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ASSISTING PATIENTS WITH FEEDING

APOLLO ODANGA, BScN

MWAI KIBAKI HOSPITAL-KNH ANNEX

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INTRODUCTION

One of the nurse's special roles is to help patients with feeding.
Assisted feeding is the type of feeding provided by nurses to assist patients in feeding with food or fluid due to patient’s ailment (Connie et al. 2014)
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.

WHY ASSIST PATIENTS WITH FEEDING?

Nutrition more important in controlling recovery in the sick.
Helping patients in eating and drinking important in recovery and rehabilitation of patients.
This is a complex medical intervention requiring knowledge and skills (CNA Skill, 2017
Many patients are admitted in a malnourished state
Deterioration of nutritional status frequently occurs during hospitalization.
Appropriate and prompt attention to patient nutrition by nurses and other health professionals has a positive influence on patient outcome and hospital costs.

KNOWLEDGE IN PATEINT FEEDING

All health professionals who are providing direct care should receive theoretical and practical training on nutrition.

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.

�ENSURING ADEQUATE NUTRITION �

Patients’ nutritional risk in hospital exacerbated by their dependence on the healthcare team from simple things such as making choices over food to the provision of intensive support with feeding at mealtimes.
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.

WHO SHOULD FEED PATIENTS

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.

REASONS WHY INPATIENTS MAY NOT EAT�

REASONS WHY INPATIENTS MAY NOT EAT

Lack of individualized utensils specific to patients’ needs
Food being placed out of reach
Staff not available to help patients eat
Mealtimes are disrupted by clinical care or investigations
Insufficient time given to eat meals
Being placed nil by mouth, awaiting swallowing assessment or procedure
In a qualitative study by Ross et al. (2011) on Nurses and other medical practitioners, the clinical activities assigned by the doctor is viewed more important than feeding patients on a sick bed

POINTS TO CONSIDER AT MEALTIMES�

Check that the patient is not nil by mouth (NBM)
Position yourself at the same height as your patients (do not stand over them) to maintain communication and eye contact
Ensure food is not too hot or too cold
Give only small amounts each time
Wait for patients to finish chewing before introducing the next mouthful, pausing between mouthfuls if necessary
Use a spoon not a fork to deliver food

�POINTS TO CONSIDER AT MEALTIMES�

Offer meals in the usual order but be aware that some patients find the smell of hot food nauseating and prefer the drink and dessert
Check the patient is receiving the correct diet in the correct format: for example do they need a high-protein, soft or puree or low-potassium diet?
If patients have a puree or soft meal explain what it is, particularly if it has been ordered for them by someone else
Pour thickened fluids into cups – do not use a straw
Monitor for fatigue
Minimize interruptions and distractions

�PATIENTS MEAL TIME PREPARATION CHECKLIST�

Patients should be alert and responsive;
where possible, they should be in an upright position or their head supported to reduce aspiration risk
Oral care should be provided and dentures properly fitted
Hands must be washed
All utensils must be within reach
Patients should have a drink where appropriate

AFTER MEALTIMES �

To ensure effective communication and improve patients’ nutritional state, on completing a meal it is essential to:

CONCLUSION �

While acknowledging that the above measures will not suit all environments, with clinical judgment and common sense they can support nurses striving to deliver the best standards of care.
Providing optimal nutritional care is heavily dependent on ensuring its optimal delivery at the bedside, a role which the nursing staff have to accept and be responsible for.
It is important that this message is made clear at every level of nursing care and that the subject be raised at an early stage of nursing education, starting during their basic training.

REFERENCES