Trlc.no does translations from English into Norwegian
Title
Oversettelse engelsk norsk tysk. Oversetting, redigering og korrekturlesing av teknisk, økonomisk, juridisk og medisinsk litteratur. Mer informasjon på http://www.trlc.no/
Meeting the nutritional needs of patients with dementia in hospital Carole Archibald. Nursing Standard. Harrow-on-the-Hill: Jul 19-Jul 25, 2006. Vol. 20, Iss. 45; pg. 41, 5 pgs
» Jump to indexing (document details)
Full Text (2266 words) Copyright RCN Publishing Company Ltd. Jul 19-Jul 25, 2006 [Headnote] Summary This is the third article in a series of five focusing on the needs of patients with dementia. It emphasises the importance of good nutritional intake for patients with dementia in hospital care. On busy wards, nutrition is often overlooked in favour of other aspects of care. Nurses' increased knowledge about dementia, assessment of nutritional needs, and personal capabilities can improve patients' experiences and outcomes. Excess dependency and emotional aspects of food refusal are also discussed. Keywords Acute care; Dementia; Hospital catering; Nutrition and diet; Older people: nutrition These keywords are based on the subject headings from the British Nursing Index. This article has been subject to double-blind review. For related articles and author guidelines visit our online archive at www.nursing-standard.co.uk and search using the keywords.
THE ART OF NURSING has been described as the nurse's ability to maintain nutrition in older people in a skilful way that upholds personhood (Dewing 2003).
Food is an important part of the healing and recovery process of patients with dementia receiving hospital care (Crawley2002). If adequate nutrition is not provided, morbidity, mortality and delays in discharge can result. According to one study reported in a literature review, 50 per cent of hospital patients had pre-existing malnutrition that was compounded by hospitalisation, and malnutrition was a factor contributing to delayed discharge (Hallstrom et al 2000).
The primary reasons for older people being admitted to hospital are infections and fractures, and delirium is a frequent complicating factor (Archibald 2002a). Although vitamin D and calcium supplements are cost-effective, preventive measures against fracture in older people (Dhesi et al 2002), good nutrition is an essential aspect of prevention of fractures and recovery in these patients.
Standards for nutritional intake in patients in acute hospitals have been published (NHS Quality Improvement Scotland 2003), however, nutrition on busy wards is often given less importance than other aspects of care (Dewing 2003). The type of food provided may not be what the person usually eats and can be unappetising.
Other factors that contribute to low nutritional intake are that the ward atmosphere may be hot and dry, the person might be anxious, agitated and frightened, and staff may have a lack of understanding of the person's capabilities. Meal times are often rushed, because of the pressure of other work, and patients who require assistance sometimes have to wait for long periods, resulting in them receiving cold food that is unappetising (Archibald 2002b).
In some people with dementia, cognitive impairment may not be immediately apparent. Nurses need to be aware of the difficulties associated with dementia so that they can care for patients effectively. Lack of knowledge about dementia can be a risk factor for inadequate nutrition, and the absence of formal nutrition assessment can result in missed opportunities for preventive and remedial action ( Archibald 2002a).
Detailed accounts of the difficulties related to eating and dementia have been presented and strategies have been proposed, such as verbal or manual cues like placing the eating utensils in the patient's hands (Crawley 2002, Dementia Services Development Centre 2002, Crowe 2003, Alzheimer's Society 2004, Amelia 2004). This article aims to raise nurses' awareness of the eating needs of people with dementia in hospital care, and to alert nurses to the functional eating and drinking needs of these patients.
Effects of dementia
Dementia affects all aspects of life including the ability to eat and drink (Barratt et al 2001). People with dementia may not be able to recognise hunger or know when they have eaten enough. Inadequate nutrition increases the risk of fractures, delays healing and can exacerbate pressure ulcers in patients with dementia (Crawley 2002) (Box 1).
Weight loss and malnourishment are often perceived to be symptoms of dementia. Although people with dementia experience weight loss, this occurs because they can forget to eat in addition to a complex array of biosocial factors, such as staff not being aware of patients' eating needs, presenting food that they do not like and patients being unable to communicate this (Amelia 2004). It is important to be aware of issues such as how the food is presented, how the individual's difficulties may be overcome, and how the person can be helped to enjoy the experience of eating (Biernacki 2002).
BOX 1
Effects of dementia
Hospital food
Despite the importance of food to human existence, it is a relatively underdeveloped subject in health and social welfare (Manthorpe and Watson 2003 ). Patients' mealtime care can often be viewed as another task to be completed (Dewing 2003), and therefore may not receive adequate attention.
In the mid-1990s, the Caroline Walker Trust ( 1995) highlighted concerns about the quality of food for older people. Later, the Health Advisory Service ( 1999) raised concerns about hospital food for older people. The Alzheimer's Society presented evidence to show that patients with dementia were particularly poorly served as staff had little knowledge about the needs of this group (Manthorpe and Watson 2003). While raising awareness of the eating needs of those with dementia, there is still considerable work to be undertaken in terms of staff education.
As people with dementia, particularly those with visual agnosia and/or apraxia, can have difficulty recognising food or managing a knife and fork, finger foods can help to encourage eating. Sandwiches, hard-boiled eggs and banana pieces are nutritious alternatives to a set meal (Barratt et al 2001). Different types of finger foods can be given according to the patient's needs, with food ranging from normal to soft and 'mashable' (Biernacki 2002). Discussion with a dietician is also helpful in delivering individualised care to patients with these conditions.
Assessment of needs and abilities
A key factor in providing effective care to patients with dementia is to find out about the person -ask what the patient likes to be called, where he or she worked, about his or her family (Archibald 2003); this is particularly the case for nutrition. Nurses have many competing demands when working on acute wards, but it is possible to improve nutrition of patients by being aware of individual patient needs.
A system for assessing and documenting patients' eating needs was piloted at Falkirk Royal Infirmary, Scotland in 2001. An eating observations form was devised for nurses to assess the nutritional needs and preferences of patients (Figure 1), and the information from the form was translated into a 'traffic light' chart that could be displayed above the bed for easy reference (Figure 2).
A personal profile form was also devised so that nurses could work with carers to identify important information about patients, including whether help was needed during mealtimes (Box 2). The information from the personal profile was used to develop an individualised chart which could be placed in the patient's locker or at the bottom of the bed (Box 3). The charts were laminated for ease of moving if the patient was transferred. This system enabled personalised care and easy identification of the level of help nurses needed to provide.
Other systems to improve nutrition are the Edinburgh Feeding Evaluation in Dementia Scale (Green et al 2001 ), which is often used for assessment (Amelia 2004). The 'Stickerpack' system which has been designed for patients with swallowing difficulty or dysphagia has been used effectively in different care locations including acute wards (Crowe 2003). This system provides a comprehensive range of stickers. These are clear coloured illustrations with concise, unambiguous text, which inform nurses about the use of specific techniques to achieve safe eating and swallowing for patients with dementia.
FIGURE 1
Eating observations form
Staff should allow time to find out about the patients' likes and dislikes, their eating routine and their capabilities. This helps to reduce agitation and confusion in patients with dementia and helps staff to tailor care to the needs of individuals (Alzheimer's Society 2004).
Dependence and excess disability
People with dementia may need help with eating, particularly those with severe disability. However, they can be placed at risk of excess disability by staff providing more help than is necessary. For example, patients with dementia may only require some prompting to begin eating or have the knife and fork placed in their hands, but because of time pressures or lack of awareness of their residual abilities, staff can take over and feed patients rather than offering support and assistance ( Barrait et al 2001).
This may result in low self-esteem and loss of independence and can add to carer burden when the patient is discharged from hospital. Taking time to assess the capabilities of the person can minimise the risk of excess disability. Assessment can also help to limit nurse input to what is required so that staff time can be allocated to patients with greater needs.
Food and emotions
Nurses can experience feelings of hopelessness and burnout when trying to help patients with dementia to eat (Manthorpe and Watson 2003). One study found that helping patients to eat was nurses' least favourite job, particularly when patients were perceived as being 'difficult' to assist (Dewing 2003). None of the nurses in the study had spent any time learning about how to assist with eating, other than the use of supplements or nasogastric and percutaneous endoscopie gastrostomy tubes.
FIGURE 2
'Traffic light' chart to be kept at the patient's bedside
Significant psychological processes can occur in those helping patients with dementia to eat. Giving someone food parallels the mother-child relationship and can be idealised as the person receiving the food being receptive and appreciative. When the person either rejects the food or spits it out, staff can experience a sense of rejection (Manthorpeand Watson 2003). It is important for nurses to be aware of their reactions when feeding patients with dementia, so that they can better respond to possible rejection during feeding.
The spitting out of food creates mess and is distasteful to nurses and other patients. It may be seen as 'naughty', and the person may be infantilised. Dribbling is associated with babies, so when it occurs in patients with dementia this can also lead to infantilisation by staff, which can result in frustration and subsequent disturbed behaviour (Manthorpe and Watson 2003).
BOX 2
Personal profile form
BOX 3
Patient information to appear at bedside
Conclusion
Being empathetic is central to the provision of good quality care. It is important to try to imagine the patient's experience when he or she needs help with eating. Hospitals can be frightening places for anyone, particularly for patients with dementia who are unable to remember where they are and, at times, who they are.
While many nurses have academic knowledge of the nutritional needs of older people, they can be under-skilled in the practical aspects of delivering mealtime care (Dewing 2003). By the simple expedients of increasing the awareness of potential eating difficulties in patients with dementia, undertaking assessments and tailoring care to the needs of the individual, nurses can improve care for this patient group who are at risk of malnutrition and consequent increased morbidity
[Sidebar]
Archibald C (2006) Meeting the nutritional needs of patients with dementia in hospital. Nursing Standard. 20, 45, 41-45. Date of acceptance: February 15 2006.
Additional Information
Related Domains
- Dansk
- Data
- Elektronikk
- Engelsk
- Engelsk Oversetter
- Engelsk Oversetting
- Forretningstjenester
- Fra
- Helse
- Juridisk
- Jus
- Juss
- Medisin
- Medisinsk
- Norsk
- Norsk Engelsk Oversetter
- Norsk Engelsk Oversetting
- Næringsliv
- Oversettelse
- Oversettelse Norsk Engelsk
- Oversetter
- Oversettere
- Oversetting
- Oversetting Engelsk Norsk
- Svensk
- Teknikk
- Teknisk
- Til
- Tysk
- Tysk Norsk Oversettelse
- Tysk Oversetting
- Økonomi
- Økonomisk
- Oversettelse Norsk-engelsk
- World