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Where to now?

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VOL: 96, ISSUE: 49, PAGE NO: 1

Jamil Khair, RGN, RSCN, DipChildDev, is paediatric nutrition nurse specialist, The Royals Hospitals NHS Trust, London

Before being beguiled by the glamorous world of tube-feeding, my earliest interests in both paediatrics and nutrition were stimulated by a knack for feeding acutely ill infants without tiring them. Nearly 20 years ago I was taught that tube-feeding was an admission of failure unless you were convinced that the patient was physiologically incapable of meeting his or her nutritional requirements orally.

Before being beguiled by the glamorous world of tube-feeding, my earliest interests in both paediatrics and nutrition were stimulated by a knack for feeding acutely ill infants without tiring them. Nearly 20 years ago I was taught that tube-feeding was an admission of failure unless you were convinced that the patient was physiologically incapable of meeting his or her nutritional requirements orally.

My own, more recent, experience in paediatrics has been that qualified staff rarely have the time to feed patients themselves, student nurses are not taught much about how to feed patients and, quite frequently, highly proficient health care assistants or nursery nurses (often the longest-standing members of ward teams) are relied on for their skills with 'difficult feeders'.

Specialist nutrition nurses often state that their remit begins when a patient requires artificial feeding. Some of us claim that this is more a reflection of time pressure and workload than a limited interest in oral feeding, yet we consider learning new 'skills' that have traditionally been performed by other professions.

As we explore the directions we should take for our professional development, we are often induced to expand our practice by taking on a more 'technical' role. All too often this is driven by the requirements of our employers (to reduce the workload for medical staff or save money), rather than the needs of the patient and the profession.

The compelling argument is that nurses, with their innate cleanliness, equanimity, consistency, economy and planning ability can achieve improved patient preparation, reductions in complications and failure rates, significant cost-savings and shorter waiting lists.

Historically, this has resulted in adding such tasks as intravenous drug administration, blood sampling and cannulation to our ever-expanding role. Nurses develop technical and interpersonal skills that would be useful in any number of jobs. Does this imply that we should expand our practice to encompass everything, or that we might have something to teach other professions?

The role nutrition nurses have defined for themselves - and fought hard for - already encompasses nutrition assessment and monitoring, choosing appropriate methods of nutrition support, ensuring the safe and effective delivery of artificial feeding and discharge planning. We have responsibilities as teachers and facilitators to ward-based nurses, patients, carers and the rest of the multidisciplinary team. In addition, many of us have a remit for home-visiting and community liaison.

Nurses must progress as professionals but, in doing so, should we sacrifice our core skills and risk the benefits we can provide for our patients and colleagues in order to take on the rather tedious, technical tasks that doctors are so keen to relinquish?

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