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Practice comment

'A half-empty glass does not prove your patient can drink'


“Water, water everywhere nor any drop to drink,” wrote Coleridge in his epic poem The Rime of the Ancient Mariner.

His words reflect the experience of many patients today. We see the jug of water by a patient’s bed and a half-filled glass next to it. By all appearances, it looks like they have been drinking. But have they?

There are recent reports of water having to be prescribed by clinicians to ensure patients are getting enough to drink. Have we come to this? Do we really have to sign a chart to say we have given someone the most basic form of nourishment?

I say nourishment because water is a nutrient. Some time ago, I was at a meeting where we were discussing a nutrition e-learning tool and it was suggested that water was the most important nutrient. Do a Google search on the six basic nutrients and you’ll find water is right up there.

Yet we still ignore hydration. We are all caught up with nutrition screening. We are aghast that the latest British Association for Parenteral and Enteral Nutrition reported that one in three people are still coming into hospital malnourished. I wonder how many are dehydrated as well.

Do any of us drink enough? Do our employers ensure plenty of drinking water is readily available? How many of you on the wards are allowed to have a bottle of water on view at the nurses’ station? Not many, I would guess. So if we do not recognise when we need a drink, how are we supposed to know when our patients do?

Nutrition and hydration are related. If a person has a dry mouth because they are thirsty, they will not feel like eating. A dry mouth will be more likely to become infected, which will make eating painful, so it is likely they will eat less, lose weight and stay longer in hospital.

A dehydrated person will be sleepy so is less likely to drink, so what do we do? We put an IVI up. How many older patients have intravenous fluids when all they needed was a regular drink, which would have kept them hydrated in a far less invasive fashion?

I’d like to think things are changing. Nationally, it is being recognised that people are suffering from dehydration in care settings. This is not about apportioning blame, but about finding simple solutions to a burgeoning problem. Some organisations offer patients drinks as part of their preventing pressure ulcer care bundles. Others make sure the drinks offered are documented on the food chart.

But more needs to be done. We need to re-educate staff. Sadly, many nurses do not know the signs of dehydration. It is not enough to acknowledge the problem, wring our hands and look for someone to blame. Nurses need to own the problem of dehydration and look for ways to overcome it.

So, next time you pass a patient’s bed and see that half-glass of water, offer that patient a drink. It takes no time and pays dividends. Just think how you would feel if you could see the glass yet could not drink from it. Time is not the issue – thought is. NT

Liz Evans is a nutrition nurse specialist, Stoke Mandeville Hospital, Buckinghamshire Healthcare Trust


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Readers' comments (4)

  • Bravo Liz Evans. It's about time that some common sense was applied to this issue. Sadly, nurse training does not appear to include recognition of clinical signs of dehydration any more, and offering patients drinks is the duty of HCAs. It's time we as nurses became more proactive in preventing dehydration.

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  • Why bravo, Liz Evans? this is fundamental nursing knowledge and failing this basic commonsense

    "Sadly, many nurses do not know the signs of dehydration"

    if they are nurses how did they qualify to get on the register?

    in my last workplace we were not allowed to take a drink when our body clock dictated to us only during official short breaks - 15 minutes for coffee in the morning and half an hour for lunch. If I did not get a drink when I needed one I was preoccupied with a sensation of thirst or the need to top up my cafeine levels first thing in the morning so did not work as effectively as I would have done if I had been allowed to listen to heed my biorhythm.

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  • Encouraging fluids is a fundamental part of nursing care and should be driven by trained staff and carried out by both trained and HCAs. Recording should be easy on a simple form and catering staff should also be trained to know not to take cups from those with red jugs/trays without referring to the nursing staff.

    Sadly, it appears that student nurses are being trained now to function more and more exclusively as managers sorting paperwork and have no working experience of the signs of dehydration in patients.

    For the information of Anonymous 5:27, the following applies to all employees:

    The law requires that employers provide drinking water and ensure that:
    it is free from contamination and is preferably from the public water supply _ bottled water dispensers are acceptable as a secondary supply;
    it is easily accessible by all employees;
    Welfare at work - Guidance for employers on welfare provisions 2 of 4 pages
    Health and Safety Executive
    there are adequate supplies taking into consideration the temperature of the working environment and types of work activity;
    cups or a drinking fountain are provided.
    Drinking water does not have to be marked unless there is a significant risk of people drinking non-drinking water.

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  • Anonymous | 20-Jul-2011 11:42 am

    depends where you work. drinking water is of course provided by tap and bottled but it was the time when one was allowed to go and drink it which was constrained!

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