Progressing Development in Mental Health Nursing - Essay Example

?Discussion  Malnutrition can be refered to as lmpaired heath caused by a dietary deficiency, excess or imbalance (International Council of Nurses 2009). Malnutrition can adversely affect bodily function and cause illness.. Older people who suffer from malnutrition tend to be vulnerable and so they are at greater risk of acute illness (NCCAC 2006). To explore the meaning of ‘malnutrition , Bachrach- Lindstrom et al (2006) describe it as the result of an imbalance between nutritional needs and nutritional intake. Malnutrition can be said to be serious result of changes in health or deterioration in a long-term condition. In some situations the person may make a rigid determination not to eat. In some cases malnutrition might have taken place before such older people are admitted to the hospital. However, in some cases malnutrition may be a result of suboptimal gerontological care and management, medical or surgical interventions, the psychosocial effect of hospitalisation or a lack of proactive, therapeutic personcentred interventions purpose at promoting adequate food and nutrition. An identified caused of malnutrition in older adult is the loss of f feeding abilityy which is a common problem for older adults (Kolodny & Malek 1991, Kayser-Jones 1992, Herne 1995, Kayser-Jones & Schell 1997a, Berry & Marcus 2000) especially those with dementia (Watson 2002, Manthorpe & Watson 2003); With cognitive impairment associated with Alzheimer’s disease and dementia, malnutrition is unavoidable. Such older adults do not have the cognitive ability to initiate or continue effective feeding strategies. In contrast the older person with neuromotor disorders, such as stroke or Parkinson’s disease, may cognitively manage feeding but might not have the neuromotor skills to help chew or swallow effectively. Moreover , the older people living in retirement and nursing homes need other support, including help with dressing, defecation and help with eating. The residents in the nursing homes need extensive nursing care and medical care as they may have diseases such as cancer, stroke sequelae or severe dementia (Hedin, 1993).  . Several studies show risk of malnutrition between 30% and 38% (Visvanathan et al. 2003); in older people (>65 years) who had recently moved to a residential home. However the problem of malnutrition still persists among older people living at home, who need help, as shown by the percentage of 3.5% reported by Thorslund et al (199). Alternatively 33–37% would be at risk of malnourished when they move home (Wikby et al. 2006).  Analysis  As we age, it is more important to look into our health and well being and the the prevention of malnutrition should be taken seriously among older people with dementia. It is much easier to prevent malnutrition among older people, rather than treating them after they have become ill from it, (Larsson et al. 1990, Payette 2005). Patients who receive information about the need for protein and energy intake and are active i have an increased intake (Pedersen 2005).  l. Malnutrition can have consequences both on the individuals affected and the carers by causing morbidity, hospital admission, delayed discharge and an increased dependence on social care and next of kin ( Van Nes et al. 2001 ).  Risk factors identified for malnutrition in earlier international studies are diseases (Beck et al. 1999, Payette 2005, Alberda et al. 2006, Chen et al. 2007), to much medications, low functional status (Payette 2005) symptoms of depression. Additionally, involuntary weight loss among older people was associated with disease (Callen & Wells 2005, Payette 2005), inadequate nutrient intake and consequences for health (Payette 2005). In 2001, a concept analysis of malnutrition in older people was first published in the Journal of Advanced Nursing, in which the critical attributes of malnutrition in older people were identified to include insufficient dietary intake, muscle wasting, weight loss, poor appetite and downward trajectory.  Body mass index (BMI) is a tool which I think is really good to measure height and weight loss and score using tables provided . Also screening of nutritional risk should be taken with people with mental health needs.  In 2001, a concept analysis of malnutrition in older people was first published in the Journal of Advanced Nursing, in which the critical attributes of malnutrition in older people were identified to include insufficient dietary intake, muscle wasting, weight loss, poor appetite and downward trajectory.  Measures should be taken to ensure proper nutrition status for the older people, it will reduce healthcare costs and enhance quality of life. Body mass index (BMI) is a tool which is which can be very useful to measure height and weight loss and track using tables provided . Also screening of nutritional risk should be taken with people with mental health needs.  During my clinical placement , I observed that many older people now live at their own despite the state of health or whether they suffer from diseases or disability need help from a home care service. Yet, functionally dependent home-living older people have an increased risk of developing malnutrition (Visvanathan et al. 2003).  The finding of ( Larsson et al , 1990 ) states that older people in long-stay hospital care or in municipal care are the groups most at risk of malnutrition. Without special food intake monitoring and nutritional interventions, food intake in these people is often inadequate and below recommended energy expenditure (Unosson et al., 1994, 1995). Good nutrition has a big role to play in the general physical conditions of both healthy people and the sick , most expecially in the healing pressure sores, mental condition and on the mortality rate. (Larsson et al., 1990).  The causes of malnutrition in older people are complex, involving physical, physiological, psychosocial, medical and economic factors (Rudman & Feller, 1989; Blaum et al., 1995). Ability to mobilize, assistance with feeding (Unosson et al., 1991), and eating problems (Jacobsson & Axelsson, 1997) are factors associated with malnutrition..  The major concerns in malnutrition among older adult is the feeding problem, this problem accurately reflect the interaction between caregiver and the older adult than the term ‘feeding’ in general. The problem of feeding provides more information to the nurse or carer who must select appropriate interventionsas a solution to effectively deal with specific feeding problems.  Diseases that lead to feeding difficulties are characterized by perceptual deficits, cognitive impairment or a lack of motor control required to recognise food and eating utensils, effective use of these utensils to get the food into the mouth, or effectively control chewing and difficulty in swallowing food. Dementia patients, may experience difficulty in handling food on the plate, transporting it to the mouth, manipulating it in the mouth and swallowing (Athlin et al. 1989a,b, Morris et al. 1989, Sanders 1990, Watson 1993, 2002, Priefer & Robbins 1997, Watson et al. 2003).  By carefully analyzing the concept of malnutrition, a full in depth understanding of feeding difficulty among the older adults having dementia  emerged. Feeding difficulty affects the mental and physical health of this group . However this problem is related to the burden of care on those who provide assistance to these adults affected by dementia. An understanding of the antecedents and consequences of feeding difficulties as separate from feeding difficulties themselves allow the nurse to make a more accurate r assessment and assist the nurse to select the appropriate interventions targeted to the specific problem. The outcome of feeding difficulty can be used to assess the effectiveness of the interventions and how serious the feeding difficulty is. Out of the 13 intervention studies noted , identified by Watson and Green (2006), only two assessed food and fluid intake that is a consequence of improved feeding difficulty (Ragneskog et al. 1996, McDaniel et al. 2001). Feeding behavior of residents should not only be assessed but also the effect of the kind of food and fluid intake. Both outcomes must be assessed because of their importance for future studies of intervention targeted to feeding difficulty.(Coyne & Hoskins1997 ).  Reflection  Reflection is an important aspect of nursing. Reflection allows the practitioner to acknowledge and explore the choices they make in practice ( Price 2005 ). Through my practice placement in older peoples dementia ward, I had the opportunity to learn a lot about dementia, most especially in patients with nutritional problems and also those that do not have the ability and initiatives to feed themselves. agreed with Melville (2008) that a healthy balanced diet could be the best way to ensure the body is getting the nutrients it requires, and that keeping note of food intake could help people to be aware if they are taking the right diet and help them to identify where they need to make adjustment.  According to Watson & Green (2006 ), not much has been done to assess interventions to minimize feeding difficulty and increase nutritional intake. Some studies described and identified feeding problems of older people with dementia and the relationship between feeding difficulty and nutritional intake (Berkhout et al. 1998, Porter & Kayser- Jones 1999). Thus the research on interventions for feeding difficultyl control of confounding factors is insufficient (Watson & Green 2006) . A variety of feeding difficulties are solved by trying simple interventionsuch as encouragement and so there needs to be studies to provide evidence of this. As a future mental health nurse I quite agree that treatment for malnutrition should be checked on a regular basis by trained nurse staff and healthcare professional to ensure that the patients are getting all the nutrients they need since lack of nutrients in the body can be caused by different circumstances and conditions such as depression, stomach condition, alcoholism, diarrhoea and vomiting. I observed that some patients need only physical assistance or verbal motivation to feed themselves, while others who are able to chew and swallow the food effectively only need help to get the food across to the mouths. Some feeding difficulties are related to antecedent problem behaviours such as not paying attention or being distracted easily. And interventions may vary dramatically if the feeding difficulty is related to poor motor control, cognitive impairment or inattention. Eaton et al. (1986) assessed the effects of touch and verbal motivation on nutritional intake among older patients without cognitive impairment and others assessed the intervention among older patients with organic brain syndrome (Lange-Alberts & Shott 1994).  There is a need for nursing intervention in order to address the difficulties of  feeding in the older people “ Feeding Behaviours Inventory” is another assessment of factors related to the need for nursing interventions and measure of feeding difficulties of dementia patients and thus includes 33 mealtime  behaviours (Durnbaugh et al.1996) based on clinical observations from a long-  term quality assurance program to manage problem behaviours at mealtimes.  The score is the sum of the behaviours observed. Music has been noted to  reduce the agitated behaviours during mealtime (Denney 1997) and could  have positive outcome on feeding problems and food intake among dementia  patients (Ragneskog et al. 1996).  Some studies have suggested that good feeding skills, and creating enough time  for feeding may improve food intake during mealtime, also the provision  of snacks and food supplement may improve food intake in patients with  dementia (Nangeroni & Pierce 1985, Michaelsson et al. 1987, Suski & Nielsen  1989, Hall 1994, Hellen 1998 McGillivray & Marland 1999, Wasson et al.  2001).  Kayser-Jones and Schell (1997b) studied the mealtime experience of  cognitively impaired older people and documented counterproductive care  strategies that included negative addressing of the resident, not getting  assistance and supervision at mealtime and mixing food together. Not serving  it one at a time- meal, dessert and tea separately- and successful feeding may be  a strategy used by caregivers but raises ethical issues (Norberg & Hirschfeld  1987).  Whilst in placement, we do encourage independence at mealtimes  by providing supervision and assistance to the elderly ones .This has been proven  to be an effective strategy also creating a social mealtime environment  (Melin & Gotestam 1981, Diaz 1999) such as using family style meals (Altus  et al. 2002) and simplifying the process of eating.  There has been suggestion of using other interventions that included multi-  sensory cueing, task simplification and sequencing, mirroring, hand-over-hand  approach, bridging and eating facilitation techniques( Hellen 1998 ).  In the nursing assistants’ feeding skills training program, individual  intervention effects on reducing feeding difficulties among people with  dementia have not been empirically tested (Chang & Lin 2005, Chang et al.  2006).  According to the Department of Health (DH)( 2001, 2003, 2007), Age Concern  (2006), Royal College of Nursing (RCN)( 2007a) the importance of adequate  food, nutrition and hydration in the care of older people is well recognised.  Older people accessing services and care in hospital have been identified as being at particular risk of becoming nutritionally compromised and at risk of malnutrition (Age Concern 2006, Murray 2006). This is not only as a result of the ageing process, acute or chronic illness and the interplay of co morbidities, but food and nutrition are key to health, healing and general wellbeing and as such are core components of essential, not basic, care. It is a fundamental human right.  It is important for health care professionals to be proactive and skilled in nursing hospitalized older people, in order to identify small, but potentially influential problems that can lead to malnutrition if left unmanaged (Eberhardie 2009).  Gaining theoretical knowledge and understanding in relation to the ageing process and the effect of ageing on older people’s nutritional needs are important. However, of equal importance is the need for practice of development approaches aimed at increasing the effectiveness of person-centered care.  Older people have a right to receive nutritious food and help to eat that  food when needed.Nurses working with older people have a professional responsibility to ensure, that we identify the risk of malnutrition in people through health screening using the methods of assessment that capture the nutritional needs of the person. In addition, we also have the professional responsibility to ensure that people who require help with eating and drinking receive that help. As a future nurse we must best meet this patient’s needs, by acting in their own best interest.  Conclusion  During the course of this project , l have gained more experience and understanding into the  cause, prevention and intervention for the management of malnutrition in older adult.  Furthermore, this essay has enabled me to establishe that malnutrition in older adult can be  prevented and could be totally eradicated lf all measures are followed to care for our elderly.  Based on the research into the subject and my direct observation of interventions during my  placement, I strongly feel that patients should be cared for by health care professionals who  have undergone appropriate training and who know how to initiate and maintain correct and  suitable protective measures.  Weight loss is common among elderly people and as such can have a deleterious effect on the  ability to function and on quality of life. I believe keeping hydrated and eating areamong  the essentials of human need. Few people who are cared for by health and  social services at times do not get adequate support to meet their nutritional needs. . Progressing to enjoy food and to eat a diet that maintains nutritional status is a key to  coping with illness as poor nutrition has been recognised to increase the risk of infection and  poor wound healing.  All patients in care have the right to receive appropriate levels of food and nutrition ( Tolson  et al 2002). Nurse and other members of the multi-professional team need to be aware that  we all have a duty o to ensure that all patients receive appropriate care they deserve.  Clinical supervision has exposed me identify the areas within the admission assessment  process that were good and bad. This exposure has has enabled me to improve my practice on the good  area and allowed me to amend the bad areas to promote change to enhance  patient care. This has helped me to identify that reflection  and supervision enable health care professionals to feel better supported and confident  contributors to safer and more effective patient care. Read More