Examplars
Critical nursing incidents where you made the difference
Helen Calabretto
School of Nursing, University of South Australia, SA
PP: 080 - 082
Article Text
Independence through finger food
I was recently appointed to the position of Director of Nursing at a small nursing home. Having previously worked part-time in aged care, I had usually observed only one meal a day. When working fulltime and observing three meals a day, I became concerned about the large number of residents who were dependent upon staff for their meals. Eleven residents of the 22 who live at our nursing home were fed vitamised meals. Another observation was the number of normal meals returned barely touched. On reflection, I realised that a large number of residents unable to cope with normal meals suffered from dementia.
As nurses and carers, we are encouraged to apply holistic and individualistic principles to our care of residents in nursing homes. Meals however, have been traditionally planned and served as a routine exercise in a task orientated manner. Residents who have difficulty self-feeding due to physical or cognitive deficits soon become dependent upon the staff. Due to time constraints, the meals to be fed soon become 'soft' or vitamised.
Being in a management position, I was able to introduce changes to the style and preparation of meals to adapt them to suit the needs of individual residents who were experiencing difficulty with traditional 'normal' meals. The goal was to assist the residents to maintain independence. One of the first instincts learned by infants is to take food from their hands to their mouths. It is also one of the last instincts that older adults lose. By structuring the meals around finger food, residents with dementia were able to use their natural instincts, and residents with physical deficits who were unable to manipulate utensils but who were mentally alert, were also able to self-feed.
In observing the reactions of residents' self-feeding with finger food, we noted an increase in awareness and excitement. They now had a choice as to what food they would eat next, and displayed a sense of fulfilment in response to regained independence. However, some residents also became frustrated as they had lost skills once previously taken for granted.
We also found that meal times developed into a social activity. There was greater communication and interaction between staff and residents. The atmosphere was more relaxed with meals taking longer, but without the task orientated aspects of staff moving from one resident to the other to 'feed'. We noted that it took time for some of the residents to become accustomed to self-feeding again, with some graduating from fingers to forks.
Whilst it is easier and less time-consuming for staff to feed residents a vitamised or 'soft' diet, we observed that they have less difficulty self-feeding a more solid diet, resulting in less spillage whilst maintaining independence. We are still experimenting with menus but have made changes such as tuna mornay to tuna rissoles and shepherd's pie to meat balls. The importance of a team approach to this project cannot be stressed enough involving both catering, carers and nursing staff.
Whilst our findings are still preliminary, we now only have two residents fully fed vitamised food due to physical conditions. We have found that by offering finger food to residents with dementia, we have eliminated the struggle which often ensued in encouraging them to eat. They often objected to being fed and would at times barely eat anything. Some residents require supervision and prompting and on some days also require feeding. Meal times have become a daily assessment of residents' needs, not an automatic necessity for staff to 'feed'. However, the most important lesson learned by the team at our nursing home, is that just because a resident has to be fed, it doesn't mean the food needs to be vitamised.
Suzanne Syme RN RM GeronticCert
Human warmth is a form of nutrition
One Friday evening I was working with Dr Curtis, an 80-year-old professor emeritus who, little more than a month before, had been diagnosed as having pancreatic cancer. Dr Curtis had spent the last four weeks in hospital recovering from a Whipple procedure. But this, the evening before he was to be discharged, was my first opportunity to meet him and his wife Katie.
I happened to be in Dr Curtis' room when his dinner tray was delivered. While he was eating, I asked Mrs Curtis if she would like a coffee or a tea. 'No thanks,' she replied. 'The children (people in their 40s and 50s) are coming to take me to dinner.'
'Are you taking care of yourself?' I asked Mrs Curtis. 'Are you eating well and getting enough rest?' 'Yes,' she answered, 'but I'll be glad when Peter comes home. I really miss him at meal times. I hate eating alone'.
'You know what I miss the most?' Professor Curtis asked me. 'I don't have a clue' I responded. 'I miss sleeping with my wife,' he said. Thinking about the fact that Professor Curtis and his wife had been married 60 years and rarely separated, I said, 'I'm sure you do'.
'You know,' I said to him, 'we have a lot of empty beds on the unit tonight and we're certainly not going to need to use this other bed in here. So we could push these two beds together, and Katie could stay'.
Professor Curtis' eyes twinkled as he said, 'You'd do that, wouldn't you?' 'In a heart beat' I quickly replied. 'But then what would you do?' he asked. 'Well, then I'd leave and get a Do Not Disturb sign and put it on your door.'
'Well Katie, what do you say?' Professor Curtis asked his wife. Her face turned a very bright shade of crimson and she said, 'Peter, the children are coming. Whatever would they say?'
By making it possible for Professor and Mrs Curtis to spend the night together I acknowledged that Professor Curtis was much more than the medical diagnosis that brought him into hospital. First and foremost he was a person, a human being with physiologic and psychoemotional needs. Technology has facilitated his 'cure' and his physiologic needs had been met. But my offer attested to his humanness and acknowledged his psychoemotional needs.
Writing about his experiences as a patient recovering from a horrific motor vehicle accident, Tony Moore, a well-known surgeon and rehabilitation specialist, affirms the importance of nurses and other health care professionals being attentive and aware of patients as people. 'There were times when to be held close to a warm breast would have helped me more than pethidine or penicillin' (Moore 1991). I offered Professor Curtis much more than pethidine or penicillin. By affirming humanity, I offered him human warmth, which is a form of nutrition (Moore 1991).
Edwina McConnell RN PhD
References
Moore T (1991) Cry of the damaged man. Picador, Sydney: 24
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