Who should be feeding patients?

Posted by:

21 November, 2011

At some point during your student nursing life you are going to come across a patient that is unable to feed himself or herself unaided.

In these situations it may be you or another member of staff that will help out but who would be best placed to do this?

The accountability for a patient’s condition lies with the nurses.

They have to ensure that their patients are adequately fed. Shocking statistics have emerged detailing the number patients that leave hospital malnourished. Why? Probably a mix between the ward environment, the actual nutritional content of hospital food and the patient’s condition.

However one problem is that mealtimes often coincide with the nurses’ drug round and when trying to prioritise a nurse’s time, the medication round usually prevails. There are the auxiliary staff like healthcare assistants and associate practitioners, but on a busy ward there can be more patients in need than there are staff available.

The obviously simple answer would be to hire more members of staff but in times of financial austerity and cutbacks this is a luxury that few wards can afford. How about volunteers? The often secret workforce that runs shops, sells sundries on the ward and carries out admin tasks may be members of the ‘League of Hospital Friends’ or another voluntary organisation. Unfortunately the reality is that not every hospital ward in every trust has access to generous volunteers.

Finally we have relatives. Having considered some of the other options is it hard to imagine why this particular hospital trust would ask relatives to assist at mealtimes. There are clear benefits from the hospital’s perspective and I’m sure the purported outrage is in reality a few grumblings. Maybe the best solution would be a mixture of all the available options.

In my opinion we need to be honest and realistic. Hospitals have to be honest with the public and with relatives in conveying the rationale behind their decisions and, in turn, we all must be realistic in our expectations of the health service. The population is increasing and the funding seems to be decreasing so I think this is far from the last controversial subject that I will be discussing.

As usual I want to know what you think. What has been your experiences on a busy ward during mealtimes? How do the staff juggled their many responsibilities?

Let me know.

Readers' comments (24)

Anonymous | 21-Nov-2011 1:18 pm
Unless swallowing needs assessing I do not feel it is the job of the RGN to be feeding patients - HCA's are perfectly able. There are a hundred and one other jobs that RGN's should be doing instead.
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Anonymous | 21-Nov-2011 1:25 pm
Personally I have never had any problems surrounding mealtimes versus other duties. There is a protected mealtime policy in place within the local trusts in Northern Ireland which means no visitors unless agreed by sister and drugs rounds and mealtimes are two hours apart. This ensures all staff are available to assist with patient feeding. All staff must be aware of each patients nutritional needs and level of support required. To add to this each patient has a dinnerplate notice above their bed which displays the level of support the patient requires. If there are difficulties around mealtimes then surely management need to look at the ward routine and implement appropriate changes to ensure patients are receiving their meals.
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Anonymous | 21-Nov-2011 1:32 pm
To: Anonymous | 21-Nov-2011 1:18 pm

The basics of nursing care is important as well. Nutrition is part of this, how can you say a nurse should not be involved in this aspect of care. Are nurses not responsible for documentation regarding nutrition and referrals. I am shocked by your attitude. Staff were I work act as a team especially around mealtimes. If there is another task that takes priority then thats different. But to say you are too busy to even provide basic care is ridiculous.
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Anonymous | 21-Nov-2011 2:30 pm
I'm appalled by the high handed, arrogant attitude of the first respondent. It's the responsibility of every member of the team to do what is necessary as and when. What would he/she do if all the HCAs were busy doing something else- ask the domestic to do it because he/she is perfectly capable? Every ward would be in a fine state if everyone acted in this way. Good HCAs are the backbone of most wards and should never be treated as though they are lesser beings, just because we have a degree. Shame on you!
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George Kuchanny | 21-Nov-2011 3:08 pm
This is a good question to pose without doubt. For those patients who are lucky enough to have doting relatives on hand (by no means all patients unfortunately) I do not see that it is wrong to use the relatives as a resource. Admittedly this can put other ward activities out if the relative(s) are always calling for help/advice/utensils/odd food requests or suchlike but I feel this can be managed quite well. If they are a disruptive group of Victor/Victoria Meldrews their assistance can at a pinch, be kindly turned down.
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Samantha Johnston | 21-Nov-2011 5:12 pm
In response to the discussion and the first comment, it is everyone's responsibility to ensure patients are fed, not just the nurse and not because a person is too qualified to do it...the whole point of initiatives like protected mealtimes was to do just that, free up staff to help with this very important part of nursing care, but no one should be exempt if they can help. However, I have been on ward placements where patients have missed out on help because, yes, the nurses were too busy and the HCA's were run off their feet. I think if the public want to grumble then they definitely should be given the harsh reality that all wards face and I would personally like to see family help out, if the patients want it.
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Anonymous | 22-Nov-2011 2:31 am
I don't see any problem with volunteers feeding patients provided they receive adequate training. I used to volunteer at a local hospice and my primary role was to ensure the patients were fed and had a drink during my shift. I was appropriately trained to carry out this role and this freed up the healthcare staff to complete other duties. However I can say hand on heart every single shift I worked, if a patient needed hands on assistance with eating then a registered nurse would happily go and assist.
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Anonymous | 22-Nov-2011 7:57 am
I start on my first placement in January, and expect to be assisting patients at mealtimes. I see it as one of the basic needs of care. Coming from another perspective, it was only 5 years ago that my grandmother with severely arthritic hands was on a ward with serious cut backs to staffing levels and she was totally unable to feed herself. We as family members were there at every meal time to feed not just her but the 3 other patients in her section, the only time there was staff present was so they could slide the inedible trays of food onto the tables in front of the elderly patients and walk away.. Some of them would cry because they were unable to cut their food or even get it onto their forks. Mind you when trying to cut the spouts they would take off across the ward,(they were inedible). After a certain terrible incident in which the lady in the next bed died while my sister held her hand for over 10 minutes before a member of staff was found, that day we argued with the hospital social worker and signed all the necessary paperwork and took my grandmother home, never to return to that hospital ward. And the faces on the other patients crying as we all left as fast as possible, will always haunt me.. I will never ever think that it is beneath myself to assist with feeding and I hope that I will have the time or should I say be able to make the time to assist with feeding.
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tinkerbell | 22-Nov-2011 8:56 am
Anonymous | 22-Nov-2011 7:57 am

Good for you, you will become a wonderful RN because of your appalling experience you know how bad it can get if meals aren't seen as 'vital' in the recovery process. It's no good just stuffing pills down peoples throats if they haven't had their
basic physiological needs met that are life sustaining diet and fluids.

As a ward sister i regularly participate at mealtimes. It gives me a chance to monitor and observe nutritional intake and spend quality time with our patients. Mealtimes are a big deal and for a patient may be the highlight of their day.

When the CQC come to vist i will gladly sit them down with a patient too & offer them instruction if they want to participate in meal times and offer them a plate of it as well to see if it is edible. No its not rocket science but it is vital. After all the bad press on nutrition in elderly care it should be a top priority to ensure that the RN has made sure this is one of their top priorities in care delivery, a decent meal that is actually eaten wherever possible with a competent person regardless of rank getting involved. All our RN's are involved in meal times even if only offering support and encouragement. You have to lead by example.
The next shift coming on duty also help out as we have an overlap time before handover, yes i then have to dispense medication, do supervisons and write up notes but all this is secondary in most instances as our first priority is ensuring that our patients have had their basic nutritional needs met. Time management plays a big part in ensuring that things run smoothly as we cannot make time but only work with the time we are given. It's not who we are that matters but what we do that counts and we are all part of a team delivering excellent care in nutritional needs.
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Little One | 22-Nov-2011 9:55 pm
I can understand what Anonymous | 21-Nov-2011 1:18 pm is saying, if patients do not have swallowing difficulties then I think that a health care assistant is perfectly capable of assisting a patient to eat but I do think that it is a Nurse's job to feed patients and that we should never hold the attitude that patient care is 'beneath us'.

All aspects of basic patient care are a Nurse's job, that's why we are Nurses isn't it? To care for people?! I don't know, maybe I'll be an awful Nurse because I prefer to spend my time having direct patient contact than anything else but I think it is important to remember that as we need nutrition to survive, and to heal, to grow stronger and even to make us feel better, it is incredibly important that Nurses play a part in it when they can. It is a shame that as Nursing advances and we take on more complex roles, feeding a patient is becoming a task that there is no time for.

The red tray system and protected meal times have been enforced in the Trust that I work for and I feel that it has gone a little way to making a difference, patients requiring help are less likely to get left out but medication rounds still take place at mealtimes meaning that at least two nurses ar not available to help.

When at a community hospital there were 4 HCAs and 4 qualified nurses to 15 patients, a luxury, and yet the nurses that were not doing the drug round still did not help to feed patients as they were writing notes etc. I think this is a sad state of affairs and Nurses should remember that the direct contact is one of the most important things that a patient is going to remember.

I know that paperwork is important and it must be done, but the patient themselves is not going to remember immaculate and detailed notes, they are going to remember that you had the time to feed them, that you took the time to ask them if they were ok and if they needed anything, that you straightened their bedsheets and covered up their cold tootsies.
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mike | 23-Nov-2011 11:51 am
I too understand to an extent what Anonymous | 21-Nov-2011 1:18 pm is trying to say.

Nutrition is vital, and of course it falls under the Nurses remit to ensure that good nutrition is being maintained; and whilst noone is suggesting that patient care is beneath us (I really despise that ridiculous statement whenever we talk about delegation of tasks), sometimes other tasks have to be done as well, and in those circumstances the HCA should do the basic task while we get on with the clinical. I often feed patients myself as there is not enough staff, trained or untrained to feed all the patients at once (even then there is often not enough), little one you hit the nail on the head when you said that it is important for us to have direct contact WHEN WE CAN, however, sometimes we do have other tasks, such as clinical emergencies, giving out timed medication to be taken with meals or whatever (the list is very long) to deal with, so the actual task of feeding a patient SHOULD be delegated to the HCA in those circumstances. That is what they are there for after all.
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Kevin1972 | 23-Nov-2011 12:08 pm
Well if it is the qualified staff nurses job to assist the HCA, could someone please explain to me exactly what the HCAs role is exactly?

I mean if qualified nurses now are expected to do all the basic care as well as all the clinical care, what is the point in having HCAs at all? We may as well get rid of them all completely and just hire a load of qualified staff in their place? Care would improve significantly anyway!

Basic care is the HCAs job, it is their role, and that includes the washing and the feeding. They assist us. And to say that is NOT, and I repeat NOT, suggesting that patient contact is beneath me, or I am above that, Anonymous | 21-Nov-2011 2:30 pm. What a stupid and unhelpful statement. It is simply expecting everyone to perform within the roles appropriate to their rank. HCAs are not the backbone of any ward, the staff nurse is.
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Anonymous | 23-Nov-2011 3:52 pm
I find it amazing that this is even a question, OF COURSE patient feeding is the registered nurses job - it is essential in establishing trust, communication...
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Anonymous | 23-Nov-2011 4:18 pm
Well said Kevin1972
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Anonymous | 24-Nov-2011 10:58 am
This is scary. Is there a distinction between clinical and nursing care?
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Anonymous | 24-Nov-2011 11:18 am
The nurse's responsibility is to ensure that patients have been fed, that they are not suffering from malnutrition. This does not mean that said nurse has to personally feed patients. However, it would make sense for he/she to ensure that other staff are doing so. Of course, in an ideal world, all nurses would be involved in helping to feed patients.
Not being a hospital nurse, I would ask are mealtimes protected in hospitals? Perhaps there could be a "rule" that all clinical staff help to feed patients. I would presume that it comes down to good management, clear communication and time management (changing times of other nursing tasks to make time for feeding patients). I would welcome feedback on my comment (be kind please!)
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Anonymous | 24-Nov-2011 2:23 pm
Any nurse RN or HCA shouldbe perfectly able to do so.
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Adam Roxby | 24-Nov-2011 7:27 pm
Hello all.

Just to let you know that I am extremely pleased that so many are getting involved in the debate. As per usual, I will be going through the comments and adding my own thoughts.

Speak to you all shortly.
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tinkerbell | 24-Nov-2011 11:32 pm
Anonymous | 24-Nov-2011 10:58 am

Good question as i myself do not see the distinction. Perhaps someone could advise what it is please. I still see basic care as part of my clinical/nursing care. Although i may be too busy on occasions to feed patients when i do feed patients i also see it as clinical/nursing care. What is the distinction?
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Anonymous | 25-Nov-2011 9:17 am
I think the distinction is between clinical care (e.g. medication and obs) and personal care (e.g. assisting with eating) rather than clinical and nursing care. Both clinical care and personal care form nuring care, this could be split into three levels of responsibility:

1) RN only (e.g. medication),
2) HCA delegated care from an RN (e.g observations/MEWS)
3) HCAs acting autonomously (e.g. personal care)

The RN can of course be involved at all three levels, however I would suggest that level 1 tasks take priority over level 2 tasks which takes priority over level 3 tasks.
There is of course a means by which a level 2 task could be escalated to a level 1 task when a patient deteriorates as shown by a change in MEWS score as identified when an HCA takes the observations.

It may be of interest but the level 3 tasks are expected to be undertaken by family members in some EU countries.
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