9. Who should feed our patients?

Suffolk Branch

(MFD) That this meeting of RCN Congress discusses who should feed our patients

Debate report

During this discussion, it was agreed by the majority of delegates that the wording of this item should be amended to: ‘That this meeting of RCN Congress discusses who should support our patients to eat and drink’.

Proposer, Lisa Mickleburgh of RCN Suffolk branch stressed that patients were not being given help with eating and drinking. The Care Quality Commission reports that one in five patients receive no help, and has issued 12 hospitals with warnings for failing to feed and water their patients correctly. She said “hospitals are failing because staff are too busy, there are too many patients, or because staff are not aware of their patients’ requirements”.

There were arguments for nurses to take on the responsibility, alongside using families and volunteers to assist with feeding.

“Malnutrition is everyone’s business” said Tracey Paine from the RCN Older People’s Forum. She reported that 15 per cent of hospitals and 20 per cent of nursing homes are failing to adequately feed their patients. This figure is unacceptable and there is a need for investment.

Mike Hayward, Outer South West London branch, recommended that, following his work in Afghanistan, we learn more from Asian family values and let extended families help with feeding of patients. “It saddens me to hear of patients being malnourished and drinking water from vases. We need to do things differently”.

Patricia Leung from the North West Inner London branch suggested that nurses should take on the responsibility to deliver this important care and protect meal times for their patients.

“Nutrition is part of nursing. It’s as important as giving drugs” said Doreen Angell from the South West Dorset branch.

Lisa Mickleburgh closed the debate by thanking all speakers for their time and input.

Background

There remains inconsistency across UK hospitals in terms of policy and guidance relating to support provided to patients at mealtimes, and its quality. The most recent inpatient survey from the Care Quality Commission reports that of those patients who required help with eating meals, 1 in 5 did not receive any.

To help maintain high levels of patient nutrition in an increasingly pressurised working day, volunteers are assisting patients at meal times – in the place of nursing staff. Examples of this include the Volunteer Mealtime Companion initiative in Northern Ireland and NHS Ayrshire & Arran in Scotland who developed a national pilot to introduce Ward Volunteers at Mealtimes in selected ward areas.

RCN Scotland has welcomed such measures undertaken by health boards to ensure the nutrition of patients is a central part of their care. The Scottish Government has committed more than £1.75m since 2008 to tackle the problem of malnutrition in hospital patients. Nutrition champions have been introduced to promote nutritional standards. RCN Northern Ireland has also agreed a joint charter with Volunteer Now to encourage and promote volunteering whilst safeguarding against role substitution. This will be formally launched shortly.

As Green et al (2011) state this concept is not new and examples can be found around the world – but the level of training for volunteers is not universal.
Research shows that trained volunteers can facilitate patients eating well, improve patient care and help maintain protected meal times. Volunteers, cannot however, be used universally, for example where there are medical complications or disorders that could compromise patient safety. Therefore research advocates that nurses should initially supervise volunteers to assess their competence and confident in assisting patients to eat and drink.

However, in contrast to this Sneddon and Best (2011) state that there is no information available on the clinical or the cost-effectiveness of volunteer assistance programmes – an issue echoed by Green et al (2011). While all studies reviewed by Green et al report benefits in using volunteers, the evidence in support of such benefit can be said to be generally limited.

Nutrition and hydration are fundamental to good nursing care, and the responsibility for arranging or providing them lies firmly with the nursing team. The RCN Principles of Nursing Practice describe what everyone can expect from nursing practice. Principle D states that nursing staff provide and promote care that puts people at the centre, involves patients, service users, their families and their carers in decisions and helps them make informed choices about their treatment and care.

References and further reading

Green S, Martin H, Roberts H, Sayer A (2011) A systematic review of the use of volunteers toimprove mealtime care of adult patients or residents in institutional settings, Journal Clinical Nursing,20(13-14), July, pp. 1810-1823.

Sneddon J, Best C (2011) Introduction of mealtime volunteers in a district general hospital, Nursing Standard, 26(15-17),14 December, pp. 37-40.