Assisting client with eating and drinking in nursing
In many acute hospitals domestic or housekeeping staff now serve meals but it is still essential that nurses supervise mealtimes to ensure that clients receive adequate amounts of the correct diet, that they eat it and that an evaluation is completed if any problems arise. Unfortunately, food and drink is sometimes left out of reach, or the client is not given any help when required, resulting in the client receiving neither. Nutritional assessment should identify those people who need assistance with feeding. Guidance in assisting adults to meet their nutritional needs is given below. Assisting with feeding the client orally will be discussed in detail later in the chapter. Clients with special feeding needs such as enteral feeding via nasogastric or gastrostomy tubes have different needs and this is beyond the scope of this text.
In relation to infants the procedure for giving a bottle feed varies from hospital to hospital. Some have feed units where formula feeds are prepared and pasteurized centrally, thus preventing the need to make up feeds in ward kitchens. If you are required to prepare a formula feed, the manufacturer’s instructions should be followed strictly, as the wrong concentration of powder to water can cause too-high sodium levels and be very dangerous to the infant. All the equipment to be used must be sterilized prior to undertaking the procedure, in keeping with local policy. Most acute hospitals have ‘ready to feed’ bottles of formula whereby a disposable teat is screwed onto the bottle and all that is required is to heat the feed to the correct temperature prior to giving. A full assessment is essential as some infants prefer the milk to be very warm and others just aired.
It is common for infants to have a small vomit when bringing up wind. This is known as a posit and is quite normal. There are various ways of helping the infant to bring up wind but placing the baby upright and rubbing or patting the back is a general recommended principle. It is also recommended that weaning is introduced at 4 months of age and usually begins by introducing a few spoonfuls of baby rice mixed with breast milk or formula feed. Children should never be forced to eat, as this is often a cause of feeding problems such as food refusal later. It is normal for children to refuse food when they are ill or stressed. When feeding children the following foods should be avoided:
• under 3 years: nuts and nut products (can cause choking and are a potential allergen)
• under 1 year: nuts and nut products (as above); milk as a main drink (nonmodified protein and therefore difficult to digest at this age); and added salt or sugar (can cause electrolyte imbalance)
• under 6 months: nuts and nut products (as above); milk as a main drink (as above); added salt or sugar (as above); fish, wheat, eggs (potential allergens), food with lumps in (potential for choking), and fresh fruit juices, which can cause diarrhoea if given in excess.
It should be remembered that mealtimes can also be used as teaching opportunities for children and other people with learning needs. In addition people with eating disorders may have individualized feeding programmes. Eating and drinking also have a sociable element so it can sometimes be beneficial to involve relatives and friends in assisting clients to eat and enjoy their food, though this should be considered carefully beforehand, preferably in discussion with the client, as too many distractions can result in some clients being put off their food.
Clients, if able, may also benefit from being encouraged to eat in a separate dining area if one is available. This is especially pertinent in long-term care facilities and can also act as a useful reminder to those with limited memory who simply forget to eat without the external prompt of seeing others doing it. However, it may be more appropriate with clients who have difficulty feeding themselves, or those who need to be fed, to undertake this activity in more private surroundings in order to reduce embarrassment and distractions. What is important is that clients are involved in decisions about their food – its amount, timing and so on.
The aim of assisting clients with eating and drinking is to ensure that they receive the optimum amount of food and fluid whilst promoting independence. The following should be taken into account when preparing to assist clients:
• Consider the cleanliness of the surroundings and ensure that there are no unpleasant odours or sights.
• Remove any offensive material such as sputum pots, urinals, etc. from the client’s bed table/eating area and clear a space for the tray.
• Place a chair beside the client’s bed/chair for the nurse.
• Have to hand:
non-slip plate mat plate guard appropriate handled cutlery or soft spoon in the case of children. (You may need to liaise with the occupational therapist to determine appropriateness of the above.)
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