How Nurses Can Improve Nutritional Safety - Research Paper Example

? How nurses can improve nutritional safety Outline Key terms…………………………………………………………………………….3 Introduction…………………………………………………………………………4 Historical Background………………………………………………………………5 Themes related to patient safety affecting nutrition care…………………………..6 Standards to improve nutritional safety…………………………………………….7 i. Meal time protection…………………………………………………….….7 ii. Screening of Admitted patients for risk of malnutrition……………………9 iii. Nutritional plan for Malnourished Patients ………………………………..10 iv. Monitoring of Patients ……………………………………………….……..11 v. Replacement Meals………………………………………………………………………..12 Conclusion…………………………………………………………………………..13 References…………………………………………………………………………...14 Key Terms Standards: Refers to a level of quality against which performance can be measured. Protected Meal times: Described as protected uninterrupted time to focus on providing an environment conducive to eating, when there are no clinical interventions and all staff focus on people’s nutritional needs Screening: Refers to the process of identifying patients already malnourished or at the risk of becoming malnourished. Assessment: Refers to a more detailed process than screening where a range of specific methods are employed to identify and quantify impairment of. nutritional status. Nutritional needs or requirements: These are indispensable nutritional individual demands. Crockery: refers to tableware, eating and serving dishes collectively. Utensils: refers to implements for practical use; especially in a household. Introduction Nutrition and food experience are imperial to a patient. Not only is food essential for life and symbolizes a basic human right, but It is also a basis for extensive enjoyment, with vital social, religious and cultural roles all of which require deliberation within a health care unit. The provision of food and nutritional care in health care centers is a complex field of service and is the obligation of many members of the hospital team. This is a varied team that consists of the clinical staff: nurses, doctors, midwives, speech and language therapists, dieticians, domestic and catering health care assistants, and therapy assistants. For patients to get high quality service and get optimum benefit from food, all the members of the health care unit must work together and must “do their bit” in partnership with the caretakers. Nurses offer nursing services 24 hours a day, and for this reason, nurses are the only group in a health care center who have direct contact with the patient during meal times and any other time of the day. Therefore, nurses play an essential role in nutritional care and meal experience of the patients. Nurses have a broad obligation in a hospital. Their responsibilities include assessment planning, screening, serving, monitoring, practical assistance with drinking and eating and on occasion, preparation of food in the ward area. Nurses are answerable for their practice in the hospital in all facets of nutritional care, provision of food and drinks. Nurses should deliver services and care to the highest standard possible. Nurses and midwives in the United States are committed offering the best possible care and treatment to patients. As the health workers who spend most of the time with the patients, nurses have an enormous possibility to improve patient safety in relation to nutrition care, drinking and eating. This potency can only be realized by focusing on improving aspects of food, fluid and nutritional care and providing nurses with realistic equipments and sustenance. Historical Background "Hit and Miss" epitomized nutrition services in hospitals, in the early part of 20th century (Glover, 2009). The services could not guarantee any degree of funding by the government. Arguably, nutritional services were exceptionally poor and could not warrant patient safety. In 1939, rationing brought new alertness of nutritional requirements and funding. This resulted to health care centers getting food portions of the patients. In 1946, authority suggested hospitals to employ professional caterers and nutritional agents. The Authority appointed professional chefs to head catering departments in the hospitals. Debatably, by this time food service and nutritional care in the hospitals was slowly fading. While food service became proficient, nursing responsibility became more demanding and gave the obligation of food provision and nutrition away. In 1990’s, nurses realized that they had given away n imperative responsibility. In reference to McWhiter and Pennington (1997), most of the patients admitted were in a malnourished state. This went unnoticed till when 70 percent of the admitted patients became malnourished while in hospital. Themes related to patient safety affecting nutrition care Malnutrition is frequently reported in patients hospitalized with acute illness, and acutely ill individuals without nutrition problems on admission exhibit a subsequent decline in nutrition status (Mirtallo, 2012). Numerous themes have been associated with patient safety affecting nutrition care. These include: Dehydration; due to transfer of dehydrated patients to hospitals. Choking; where patients choke while taking a meal Inappropriate diet; where patients receive normal food when they require textured modified diet. Incorrect artificial feeding; where potency for incorrect dose of enteric feed given or wrong total parental nutrition given. Missed meals; due to declination of meals to. Transfer of care; poor communication between different care settings, both verbal and written. Catering services; due to supply of inappropriate meals. Poor nutrition status weakens immune function and compromises a person’s healing ability, influencing both the course of the disease of disease and the body’s response to treatment (Kelly & Tessier, 2000). Thus preventing and correcting nutrition problems can improve the outcome of disease treatments and can also help to prevent complications. For this reason, nurses have a key role to play in improving the patient’s nutritional safety. They should observe and monitor the appropriate diet and fluids, assess for swallowing problems and ensure an adequate diet and fluids intake (Guenter, 2010). Implementing safe health care is every health professional main concern. It is for this reason that health professionals and concerned health organizations should develop standards for use across all in-patient facilities in the health and social care Trusts across United States and the world in general. The standards should be clear and succinct. Standards to improve nutritional safety i. Protected Meal times Rolfes et al (2011) asserts that the introduction of meal times can be identified as one of the developing areas. Ensuring intake of food is a priority in health care is a significant move in recognizing healthy nutrition and intake of fluids to patients. Protected meal times are existent standards in the hospital. However, research shows that there are inconsistencies in which meal time services and which clinical areas are protected. Being able to access food 24 hours a day to give to people who are hungry or who have missed meals is essential for nurses to be able to supply nutritional care. The noteworthy number of malnourished patients should give cause for alarm in health care industry. In spite of the accessibility of successful treatment, malnutrition frequently goes untreated and unidentified thus leading to worse results, extended hospital stays and augmented costs (Glover, 2009). There are a number of reasons why patients cannot eat in hospitals; one cited is that their meals are always interrupted by ward activity such as ward rounds, cleaning and medical rounds, and therapeutic investigations. Needless to say, these patients have also experienced problems in obtaining help in their meals when needed. Nurses need to ensure that activities at meal times focus on the meal and the person, ensuring that the person is ready to eat and assurance that the environment encourages eating (Kelly, 2000). This can be achieved by reducing the number of activities in the ward to a minimum. Needless to say, nurses should recognize and provide assistance to older people who cannot manage to eat their meal without support, observing the person and monitoring the difficulties to ensure that they are eating and drinking fluids. The primary aim of protected meal times is to ensure commitment of hospital staffs to assisting in meal service and patients who experience problems during meals. Research shows that many professional organizations support the conception of protected meal times. Doctors and health care staff members can ensure reduction of activities in the hospitals during meal times. McWhitter and Pennington (1997) recommend the reduction of unsuitable activities during meal times. In order to ensure effective adherence to protection of mealtimes, the following guidelines should be implemented. Protected meal times can be allocated two hours from noon till 2 pm Nurses take the responsibility of preparing the area around patients prior to meal time Nurses and staff ensure well positioning of the patients Restricted visiting during meal time, with exception of the care givers who aid in feeding and monitoring the patients Halt of all non-essential activities in the wards during mealtimes Nurses should assist in meal service delivery. ii. Screening of Admitted patients for risk of malnutrition All patients should be screened before admission to a hospital. This is to enable the health care givers identify their nutritional needs and advance for their recovery and create optimum well being. In reference to a report by McWhiter and Pennington (1997), approximately 41 percent of all patients admitted to hospitals are undernourished. Failure to address this problem has adverse effects on the patients and the hospital trusts. In order to adhere to this guideline, the following principles should be implemented: All the staff members in the hospital should apprehend the elementary significance of nutritional care to patients All staff should be conscious of screening the guiding principles and comprehend their obligation in it. Dependable and legitimate tools should be used to screen patients on arrival. All the staff members should be trained on how to use the tools and how to carry out screening process. After identification of patients as malnourished or at a high risk of malnutrition after screening, they should be subjected to an in depth nutritional assessment. Assessments should be carried out by qualified, competent and registered practitioners such as a dietician. iii. Nutritional plan for Malnourished Patients A nursing care plan for patients subject to nutritional assessment should be devised, put into practice and evaluated to document and communicate the nutritional care and treatment requirements (Mirtallo, 2012). A nursing care plan will ensure all the nutritional needs of the patients are identified and taken care. Different patients have different nutritional needs. To ensure this guideline is in place: All staff members, especially the nurses, should ensure that screening is done accurately. The patient’s clinical notes should be appropriately evaluated. Nursing care plans should be well planned and implemented. All staff should understand the importance of care planning. iv. Monitoring of Patients Patients in need of food and fluid intake should be supervised to ensure the activity is carried out in an accurate, informative and up to date way. The amount of food and fluid offered to a patient for consumption should be known. This is a fundamental pointer of effective care and treatment (Glover, 2009). Patients should be provided with adequate food that can sustain them. Provision of less or excess food and fluids may result to health complications and may prolong the patient’s recovery. For this guideline to be effective in improving nutrition safety of the patient, the following principles should be implemented. All staff should apprehend the elementary significance of recording and monitoring food and fluid intake, and the requirement to take action when there is cause for alarm. Nurses should go round in the wards to ensure that the patient’s food and drink consumption are monitored. Nurses should record down each patient’s drink and food consumption requirements. v. Identification of patients who require support with eating and drinking Rolfes et al (2011) argues that any hospital staff members interact with the patients during meal times and after meal times. For this reason, it is possible to identify patients who require support and help with eating and drinking. This policy can be attained within the context of the following principles. The hospital staff members identify patients who require assistance during meal time e.g. with a colored napkin or a tray or require smaller pieces of the food. All the staff should be taught on how to identify such patients Nurses should interact and ask the patients if necessary about challenges faced during their mealtime. After identification of the patients that require assistance during eating and drinking, the staff members should take the responsibility of assisting them. This may involve either positioning of the patient before meal times, washing their hands or actual “hands on assistance” where the nurse can wholly help the patient with eating and drinking (Kelly, 2000). In addition, the patients may require assistance with the crockery or utensils. In order to ensure satisfaction of the patient needs, the nurses should take individual responsibility of assisting the patients during their eating and drinking and eating. In addition, the hospital or health care establishment should ensure that there are people in place to help the patients in their meals. Needless to say, there should be modified utensils and equipments and tools in place to be used in case a need arises (McWhitter & Pennington, 1997). vi. Replacement Meals Research shows that only 18 percent of patients are satisfied with the food that they consume. Good nutrition is the foundation of successful care and treatment. Access to food and drinks should be equivalent to the patients’ requirements (Glover, 2009). Debatably, it should not be restrained by ward or service delivery schedules. Glover (2009) notes that nearly 18 percent of patients misses out on any one of the meals. This could be attributed either to diagnostic investigations or declination of meals by the nurses. Nurses have the primary of ensuring that patients who miss out on meals receive replacement meals or substitute food and beverage. The food given to the patients should be suitable in terms of religious and cultural factors, age and exceptional needs. In addition, nurses should ensure that the food is served in the right temperatures or according to the patient’s preferred temperatures. vii. Conclusion Patient safety and the risk of malnutrition can be minimized. Nurses play a primary role in patient nutrition safety. In order to provide significant nutritional care, nurses should be responsible for person centered care that is evidence based, keeping thorough accessing and using quality information and challenge poor practice in relation to nutrition and hydration. These are among the aspects that can lead to the implementation of the mentioned standards and the improvement of patient nutritional safety. References Glover, S. (2009). Food safety, hygiene, Quality Assurance and Control. International Journal of Food safety, Nutrition and Public Health, 1(1), 1479-3911. Guenter, P. (2010). Safe Practices for Enteric Nutrition in Critically III Patients. Critical Care Nursing Clinics of North America, 22(2), 197-208. Kelly, L., & Tessier, S. (2000). Still Hungry in Hospitals: Identifying Malnutrition in Acute Hospital Admissions . Quarterly Journal of Medicine, 93(2), 93-98. McWhitter, J., & Pennington, C. (1997). Go Hungry in British Hospitals: Malnutrition is Common, unrecognized and untreatable in Hospital patients. British Medical Journal, 314(7082), 752. Mirtallo, M. J. (2012). Consensus of Parental Nutrition Safety Issues and Recommendations. Parental Enteric Nutrition, 36(2), 62-67. Rolfes, S. R., Pinna, K., & Whitney, E. (2011). Understanding Normal and Clinical Nutrition. Cengage Learning: , (7082): 752. Quarterly Journal of Medicine 93 (2): 93-98. Read More