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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)

  • We should do as they do in Spain and elsewhere, some of the care of patients is the responsibility of the family.
    Why can't visitors assist patients with eating/drinking?
    I would suggest that the minimum time required to ensure that a patient eats and drinks properly is 20 minutes; if you have more patients reqiring assistance then there are staff then someone will have to wait at least tweny minutes before getting their now luke warm and potentially hazardous food.

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  • I wish people would stop using malnourished when they mean undernourished. Mal means bad and can be both undernourished and overnourished.

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  • we never had this problem when student nurses were `nurses' and the kardex was all we wrote on. no malnutrition, occ pressure sores only, and plenty of dignity. We lost much of the good care in the name of `progress'

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  • there was no malnutirion, only occ pressure sores and plenty of dignity when student nurses and `the kardex' ruled. we lost all this in the name of `progress' ... and don't expect to see it return

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  • Most hospital food is quite simply disgusting.
    I recently spent two weeks in hospital with malnutrition brought on by gastrointestinal problems.

    I was discharged from hospital in a worse state than when i arrived!

    the meals are cheap....that's the way the NHS is now an accountable business. And anybody with a shred of common sense knows that the care of human beings cannot be and should not be financially dictated.

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  • I work on a busy 32 bedded elderly ward. We have implemented protected meal times and must say that it works the majority of the time. Working together and empowering nurses is the main key. Doctors do forget but need reminding that they need to stop what they are doing and all nurses stop paper work and answering the phones for that important hour.

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  • why has patient nutrition become such an issue? in the 1970s we never had any shortfalls in our training or left patients on our wards undernourished. we served the meals and knew how much and what each patient would and could eat and we helped those who were unable to feed themselves without rushing them. the only problem later on was with the increase in investigations and with doctors visits which sometimes clashed with meal times but we were never slow to point this out and try and change the agenda. we also had microwaves to reheat the meal when this was not possible. collected meal trays were always checked, especially for those at risk and if there was a medical problem, or problem of quality or quantity or the food was not to the patient's liking this was always followed up and records were kept for any patients at risk for poor nutrition. accurate records were also kept of weight and fluid charts so that any changes were observed and reported to the medical team. we never had cases of malnutrition or weight loss through professional negligence or organistional failure and i find it difficult to tolerate any excuses in this. we are nurses and nursing means holistic care!

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  • nurses or whoever else feeding a patient should not rush the patient or be interrupted for very obvious reasons but colleagues, managers and doctors, and even hospital porters who are often just following orders do not always understand this! maybe one does have to spell out the fact that feeding is essential to the wellbeing and health or the patient and the attention from a helper and the physical act of eating my even be the highlight of their day - physical, biological and psychological effects.

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  • 'New tools to improve hospital nutrition in Wales' 15 August, 2009

    All this jargon for goodness sake
    why do nurses need 'new tools' to help them and their patients perform an essential and basic survival function

    in the good old days and almost since the stone, or at least the bronze age, knives, forks and spoons were perfectly adequate with the more recent addition of some genuine helping tools to assist infants, the handicapped and the elderly

    are nurses no longer capable of thinking that they need these 'new tools' to perform such functions?

    i do despair of the profession and even more of those responsible for training the nurses

    if ever i have the misfortune to enter an nhs hospital i want to be looked after by intelligent well-educated thinking and sentient nurses and not by a bag of 'new tools'

    for information of those who are not in possession of these basic cognitive faculties, and in case there is any doubt about what a 'tool' is, the COED 11th edition says:

    n noun
    1 a device or implement, typically hand-held, used to carry out a particular function.
    2 a thing used to help perform a job. Øa person exploited by another.
    3 a distinct design in the tooling of a book. Øa small stamp or roller used to make such a design.
    4 vulgar slang a man's penis.
    n verb
    1 impress a design on (a leather book cover) with a heated tool.
    2 equip or be equipped with tools for industrial production.
    3 (tool up or be tooled up) British informal be or become armed.
    4 informal, chiefly North American drive or ride in a casual or leisurely manner.
    5 dress (stone) with a chisel.

    tooler noun
    tooling noun

    Old English tol, from a Germanic base meaning 'prepare'.

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