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Better training would prevent patients from being malnourished

Nurses must be better trained and take more responsibility in ensuring patients are not malnourished, a hard-hitting report has warned.

The Nutrition Action Plan Delivery Board report, commissioned by the Department of Health, found not enough attention is being paid by organisations or healthcare professionals to prevent patients from becoming malnourished.

It says: “At the extreme, some of those people die because our health and care system is not meeting some of their most basic needs.”

In many more cases, “recovery is delayed and long-term decisions are taken which affect the whole of people’s future lives”, it says. This is “simply because sufficient attention is not paid to nutrition and one of the most basic responsibilities of clinicians and care workers: to ensure that people in their care…take in the food and water which they need”.

The report warns that messages around nutrition are not getting through to frontline staff, possibly because national campaigns have focussed on obesity rather than the dangers of being underweight.

The board has updated guidance for professionals (see box). It also calls for a recognised training module for all clinicians in supporting patients’ nutritional wellbeing.

NHS Tameside and Glossop nutrition nurse specialist June Shepley said a lack of staff in hospitals sometimes made it difficult to ensure protected mealtimes were kept to.

She said the malnutrition universal screening tool – highlighted in the report as a useful way of tracking patients’ levels of nutrition – could be difficult to use and required specific training, but a simplified, three step, version was working well in some organisations.

The Department of Health said it would continue to address nutritional issues through new regulations and the chief nursing officer’s eight high impact actions.


The Ten Key Characteristics of Good Nutritional Care

• Food service and nutritional care is delivered safely

• An environment conducive to people enjoying their meals and being able to safely consume them

• Multi-disciplinary approach, valuing contributions of staff, patients, carers and volunteers

• Specific guidance in service delivery and accountability arrangements

* Universal screening to identify those who are malnourished or at risk of becoming so

• Facilities and services designed to be flexible and centred on the needs of patients

• Patients to have a personal care/support plan to identify nutritional care and fluids needs

• All staff/volunteers to have appropriate skills and competencies and receive regular training

• Patients involved in planning and monitoring arrangements for food and drinks provision

• Providers to have policy for food service and nutritional care, centred on the needs of users

Readers' comments (29)

  • recently i was in hospital for abdominal surgery. meal times were protected and there was a choice of menu. however the food was cold, unpalatable and led to me not having the desire to eat. maybe the notion of food being served at the right tempurature and in a palatable manner would help patients feel motivated to eat.

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  • What is the matter with these people?

    No amount of training is going to help me feed 10 people simultaneously in 20 minutes while managing critically ill patients, getting interrupted by family members, doctors, path lab, pharmacy and answering every phone call that comes into the ward during that time.

    Management won't pay for a ward clerk but will formally discipline the nurse for not answering the phone promptly.

    We (nurses) asked the domestics if they could please not collect the trays back in until we could help everyone to eat. W can't do it in 20 minutes, primarily due to interruptionsa and numbers. We were told that it isn't their problem and the domestics will not be held up because the nurses want to feed patients.

    Doctors ignore the protected meal times and show up to do their ward rounds almost the minute the trays are being handed out. These consultants demand that the lone nurse on duty immediately stops what she is doing to follow them around on the ward round regardless of the staffing levels. When the nurse refuses, because she wants to feed patients or administer much needed drugs (no other nurse around to do it) she is reported by the consultants.

    And the DoH thinks that it is the nurses who need training about this?

    Screw the DoH. They are obviously unaware of the real situation.

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  • Thank you.
    I am a nurse working on an acute admission ward for elderly patients.
    I know that from the experience on our ward, it's not a question of whether staff need more training to meet the nutritional needs of our patients but a the age old question of staffing and manpower.
    That need to be addressed first and the care and attention our patients need will be met. As always, the crisis level of staffing goes on and managers sit proudly in their seats and say there is no more funding.

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  • i totally agree with the above comments.its not the training required but the staffing to be able to feed all these patients. i can remember not so long ago where we had 14 patients to feed out of a 28 bedded ward. meal times are supposed to be calm and not rushed but by the time you get to feed your 3rd patient their meal is stone are only supposed to keep their food warm in the trolley for 30 minutes and after that it should be not begiven. and lets not forget that some of these patients refuse their meals and not necessarily being starved or ignored. meanwhile whilst you are feeding there are patients that want the toilet and there medication.we are torn all ways and will never please everyone.

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  • A degree will not make an difference, as in most cases its not the staff nurse who helps the patient with their food its the HCA, or student nurse in the trust I'm in placement.
    The ward I'm on placement with the ward assistant who serves the food is more interested in saving food for the volunteer that helps out on another ward, also she never offers hot food in the evenings for those that want it and it goes back to the kitchens and thrown away

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  • You can train people til their eyes are on stalks but if there are not enough hands to give out the food and care it will not be delivered. All of the above recommendations require bums on the floor doing the work. Pontificating from a higher management plane is no use to the mere mortals in the mundane world of wards/caseloads doing the nursing.

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  • Im sure these big wigs like the sound of their own voices and they look to be doing...
    They have no idea how we as nurses are put under pressure with as the first comment says phones, buzzers, visitors, doctors etc etc etc, they should have to be made to work on the wards seeing how difficult they are making it for us, My degree has not made me a better nurse, development is good but doesnt give us more staff, better conditions, what do we have to do to stop everyone having a go at us, we know there are always going to be not so good nurses, but im sure the majority of us do our best with limited resources, the more everyone starts on nurses the more i am digging my heels in as my health is suffering AND this should not happen, we are a big organisation we could definately help ourselves by sticking together, we do our best leave us alone

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  • We have to stop being seen to be able to cope. That doesn't mean leaving people dying in their beds either, it means filling in the forms and taking it higher up and to more places, eg. MP's.
    I don't want to be on the receiving end of care as it is now, not because the nurses are not good enough but because the system is set up and run badly, and the nurses and other staff are not able to do the job.

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  • When Noah left the Ark & I started nursing only three things were required - the right knowledge, the right skills and the right attitude.
    It's common sense not rocket science - can we all go back to basics and start looking for solutions rather than whining.
    No doctor should demand attention at the cost of patient care - if a nurse can account for their actions then there is no case for complaint.

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  • the nhs is taking the michael if it really thinks patients will eat the food - it is the vulnerable and lonely who dont have visitors to bring them a proper meal - and those who are lucky enough to get food from outside leave their hospital food. what a waste! why dont they provide those who cant afford take outs to get better meals and stop wasting poor quality food!

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  • I agree with the above comments that it is more nurses that is needed on the wards. So much to do and not enough staff to do it all.

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  • Why is it that when there is a problem, it is always Nurses lack of training that is at fault???!!!!???

    Well here's a message to the government, the trust directors, managers and any other incompetent moron with a similar title, IT IS NOT OUR TRAINING THAT IS AT FAULT, IT IS YOUR INCOMPETENT, USELESS AND FRANKLY DANGEROUS 'MANAGEMENT' AND COST CUTTING EXCERCISES THAT ARE THE PROBLEM!!!!

    So stop blaming Nurses, I am getting sick and tired of it.

    Heres a simple way to solve this one problem, and I'll phrase it very carefully so your simple management minds can take it in, HIRE MORE HCA'S TO HELP WITH THE DISHING OUT OF FOOD AND HELPING THOSE PATIENTS WHO CAN'T FEED THEMSELVES!!!!!!!! NOT ROCKET SCIENCE IS IT!???

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  • OK Mr Brown, lets say your elderly mother is a patient on my ward. There are 16 dependent petients, 5 need feeding, your mother is 1 of them. There are only 2 staff on duty, 1 qualified, 1 hca. It's tea time, 3 patients are wanting to go to the toilet, 1 patient is terminally ill & needs some pain relief which I have to prepare & go to the adjacent ward to get the drug checked with another registered nurse. Here's the question: 1. What do we do 1st? Toilet patients needing to go? Attend to the pain relief? or ignore all of them and get the teas served as they are going cold?
    2. When the teas are served, which of the 5 who need feeding gets fed 1st, 2nd etc, - ---your mother perhaps, or shall we leave her til last?????????

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  • we once had an arrest on our ward and as we were attempting CPR a relative barged in behind the curtain and demanded that someone help his aunt with her lunch! It's not just the penpushers but also the general public who believe that while in hospital they are entitled to their own personal nursing care.

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  • YES,
    We have exactly the same problems on our ward, but unfortunatley, management will just not have it.
    There are 24 patients on our ward and at mealtimes, at least 50% of the patients require supervision and or feeding, but how on earth are we meant to do it when there are only 4 nurses on duty, and one might be called away to see a poorly patient or speak to the demanding doctors or the patronising infection control nurse!
    If the government are not careful (and the general public) there wont be any decent nurses left because we are so sick and tired of being blamed and abused that we will just leave the NHS and find a job where we get a bit more respect.

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  • It goe's on & on , I've been Nursing 30 years + , it's getting worse & worse, i agree with everyone else who have made comments, it's lack of nurses, too much expected of us, it makes me want to cry most days, I'm thinking of leaving to find another job!

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  • Look it's up to nurses to stand up for themselves. We need a new union and new leaders who will stand up to rubbish management and lousy politicians. We need a new union urgently....the RCN and unison are crap.

    It's time to take a stance and time to get militant. Mark my words if you don't do this working conditions will worsen....i'm telling you.

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  • I work on an Acute Stroke Unit and many of our patients have dysphagia. It can take up to 20mins just to feed one patient, and at any given time we can have eleven or more feeds. It is so frustrating I get so annoyed. I have even bleeped the matron to request assistance so that my patients can have a hot meal.Sometimes I feel we need a feeding squad.

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  • Staff the wards adequately with trained nurses with spare for sickness, etc and they'd soon find that standards would rise in all aspects of care. Try and raise concerns verbally in our trust and the response from the matron is "if you don't like it, leave", reporting formally means I have to stay behind on top of the time I already stay to catch up when a shift finishes to complete the form and then there is absolutely no response, except a few nasty comments. I've never seen our Director of Nursing on the ward - they should be visiting monthly each base to support staff!

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  • I can remember when I was a student nurse trying to feed a patient and the staff nurse who was sat behind the desk coming to me and wanting to know why I was not answering the callbell. I know now she was probably very busy with the all important paper work instead of the all important patients. I hear words of wisdom from managers saying its not lack of staff, you just need to organise the workload more effectively. Unfortuately bodily functions cannot be organised, its time the managers spent some time working on the front line, they would not last a day!

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