here

Introduction

Malnutrition costs the UK health economy £19bn a twelvemonth and affects 1 in four people admitted to care settings (Elia, 2015). Information technology is most prevalent in the community only nutritional status often deteriorates when patients are admitted to hospital because of acute injury or illness that tin can impair swallowing, appetite and gastric assimilation. When patients are unwell and practise not feel similar eating it can be a claiming to help them see their nutritional needs.

Patients with malnutrition will have a deficit of vitamins, poly peptide, minerals and energy and this will take an adverse effect on the torso. Complications associated with malnutrition include poor wound healing, skin breakdown, increased risk of sepsis and hospital-acquired infections, such as breast and urinary tract infections (Elia and Russell, 2009). Provision of adequate nutrition and hydration is a hallmark of adept, compassionate care just remains neglected in many areas of healthcare (Leach et al, 2013).

The Infirmary Nutrient Standards Panel study (Department of Health, 2014) recommends that all NHS hospitals adhere to and be compliant with the Ten Key Characteristics of Good Nutritional Care (Council of Europe, 2003); this includes ensuring an environment that is conducive to patients existence able to savor their meals uninterrupted. Expert nutrition and hydration is part of the Care Quality Commission's Fundamental Standards (CQC, 2015) and all intendance settings are expected to demonstrate how they put nutrition and hydration at the centre of patient intendance.

It is essential that all patients receive adequate food and drinkable appropriate to their needs (Nursing and Midwifery Council, 2015) and while many volition be able to manage independently, some patients will need assistance.

All patients admitted to care settings should have nutritional screening performed within the first 24 hours (CQC, 2015; National Plant for Health and Care Excellence, 2006) using a validated tool such as the Malnutrition Universal Screening Tool (MUST). This is essential as information technology helps to ascertain whether a patient needs help and informs their nutritional plan of care.

At that place are a number of patients who have medical conditions that hateful that they may need assistance with eating and drinking; these are summarised in Box 1.

Box 1. Medical weather condition that may impact eating and drinking

Swallowing complications: may be associated with weather condition such as stroke, Parkinson'south disease, motor neurone disease and multiple sclerosis

Cancer: some patients with cancer have increased energy requirements but they may feel unable to swallow due to nausea, airsickness, pain or gastrointestinal obstacle. Patients prescribed chemotherapy often experience a change in taste which tin affect their ambition

Surgery: people who have had surgery require actress free energy to assistance heal wounds but they can sometimes detect eating difficult due to pain and nausea

Other: people with severe learning disabilities, visual impairment or dementia, and older people who have an acute delirium, demand specialist support to ensure they are adequately nourished

Preparing for mealtimes

Nurses should assist patients to make appropriate meal choices; for instance, if they can but eat soft food due to poor dentition they should be fabricated aware which foods on the bill of fare are soft and easy to chew. Nurses should not cull food for patients without consultation; if they are unable to cull for themselves, their nurse should speak to a carer or relative to find out their likes and dislikes where possible.

Equally part of the assessment process, it is of import to know whether patients have any special dietary needs. For example, a patient who has swallowing difficulties (dysphagia) may need a texture modified diet (National Patient Safety Bureau, 2011) as giving food that is difficult to eat may lead to choking. This information should be obtained when admitting the patient to hospital and shared with the multidisciplinary squad; refer to local policies for further guidance.

Protected mealtimes

Information technology is best practice for clinical areas to follow a protected mealtime policy. During protected mealtimes, all non-urgent clinical activity should end and staff should take the time to aid patients to eat and beverage in a relaxed, and unhurried atmosphere (Council of Europe, 2003).

While this can often exist challenging in practice, especially in a busy astute surroundings, staff should brand every effort to ensure that patients are able to consume and drink their meals without unnecessary interruptions.

Many organisations encourage family and carers to come in at mealtimes to assist their relative with eating and drinking. This is good practice, specially for patients with dementia or learning disabilities equally they may be more than willing to accept aid from a person they know.

Equipment assessment

The use of red tableware such as red trays, jugs and beakers tin can assistance to highlight patients who need help with eating and drinking. This cess should ideally be made at the same time as the nutritional screening and included as part of their care program (Fig 1a). This is an ongoing procedure and should exist reviewed regularly.

Adapted cutlery such equally piece of cake-grip handles and other equipment such as plate guards and nonslip mats tin be useful for patients who have restricted use of their hands or who have had a stroke and tin can only manage to eat with one hand (Fig 1b). These are normally provided by an occupational therapist.

Source: Peter Lamb

Source: Peter Lamb

Preparation for mealtime

Before mealtime, nurses should ensure all patients are prepared to eat their meal in a dining room or in a chair by their bed. If this is not possible they should exist sat upwardly in bed, well-supported with pillows (see checklist in Box 2). Independence should be encouraged and it is important to appraise what aid the patient needs, for instance:

• Unwrapping packets;
• Removing yoghurt pot lids;
• Cutting food into bite size pieces to promote independence.

Box two. Training checklist

• Is the bedside tabular array articulate of clutter and of the right height for your patient to eat comfortably?
• Has the patient been given the opportunity to use the toilet and wash their easily?
• Does the patient have dentures in and hearing/visual aids on if worn?
• Does the patient have all necessary items within easy reach?
• Once the meal has been delivered, is it what the patient ordered?

Profitable patients

Helping patients who cannot consume and drink independently takes time, understanding and patience. It must not be rushed and any nurse who is involved in this task should not exist interrupted.

Equipment

• Clean table or tray;
• Gather equipment required to assistance the patient to eat, such equally adjusted cutlery;
• Provide a serviette to protect clothing;
• Obtain a chair to sit beside or opposite the patient (Dougherty and Lister, 2015).

The procedure

1. Explain to the patient that y'all are going to help them to eat their meal.

2. Decontaminate your hands to reduce the chance of cross infection and put on an apron (Dougherty and Lister, 2015).

3. Assist the patient to sit in an upright position at a table in a dining room, in a chair by the bed or upright in bed if the patient cannot get up. This helps with swallowing and protects the airway (Dougherty and Lister, 2015). Eating in a dining room as well makes the meal a social occasion.

iv. If the patient use dentures ensure they are clean and offer assistance to insert them if necessary.

five. If necessary decontaminate your hands before handing food and allow the patient to wash and dry out their hands earlier the meal.

vi. Protect the patient's clothing with a serviette to maintain nobility.

seven. Sit down at the patient's center level. This aids effective communication but as well provides reassurance the patient that y'all have the time to help the patient to eat (Fig 1c).

viii. Do not be distracted past what is going on around y'all or talk to other people.

nine. Tell the patient what is on the plate – this is particularly important for those who are are visually impaired or eating a puree nutrition equally food may not be instantly recognisable.

10. Ask whether the patient wants any seasoning or sauces and has a preferred order in which they wish to eat the food.

11. Inquire how the patient would similar to receive the food; some may prefer a fork, others a spoon. It is of import to permit the patient experience in control of the mealtime.

12. Visually impaired patients should be told what y'all are putting on the fork or spoon before raising it to their lips. Practise not overload the fork. Bring it upwardly to the patient's oral fissure to avoid the demand to bend to reach the nutrient. Allow plenty of fourth dimension for the patient to chew and consume.

13. When patients have a small appetite, suggest that they endeavour to eat a piddling of each course for a counterbalanced nutritional intake. Nonetheless, these patients are at high adventure of malnutrition and should be referred to a dietitian to appraise their dietary intake.

14. Offer sips of fluid afterward every couple of mouthfuls; this can help eating.

15. When the patient has had plenty of the master course, offer dessert in the same style. Make sure the spoon is the correct size, for case, using a teaspoon for a yoghurt.

16. Afterward the meal ensure the patient is clean and comfortable and has had plenty to eat and beverage. Patients should be encouraged to consume but should non be pressured when they have indicated that they have had enough.

17. Offer the patient a run a risk to clean their teeth and dentures or if this is not possible, perform mouth intendance.

18. At the end of the meal ensure the patient has a drink to hand but exist aware that those who need help with eating volition need help with drinking too and regular fluids should exist offered.

nineteen. Remove your apron, decontaminate your hands and document the patient's dietary intake.

Source: Peter Lamb

Documentation

Food and fluid charts are a vital way of assessing patients' nutritional status. Dietitians and nutrition teams rely on them when working out nutritional requirements and the need for additional nutrition support. These charts are a useful tool when assessing weight loss. An example of a completed form is illustrated in Box 3.

Impaired consume

Mealtime is an ideal opportunity to assess swallowing. An urgent referral should be fabricated to a speech and language therapist if the patient has any of the following symptoms of dysphagia:

• Cough/choking;
• Wet/'gurgly' phonation;
• Taking a long time over a repast/falling asleep;
• Complaining of difficulty eating or drinking;
• Reluctance to consume certain consistencies;
• Feeling of food getting stuck in mouth, holding food in cheeks;
• Nutrient/beverage falling out of the mouth.

If you lot notice any of the above observe the patient for signs of aspiration pneumonia; this occurs when patients take swallowing issues and food inadvertently enters the respiratory tract. Symptoms of aspiration pneumonia include: breathlessness, decreased oxygen saturations tachycardia and pyrexia. If these are nowadays, seek medical advice urgently.

Reflection

Look at your own expanse. Are patients prepared for meals? Do they have the help they need? Are all staff helping with meals? If not, what are they doing? Can you make five pocket-size changes that will improve the mealtime experience? Look at the food record charts – are they completed accurately? If non, tin can you share good practice and ensure that all staff know how important it is?

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Source: https://www.nursingtimes.net/clinical-archive/nutrition/assisting-patients-with-eating-and-drinking-to-prevent-malnutrition-09-10-2017/

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