While it is often assumed that nurses have responsibility for nutritional care in hospitals, they do not have proper control and accountability, argues Barbara MacDonald
Nurses should be made more accountable for nutritional care in hospitals. Without this accountability there can be no responsibility.
Malnutrition was noted as a problem by Florence Nightingale back in 1859. However, it is still a problem today that impacts on nurses, whose ‘catering-care’ role has changed over the years often as a result of circumstances rather than actual planning.
In the 1960s, nurses were still closely involved in day-to-day activities related to nutritional care. Such tasks were viewed as time-intensive by the Standing Nursing Advisory Committee, which recommended that new non-housekeeping teams should be introduced.
But this package of measures was not widely implemented and nurses were left struggling to find time to cover all essential aspects of patient care. Furthermore, the 1966 Salmon Report on senior nursing staff structure gave the impression that the patient food service was a non-nursing duty.
Today, there are circumstances in which nurses struggle to ensure their patients are eating. There are issues around health and safety that have resulted in a lack of meaningful flexibility for nurses. This makes it difficult for individual patients to get something to eat when they feel like eating.
It might be that patients are unable to eat due to the poor quality and/or delivery of the food, which is outside nurses’ domain. This is demonstrated by patients’ comments, such as: ‘Food smelt awful and tasted worse – caused me to vomit on three occasions’; and ‘Disgusting, vile, nasty, sloppy, piggish’ (Commission for Patient and Public Involvement in Health, 2006).
Consider that of the 129 million meals ordered in hospitals last year, a total of 10.7 million were returned uneaten, mainly because patients refused to eat them. On the other hand, there are other reported comments that praise hospital food. All this reflects the diversity among trusts but is not necessarily a reflection on the ability of nurses to feed patients.
A former chairman of the National Nurses Nutrition Group said: ‘If a nurse had failed to give a patient their intravenous drugs that would be considered a very serious incident. However, if they don’t ensure that their patients have had a meal that just seems to be: “Well, okay, they didn’t bother eating their dinner, does it really matter?” And, of course, it does. Food’s a treatment equally as much as drug therapies are’ (Colagiovanni, 2006).
So what do nurses think? An RCN survey of 2,193 nurses from different care settings across the UK revealed that 95% rated patient nutrition as important or extremely important, with more than half of those actively involved in patient care saying they did not have enough time to devote to it. In addition, a quarter of the nurses said that NICE guidance on screening patients on admission was not being met.
There is evidence, then, on the awareness of the importance of nutrition but there are also barriers that can add to malnutrition. If it is nurses’ responsibility to ensure that patients are both screened and fed, then they should be made officially accountable, instead of being judged on a role over which they often have limited control.
Barbara MacDonald is visiting lecturer at the University of Westminster and co-author of Nutrition in Institutions.
Commission for Patient and Public Involvement in Health (2006) PPI Forums Joining Forces to Tackle NHS Food. Food Watch August – October 2006. National Summary. Birmingham: CPPIH.
Colagiovanni, L. (2006) Interviewed on BBC Radio 4 programme You and Yours.