Promoting Healthy Eating for Dementia in Residential Homes - Essay Example

? Promoting Healthy Eating for Dementia Patients in Residential Nursing Homes ID Total Number of Words: 3,022 1.0 Full Project Title “Promoting Healthy Eating for Dementia Patients in Residential Nursing Homes” 2.0 Key Words In search for literature, the four identified key words were used in search for academic books and journals: Healthy eating Malnutrition Residential nursing homes Dementia patients 3.0 Project lead and CV (to be added by the client) 4.0 Rationale for the Project Patients with dementia suffer from mild to severe memory loss. Therefore, there are some cases wherein patients with dementia tend to forget when and how to eat proper meals for at least three times a day. This makes people with dementia at risk of malnutrition (Schenker, 2003:87-120). Malnutrition is not limited to insufficient food intake. In fact, individuals who are obese are also considered as malnourished. According to the World Health Organization (2000), malnutrition related to hunger is a life-threatening situtaion. Therefore, it can lead to a significant increase in morbidity and mortality rate. Considering the adverse health effects of malnutrition on patients with dementia, nurses who are assigned to take care of this group of patients should pay more attention to the importance of proper nutrition. The number of people with dementia is expected to increase throughout the United Kingdom (Knapp and Prince, 2007:22-23). For this reason, nurses should search for new ways on how they can improve the physical health of these patients. One of the best and most simple ways to improve the physical health of patients with dementia is to focus on how nurses can effectively promote healthy eating. By promoting healthy eating among patients with dementia, the nurses can protect the patients from becoming sicklier or more vulnerable to other types of illnesses. There are certain types of food that can help prevent the incidence of dementia. For example, vitamin B12 and Folate deficiencies are also associated with developing dementia and cognitive impairment (Bruce Fife, 2011). Fish like tuna, salmon, mackerel and herring is rich in Omega 3 fats. Based on a recent study, doctors suggest that eating fish at least once a week reduces the risk of developing dementia by 60% (McFadden, 2011), Since dementia is hereditary, continuous promotion of healthy eating can help public awareness against dementia. Thus, improving the healthcare practices throughout the United Kingdom. Nurses are the front-liners within a healthcare setting. This explains why most of the patients with dementia are being cared for by the nurses. One of the role and responsibilities of the nurses is to deliver a holistic care to their patients. Therefore, nurses who are currently working in a residential nursing home should continuously improve their knowledge and skills on how they can effectively promote a healthy eating lifestyle. 5.0 Literature Review General Facts about Dementia in UK Dementia is “a global impairment of cognitive function that usually is progressive and may be permanent; interferes with normal social and occupational activities” (Kozier et al., 2004:1449). In most cases, patients with dementia suffers from “a collection of symptoms, including a decline in memory, reasoning and communication skills, and a gradual loss of skills needed to carry out daily activities” (Knapp and Prince, 2007:2). Patients with dementia are prone to suffer from the rising levels of severe illness coupled with reduced sensory function of taste, smell, and teeth which negatively impacts on the nutritional needs of the patient (Linda, 2005: 221-245). This explains why most of the elderly patients who were diagnosed with dementia are less likely to eat properly as compared to patients with dementia who are still young or in the adulthood stage. Furthermore, several studies mentioned that a significant decrease in the metabolic process of elderly patients can also lead to other health complications that are related to obesity (i.e. hypertension, diabetes, etc.) (Kyrou and Tsigos, 2009; Hajjar, Kamel and Denson, 2004; Lee, Chokkalingham and Srinivasan, 2004). In relation to the decrease in bones and muscle mass of elderly patients, a significant decrease in the elderly patients’ physical activities and reduction in their energy expenditure are the main reasons why elderly patients are most likely to accumulate fat easier as compared to young individuals (Lee, Chokkalingham and Srinivasan, 2004). Within the residential nursing homes, both over-nutrition and malnutrition may be detrimental to the health of the elderly person (Schenker, 2003:87-120). Similar to Alzheimer’s disease, dementia is also related to impaired cognitive function since it can lead to an impairment of short- and long-term memory, executive function and attention (Schiffman and Graham, 2000: 311-319). For example, during the initial stages of dementia, patients can show significant changes in their dietary behaviour such as forgetting to eat on time, forgotten that they had already eaten, eat non-edible things, or unable to recognize food from non-food items (Videbeck, 2008:470-475). In the process of going through the different stages of dementia, patients may end up losing their skills on how to personally prepare nutritious meals, easily get distracted while they are eating their meals, or even encounter difficulty doing simple tasks like uncovering the food container, using or recognizing how to use the utensils, moving their plate towards and away from them, chewing or swallowing their food (ibis). As dementia progresses, patients are most likely to suffer from more serious issues such as agnosia or inability to recognize sensory stimuli such as hunger, memory loss or inability to learn or recall information, aphasia or inability to use language in communication, and apraxia or inability to make voluntary muscle movements (Stein and Wilkinson, 2007:511). Dementia patients suffer from different complications. Therefore, nursing staffs should be competent enough and well-experienced in taking care of patients with cognitive impairment. With this in mind, the nursing Staff should have the capacity to provide the nutritional needs of each patient. By increasing their knowledge on the patient’s personal preferences, history, and background, the nursing staff can have better capacity to deliver holistic care for these patients (Skerrat, 1999:97-103). At the time dementia progresses, the patients’ changing mental and functional status may result in symptoms such as refusal to take food, being socially withdrawn or aggressive (Grace, 1999:267-287). Significantly affecting the patients’ dietary behaviour, psychological imbalances such as hallucinations and delusions are common among the late-stage dementia patients (Desai and Grossberg, 2001; Paulsen et al., 2000). For this reason, nurses should be able to provide the patients with a dinner environment that is as inviting and homely. Doing so will make it possible for nurses to meet the dietary compliance of dementia patients. Importance of Promoting Healthy Eating among Patients with Dementia Elderly patients with dementia are most likely to encounter a reduced sensory function related to taste and smell (Linda, 2005:221-245) including other more serious consequences such as agnosia (inability to recognize sensory stimuli), memory loss (inability to learn or recall information), aphasia (inability to use language in communication), and apraxia (inability to make voluntary muscle movements) (Stein and Wilkinson, 2007:511). Therefore, this group of patients are prone to suffer from the health consequences of poor nutrition. As people grow older, their appetite decreases due to the decreased need of calorie intake by their bodies. In case the elderly patient is suffering from physical problems such as tooth ache, mouth and gums problems caused by poorly fitted dentures, or side effects from their medications, people suffering from dementia can face serious appetite loss for eating and drinking (Kyrou and Tsigos, 2009; Hajjar, Kamel and Denson, 2004; Lee, Chokkalingham and Srinivasan, 2004). The NHS together with the Royal College of Nursing reported that “water is essential to health, and is one of the six basic nutrients (along with carbohydrates, fats, vitamins, proteins and minerals) (Cunningham and Fletcher, 2007:3). Aside from preventing the development of pressure ulcers, constipation, UTI, incontinence, kidney stone problems, heart diseases, low blood pressure, cognitive impairment, poor oral health, poor skin condition and other illnesses (Cunningham and Fletcher, 2007:3), Hines et al. (2010) mentioned that adequate fluid intake is necessary to protect the elderly patients from the risk of falls caused by confusion, and dizziness. Poor eating habits can lead to malnutrition (i.e. underweight, overweight, and obesity) (Schenker, 2003:87-120). In general, obesity is not only a serious health condition but also a lifestyle problem that is visible within a person, family, and the society. Aside from a long list of health problems including type II diabetes or the non-insulin dependent diabetes mellitus (NIDDM), cerebral haemorrhage, coronary heart diseases, high blood pressure, atherosclerosis, osteoarthritis, sleep apnoea, and cancer related to colon, rectum, post menopausal related breast cancer and uterus (Nazario, 2007; Nanchahal et al., 2005; Montaye at el., 2000), obesity could cause a person to deal with social adjustment disorders or social discrimination (Pearce et al., 2002). Since eating and drinking are important in the development of our physical, social and emotional health and well-being, promoting healthy eating among patients with Dementia is important. Ways on How Nurses can Promote Healthy Eating among Patients with Dementia There are many ways in which nurses can effectively promote healthy eating among patients with dementia. Since there are many factors that can cause dementia patients to avoid eating and drinking, the nurses should take it as a challenge to identify the main reason why the patient refuses to eat and drink. For example, knowing that some of the medications used in treating patients with dementia could significantly affect their appetite, nurses should contact the patient’s physician and ask for a possible substitute for the patient’s medicine. In case having a tooth ache or mouth and gums problems caused by poorly fitted dentures is the main cause of patient’s lack of appetite, then the nurses should immediately consult the patient’s case with their family members so that they can make a schedule with a dentist (Donini, Savina and Cannella, 2003; Jolley, 2003). There are also cases wherein the patient’s decision not to eat is caused by cognitive problems. In case the patient is suffering from agnosia, memory loss, or apraxia (Stein and Wilkinson, 2007:511), the nurses should prepare healthy foods and remind them to eat on time. In case the patient’s decision not to eat and drink is caused by behavioural or psychological problems (i.e. depression, distress, etc.), nurses should manage the patient’s depression by giving them the counselling they need to allow them regain their appetite. In case the patient’s loss of appetite is caused by environmental problems (i.e. excessive noise, unpleasant odour, uncomfortable room temperature, or poor lighting) (National Institute of Health, 2006), nurses should make necessary arrangement so that the dining area is more suitable for the needs of the elderly patients. Preparing appetizing foods for dementia patients is equally important. To bring back their appetite, food with different colours and attractive appearance must be served (Stroebele and De Castro, 2004). In most cases, the food presentation should be kept simple yet mouth-watering. Offering food choices can help increase the patient’s appetite (Clarke, 2009). However, nurses should limit their food choices to two in order to avoid unnecessary confusion and frustration (Jolene, 2008:237-245). As compared to the adults, elderly patient’s daily food requirement is much lesser. Therefore, nurses should serve their food in smaller portions throughout the day. To regulate the patient’s eating habits; the nurses should design a daily diet flow chart and implement it on a timely basis. (See Appendix I – Suggested Daily Diet Chart for Dementia Patients on page 13) To implement these changes, the nurse should first educate the rest of the staff about the importance of promoting healthy eating for dementia patients. By letting them know the main objective of this project, it will be easier on the part of the nurse to win the support of the entire staff. Anticipated barriers to change include the lack of time in food preparation. To overcome this barrier, the nurse should communicate with the residential nursing home owner(s) about the need to hire a nutritionist/cook who will be assigned to prepare nutritious meal for the patients. 6.0 Project Methodology Research Aim This study aims to determine the best way to promote healthy eating among the patients with dementia who are currently admitted in a residential nursing home. Method To determine the best way to promote healthy eating among the patients with dementia who are currently admitted in a residential nursing home, the proposed research study will conduct two sessions of research interview (before and after) with at least five (5) research interviews with mental health nurses who are currently caring for patients with dementia. As part of the research interview process, the researcher will use snowball sampling in order to locate at least five (5) research interviewees. Before setting a 30 to 45 minutes appointment with the highly qualified interviewees, the researcher will have to explain the main purpose of this study followed by seeking their approval to participate in the actual research interview. Snowball sampling is referring to referral sampling technique (Craig and Douglas, 2005: 286). It means that the researcher will invite highly qualified research interviewees through referrals. In case a potential research interviewee cooperates well with the researcher, a snowball sampling technique will be applied in the recruitment process of other highly qualified research interviewees. To increase the chances of persuading the target interviewees to participate in this study, the researcher will purposely limit the official interview time between 30 to 45 minutes. The role of the nurses is to provide a holistic care to the patients. Therefore, the rationale for conducting an in-depth interview with at least five (5) research interviewees is to enable the researcher gather a more subjective response with regards how their employer (the nursing home owners) are promoting healthy eating to patients with dementia. The researcher will make use of a semi-structured interview questionnaire and eventually transcribe the data that was recorded in audio tape during the actual interview. (See Appendix II and III – Semi-Structured Interview Questionnaire (before and after) on pages 14 and 15) Evaluation According to Barbara (1998:326-331), a successful implementation and enforcement of the interventions by the caregivers will enable the researcher to get a clearer picture with regards to the effectiveness of a plan. Basically, the nurses and the caregivers plays an important part in the evaluation since they are directly involved in caring for patient needs. Therefore, this group of professionals can provide a useful source of information with regards to whether or not certain interventions are working. Patients with dementia are suffering from cognitive impairment. Therefore, evaluating changes in the eating habits of the patients should be based upon the subjective response of the nurses and caregivers. To ascertain the effectiveness of the measures undertaken, the head nurse should instruct the rest of the nursing staff to carefully observe significant changes in the patients’ behaviour, mood, and desire to eat among others (Clarke, 2009). For example, after implementing the necessary changes (i.e. requesting the physician for an alternative medicine that will not affect the patients’ appetite, scheduling a regular dental check-up for the patients, providing necessary counselling to patients who are showing signs of depression, preparing appetizing food in small portion, offering food choices, and addressing environmental factors like reduction of excessive noise, removal of unpleasant odour, making the room temperature comfortable for the elderly patients, and improve lighting), the nursing staff should be called to attend a regular meeting in order to obtain a more objective feedback directly from the nurses and caregivers. Based on the feedback coming from the nursing staff and caregivers, the researcher should be able to identify the strengths and weaknesses of the said intervention. By encouraging the rest of the team members to provide their thoughts and suggestions, the head nurse will be able to be more successful in terms of promoting healthy eating among the patients with dementia. For instance, instead of preparing Food A, Food B or C can be a better choice in the patient’s daily and future menus. Governance / Ethical Issues Ethical theories such as autonomy, informed consent, non-maleficence, beneficence, and justice guides the nursing students on how one should care and treat for patients. Under the common law or case law, the mere act of ‘touching the patient’ without the patient’s consent is already a ground for professional negligence especially when the patient is harmed as a result of touching the patient (Department of Health, 2001a:2). Therefore, the nursing staff should seek informed consent from the patient before caring for them. There are stages in dementia. In case the patient is still capable of making their own decisions, the nursing staff should observe the law of autonomy by allowing the patients to make their own choices on what on eat (Social Care Institute for Excellence, 2012). In case the patient is no longer capable of making their own choices, the nursing staff should observe the law of non-maleficence and beneficence by doing only actions that can benefit the patients (Rai, 2009:6). By doing so, the nursing staff can give justice to the patients. For example, to protect the patients from harm, nursing staff should offer only utensils like spoon. Since this group of patient is suffering from cognitive impairment, nurses should keep objects like knives, pesticides and other chemicals away from the patients. Potential Benefits Patient-Client Positive health, emotional, and social impact on the patients and their families. Give the patients the opportunity to decide on what to eat. By removing all barriers to healthy eating (i.e. painful gums, excessive noise, poor lighting, etc.), the patients can enjoy eating and drinking. Giving a sense of self-respect to the patients. Help improve the patients’ cognitive behaviours and focus. Service Provision / Delivery Promotion of healthy eating can serve as a platform for verbal and non-verbal communication between the nursing staff and the patients (i.e. discuss how they feel, their emotional, health and social problems, etc.). Appendix I – Suggested Daily Diet Chart for Dementia Patients Appendix II – Semi-Structured Interview Questionnaire (Before Intervention) 1. Good morning. Are you caring for patients with dementia in a nursing home? 2. How long have you been working as a nurse in this nursing home? 3. Can you describe to me how the patients’ foods are being prepared and serve to the patients? 4. Do you think that the residents of this nursing home practice healthy eating? 5. Are you aware that nutritious foods can be used in preventing the worsening of dementia? 6. Does the nursing home you work for is using a daily diet chart when deciding for foods to be served for patients with dementia? 7. As a nurse, how do you promote healthy eating among patients with dementia? 8. Does the nursing home you work for provide a regular dental check-up for the patients? 9. In case the patients’ physician prescribed medications that can affect the appetite of the patients, do you bother to contact the physician and ask for a substitute for the patient’s medicine? 10. Do you bother to provide counselling to the patients in case they are depressed or lonely? 11. Is the dining area in the nursing home free from excessive noise, unpleasant odour, uncomfortable room temperature, and/or poor lighting? 12. Does the nursing home serve colourful and appetizing food? 13. Does the nursing home offer at least two choices of foods for the patients? 14. Thank you. Appendix III – Semi-Structured Interview Questionnaire (After Intervention) 1. Good morning. How are you today? 2. After we have implement some healthy eating intervention such as modifying the dining area, offering of at least two choices of foods, improving the food colour and presentation, etc., do you notice any significant changes in the eating habits of the patients? 3. Do you think the suggested intervention is effective in terms of promoting healthy eating among patients with dementia? 4. Do you have any suggestions on how the nursing home can improve the healthy eating among patients with dementia? 5. Thank you. Bibliography Barbara, J. 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