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Practice Comment

Nurses need to take more control of patients' nutritional needs


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.



Readers' comments (4)

  • Another disgrace that nurses are being made accountable for. Shouldn't dieticians have some of this accountability ?

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  • Why should dietitians be made accountable? It is their job to say what patients should have. It is the nurse's job to make sure that they get it.
    Dietitians should be accountable for inappropriate diets, not seeing referels and patients suffering as a result.
    They should not be accountable for ward staff who do not see why feeding patients is so important!

    No I am not a dieitian.

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  • I totally agree that mealtimes are of the utmost importance and we have protected mealtimes on our ward, however it is more a matter of staffing levels that ensure whether the patients are adequately looked after. Both nurses and HCAs should play a part at mealtimes and with feeding patients who cannot feed themselves. Personally I am fed up with seeing ill patients with trays dumped in front of them with nothing opened, no drinks poured etc as most will just sit and stare when meals are provided in this way.

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  • One of the ways we have tried to tackle the issue of appropriate staffing levels during meal times is by allowing one of the patient's family members to be present and to assist (most specifically for those patients with dementia). Although this contradicts the essence of the 'protected meal-time' policy, evidently, the majority of MDT workers completely ignore it anyway - regardless.

    Given the current climate/state of the NHS, I believe that any measure that can improve patient care should be wholly considered. In the case of my practice, I've found that inclusion of the informal networks has not only improved nutritional/fluid intake (particularly for those with dementia), but has also lead to improved fostering of relationships with relatives.

    This is not to say that nurses/HCA's should not play a significant role in the nutritional needs of their patient's. However, it cannot be denied that other members of the MDT can contribute to ensuring that patients recieve oral intake. For example; many of our patients will recieve intense physio and OT. Patients are often carted off to the relevant departments following breakfast/dinner/mid-morning tea etc. More often then not, the patient's drink/pudding is left full on the table. Would be it be so difficult to help the patient to finish their drink before taking them for therapy? Would it be so difficult for the SALT team to take a dinner break after patient meal times? We are constantly asked how a patient is tolerating food, drink etc... why don't they see for themselves?

    Given the lack of staffing, increased pressures on nursing, the ridiculous amount of paper work, coupled with the increase in critically ill patients, it cannot be denied that the governments proposals for better training, accountability and so forth is as useful as a chocolate fire guard.

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