Nutrition and Hydration Week Part 2

Dignity and meals:

To continue with the subject of Nutrition and Elderly Care in hospital, one important fact is sometimes ignored - the dignity of the patient. I mentioned in Part 1 that some patients decline to drink enough as they "will want to go to the toilet". If a patient has urgency or continence issues, this is of great concern to them for obvious reasons. Low staffing levels, distance from toilet, mobility problems all contribute to the facts that patients do not want to find themselves in an embarrassing predicament. And there are other issues....

The term "feeding" is one I dislike intensely and really try not to use. "Assistance" is the correct term I believe unless someone can give me a better one.

Many patients come to hospital following a fall unable to use an arm due to injury, or, may be so weak that lifting their arms requires too much effort although in the time prior to coming to hospital, they were perfectly independent and able to lift utensils normally. In hospital, they often find themselves awkwardly positioned in bed, weak, unable to manoeuvre a heavy china cup or a knife and fork to their mouth. We had one such patient recently who told me that she felt "weak, helpless and silly"! She did not want anyone to "feed" her but had no other means of getting any food into her.  I made the suggestion that while she was still so weak, she could "borrow" my arms and hands while she got her strength back! She cheered up then telling me I could have my limbs back in a couple of days! Sure enough, the next day she was managing a lighter weight cup and  two days later she managing knives, forks and spoons perfectly well on her own.  

Arthritis and weakness means that hospital wards should have a supply of lightweight cups with handles, straws, adapted cutlery that patients can try if their joints are arthritic and a supply of aprons or good quality napkins to allow patients as much independence and freedom from embarrassment as possible. 

Always ask if a patient would like some assistance. If they say no but are still not eating, it is important to try and find out why. Family and Nursing Homes can help with that information if the patient is unable to give it themselves.  It is important to find out what is normal for that individual.

Some patients enjoy having people around at mealtimes, and on our ward, visiting times are during meals.  However, some patients, especially if they tend to drop or dribble food, would rather not eat than have family members see them getting in a mess. It is wise to ask the patients, especially if it has been noticed they are refusing food or are "not hungry" in front of family, if they would prefer to eat when their family are not there. A meal can be arranged for non-visiting times or the family members can be asked to pop out for a coffee while the patient has their meal.

I have found that some Dementia patients may not voluntarily use utensils and eat but will eat and drink "hand over hand" which really helps their coordination. Hand to mouth, mouth opens etc. It also gives some independence with a guiding hand. 

By getting to know your patients body language (especially for the very confused patients) and talking to those who are able, you can find out what makes them comfortable or uncomfortable, making their hospital stay more pleasant and hopefully improving their chances of maintaining adequate levels of diet and hydration.