'What do Mick Jagger’s gyrating hips tell us about the future of healthcare?' The question would not be asking 'what generalisations can we make from one untypical case study?' would it?
Kathryn Godfrey's posting raises some sensible issues including a greater emphasis on preparing health staff working with the older person to expect variations in needs and abilities. However, it would be good to see not only greater evidence that this will take place, but also more emphasis on structuring health services and finances to follow through on this aim.
The numbers in this group have not suddenly appeared - it is no surprise; the demographics have been there for a long time, but the service designers and those managing budgets for health services do not seem to have taken much notice. Things need to be put in place to ensure we provide early responses to their needs before these increase and result in greater needs.
Let's take this issue seriously and do something about it.
In the meantime, let's consider evidence relating to the whole group, rather than pick on one untypical example to guide thinking.
I am pleased that Neil Wilson challenges the way that new systems can endanger holistic care, critical analysis and the clinical skills of the nurse. However, as coauthor of the original 2003 publication on the Red Tray with Lindsey Bradley, I would like to plead that we don’t accidentally demonise a nursing success story that was a response to improving individual patient’s needs. Lindsey developed the Red Tray system in Cardiff precisely to avoid patients being compromised nutritionally because their food was either left tantalisingly out of reach, or taken away without first asking the basic question of whether the individual needed help with eating. Following nutritional assessment, the red tray acted as a visual danger sign to encourage staff to think of the patient; it does not replace thinking. To my knowledge, there is no evidence that it has led to the erosion of clinical decision making skills or the loss of nursing critical thinking skills. Quite the reverse; the audits that took place following its introduction showed it was a ‘win-win’ development that was both nurse and patient friendly. Patients and their relatives were pleased that their needs had been recognised, and nurses had a visual cue to help them when in the business of the nursing day it is easy to miss someone’s needs. Far from being simply ‘well intended’, this was a carefully developed and evaluated system that was an outstanding nursing initiated response to patient need. The audits showed that there was a drop in the number of patients whose nutritional needs were unmet and the system ensured that the care was individualised to those who needed it. There were no complaints raised about increases in record making or tick-boxing activities. So, can we please stop labeling improvements automatically as wrong without first looking at the implications from the patient’s perspective, and let’s use the evidence that shows where we should be focusing our attention. Things are hard enough without those with sound and evaluated ideas being reluctant to share them for fear that they will be seen as another attempt to erode essential nursing skills when in fact they are enhancing them!
Comment on: Coloured trays aid nutrition in Norfolk
Lindsey Bradley and I are delighted that the Red Tray system, originally published in 2003, has been accepted in Norfolk. The system is clear, logical. Its widespead acceptance as a 'trigger' for hightened nutritional support demonstrates that simple ideas can be successful. Colin Rees, School of Nursing and Midwifery Studies, Cardiff.