Promoting Nutrition for Older Adult In-Patients in NHS Hospitals in Scotland
IV: STAFFING
Introduction
69. This chapter draws attention to the different types of staff who all have an important role to play in helping patients to determine and meet their nutritional requirements. It is, however, useful to give consideration to new approaches/roles in which the nutritional needs of patients can be addressed by collaborative working between nursing, dietetics and catering.
Nurses
70. Nurses in caring for patients holistically will have a central role to play with regard to patient nutrition. The named nurse will be responsible for ensuring assessment of nutritional status and the development and audit of the nutritional care plan.
Dietitian
71. Dietitians play a key role in the nutritional care of older adults and their remit within the multi-disciplinary team is crucial.
72. Identification of nutritional risk will highlight appropriate referral to the dietitian who will provide an in-depth assessment and management of nutritional care. The treatment offered is cognisant of the complex needs and care of older adults. The dietitian will also liaise with primary health care colleagues, social workers, home carers etc, to ensure nutritional care is continued in the community.
73. The dietitian provides education and training to all health professionals to ensure that staff have up to date information on food and nutrition issues. They will be involved in the development of health improvement programmes and nutritional policies, standards and procedures to support the care of elderly people. Dietitians also act as a resource for other health professionals and local communities.
74. The dietitian is an adviser in catering and food service, being involved in menu planning, development of food and health policies, monitoring of food service systems and the nutritional content of meals being offered.
75. Ongoing evaluation and audit of service delivery and therapies is an integral part of professional dietetic practice. This provides an opportunity to increase knowledge and provide effective, evidence based care.
Dietetic Assistants/Generic Workers
76. Monitoring patient food intake is crucial to improving nutrition status and hence patient care. Such studies require time but not necessarily the skills of a dietitian. In 1998 the British Dietetic Association agreed a resolution that recognised this issue and agreed to develop the concept of the 'Dietetic Helper' 26. The results of initial work undertaken suggest that there is scope for two categories of assistant: a dietetic helper and a generic worker. Details of the core activities are detailed in the box below. It should, however, be noted that although the dietetic assistant can undertake all the tasks of a generic worker, the converse does not apply.
| Core Tasks for a Dietetic Helper | Core Tasks for a Generic Worker in Relation to Nutrition |
The dietetic helper should be able to: Advise patients on menu options suitable for their dietary needs Input diet history records for computer dietary analysis Add data to nutritional database Collect print out of relevant patient related data Order special dietary products Liaise with dietitians and diet cookery staff and other relevant professional staff Monitor quality standards and participate in audit and research Teach cooking skills within a nutrition education framework Prepare information for diet preparation Maintain product information All the tasks identified above will be under the direct supervision of a state registered dietitian (SRD). Plus all the generic worker tasks | The generic worker should be able to: Check that nutritional screening is taking place Identify within protocols the need for the delivery of equipment for nutritional support Collect data with reference to diet type and usage of supplements Liaise with ward staff, catering department and patients with regard to food intake Check and collate menu cards Assist patients to complete menu cards Prepare and administer nutritional supplements as directed by SRDs Monitor and record supplements, food, fluid, snacks intake Weigh and measure patients' height and record appropriately Assist patients in eating and drinking Identify and aid provision of feeding aids Identify patients' food and drink preferences Undertake ordering and stock control of dietary supplements Check ward fridge temperatures Check there is appropriate storage of food and supplements in ward and patient areas |
Source: Dietetic Assistants - Professional Development Committee Briefing Paper No 10. British Dietetic Association November 1999.
Hostess or Health Care Assistants in Nutrition Support
77. The responsibilities of a ward hostess or health care assistant include the provision of support to the multidisciplinary ward team and to promote adequate nutrition intake for patients at risk of malnutrition.
- Duties include:
- Assisting patients with their choice of menu;
- Liaison with the catering department;
- Nutrition screening;
- Monitoring of patient food charts;
- Documentation of nutrition intake;
- Participate in the care of patients unable to eat independently; and
- Oral hygiene.
Examples of Good Practice: [1] Ward Hostesses have been piloted within the Cardiothoracic ward at the Royal Infirmary of Edinburgh and it is anticipated that these posts will be incorporated in the new hospital. [2] Within the Argyll sector of the Lomond and Argyll Primary Care Trust a helper has been employed with joint funding from nursing and domestic budgets. The helper assists with frail elderly patients to ensure adequate fluid intake and to positively promote nutritional supplements with nutritionally at risk patients. The benefits are obvious in that nutritional status has been improved and the risk of complications, due to malnutrition, have been reduced. |
Nutrition Link Nurses
79. Link nurses can assist in the training of health care workers in the prevention of malnutrition during illness and promote the benefits of adequate nutrition whilst acting as the link with the dietitian and nutrition support team.
Example of Good Practice: [1] In Lomond and Argyll Primary Care Trust nutrition link nurses have been introduced on wards to help progress standards for screening and other nutrition related issues. A training programme/network has also been developed to help support these nurses. |
Nurse Nutrition Specialists
80. The role of the nurse nutrition specialist is to provide education to increase the awareness of the importance of nutrition to patient recovery. These specialists, in consultation with colleagues from other disciplines, provide appropriate artificial nutrition support for undernourished patients, develop procedures and guidelines for the provision of artificial feeding and liaise with the dietetic service on the provision of artificial nutrition support. They also initiate audits, advise members of the nutritional steering committee and act as a source of information on nutrition related issues.
Speech and Language Therapists/Occupational Therapists
81. Speech and Language Therapists have a key role to play in assessing patients with swallowing difficulties and in making recommendations for appropriately modified consistency diets and compensatory strategies to ensure patient safety. Occupational Therapists also have an important role in assessing patients' level of disability as regards to feeding and recommending the appropriate specialised feeding aids to assist with this.
Volunteers
82. Volunteers can help patients who require assistance with feeding at mealtimes. They should be competent to carry out the task and have on-going assessment. Once the provision of a volunteer service has been established a designated person responsible for maintaining an adequate level of service provision should manage it. Volunteers can also provide much-needed assistance to nursing staff and can assist in the running of the ward at mealtimes. Volunteers should receive training in communication, hand hygiene, confidentiality, positioning of patients and patient dignity. In addition, they should know how to respond to a choking patient. A period of shadowing members of the ward staff, when they are feeding patients can be beneficial.
83. Whilst the use of volunteers and carers can be extremely useful in assisting ward staff with the service of food, it is crucial that these individuals are provided with sufficient training and indeed, are supervised. The use of a volunteer co-ordinator can greatly assist in providing additional support for the running of a ward or department, however, care has to be taken to ensure that there is always an adequate number of trained staff on duty to supervise volunteers.
84. There is a need to develop all staff involved in the service of food to patients to ensure that they understand their responsibilities and any risks involved in feeding a particular patient. They also require to feed back information to trained staff on patients who for any reason are not eating sufficient quantities of food or are experiencing swallowing difficulties.
Examples of Good Practice: [1] Basildon and Thurock General Hospital carried out a ward hostess study in 1999. The main objective of the ward hostess was to "ensure patients requiring assistance with eating and drinking received identified help, record patients nutrition intake, ensure appropriate menu ordering and improve communication between wards and catering departments". The implementation of the ward hostess programme at Basildon has shown a significant benefit to the nutritional wellbeing of patients. However, the responsibility for ensuring that the patients are fed still rests with the nurse in charge. Supplement drinks known as sip feed are regularly prescribed as a supplement to the patients oral dietary intake. Orsett Hospital found that "once assistance was given with feeding, sip feeding costs were reduced from 250 per month to 60 per month as verified by the pharmacy budget" 27. [2] An audit conducted in March 1998 looked at the potential need for a Ward Hostess for the patient meal service and recommended that "the patient meal service would improve following the permanent introduction of a ward hostess or designated person" 28. [3].The Royal Infirmary of Edinburgh commissioned a pilot study into food wastage at ward level and the resulting recommendations included the regular training of all staff involved in the meal service. The introduction of a ward hostess helped to reduce food wastage, increase patient satisfaction and facilitate additional nursing time 29. Food wastage was reduced as a result of patient choice at the point of delivery. |