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One hospital has made changes to improve care and nutrition of older people on acute wards.
22 june 15 :: vol 25 no 41 :: 2011 NURSING STANDARD
From social groups to special
menus, a new programme is
improving the care of older
people across all inpatient areas
at a Cheshire trust. This range of
initiatives has been devised by
hospital staff at all levels, from
the trust chief executive down.
One of the schemes, the
memory club, is a twice-weekly
get together for a group of eight
patients at Leighton Hospital
in Crewe. Also known as the
activity lounge, it takes place
in a living-room setting in one
of the hospital’s day rooms.
Patients chat about the past
while enjoying tea and cake,
which provides a calorie boost,
aids hydration and encourages
social interaction.
The club is run by Debbie
Slack, nurse specialist for care
of older people. She says: ‘The
beautiful china teapot, cups
and saucers help the patients
to engage with one another
and they drink plenty. They
can have as many cups of tea
as they like and many find that
the time flies by.
‘An Alzheimer’s Society
volunteer helps, or I bring
along a nursing student.
‘The memory club is such
a positive part of an older
patient’s stay. It provides time
away from the ward’s hustle and
bustle and is a welcome change
of scenery. The patients enjoy
A range of initiatives for older people in
hospital is improving nutrition and boosting
self-esteem, as Julie Penfold reports
Cup of tea and a chat
One hospital has made
changes to improve care and
nutrition of older people on
acute wards.
Care of older people
Nutrition Fluid intake
Protected mealtimes Red
trays Pictorial menus
Reminiscence therapy
p22-23w41_Features copy 2 13/06/2011 10:35 Page 22
has ensured our patients can
easily choose a variety of
nutritious meals, and protected
meal times means they can
enjoy their food without
interruptions,’ says Ms Slack.
The introduction of pictorial
menus and protected mealtimes
are other initiatives that have
made a significant difference.
‘Our menus were developed
with the speech therapy and
nutrition and dietetics teams
to ensure choosing food was
easier,’ says Ms Learoyd.
‘Each item has a photo,
line drawing and is named
in large print. Patients can better
communicate which foods they
like and dislike to healthcare
assistants (HCAs) and nurses.
‘The patient’s expectation
of what they will receive is
realistic, so they are more
likely to eat what they ordered.
We have discovered that there is
consequently less wastage on
older people’s wards.’
Mealtimes are now protected
on all wards to ensure staff
focus solely on helping patients
to eat and drink.
‘It has made a big difference
and changed the mindset of the
staff – they all know their only
task for the hour is to assist
patients,’ says Ms Learoyd.
‘Food charts show patients
are eating and drinking more
because they are no longer
being disturbed.’
The catering team allocates
red plates and jugs to patients
who need assistance.
Dietician Jaclyn Cliff says:
‘Patients struggling with their
meals are encouraged to use
the ward’s day room, which
provides a more relaxed eating
environment. This can help to
improve their nutritional intake.’
A range of staff at Leighton
Hospital, from HCAs and
nursing staff to speech and
language therapists and even
the chief executive, tasted the
puréed meals to ensure they
were appetising and nutritional.
‘It is important that all staff
understand tastes and textures
as this helps the patients when
selecting foods,’ says Ms Cliff.
‘Staff can recommend meals
and advise what they smell,
taste and look like.’
Each meal contains at least
500 calories and 18g to 25g
of protein, which is high for
a puréed meal. Patients are
offered a varied menu, with
many options in different sizes.
Ms Cliff adds: ‘We cater for
a wide range of preferences
and tolerances to help improve
food intake’ NS
Julie Penfold is a freelance
interacting, telling stories and
passing on their wisdom to the
younger assistants, which helps
to boost self-esteem.’
Patients discuss topics and
are provided with resources
such as old money, music,
objects and photographs to help
them reminisce. It is an integrated
approach – hydration and
nutrition needs are met while
providing patients with an
opportunity to socialise.
Speech and language therapist
Jacqueline Learoyd says: ‘For
cognitively impaired patients,
recalling recent events can be
difficult, yet speaking about
things that happened years ago
is much easier.
‘The patients tend to eat and
drink better if they are in a
group – they often end up
drinking at the same time. It is
excellent for keeping their
minds on what they are doing.’
The patients lead activities
and shape each session. They can
have manicures, hand and neck
massages, complementary
therapies and movement therapy.
‘These measures demonstrate
the trust’s commitment to
improving care,’ Ms Slack adds.
The activity lounge allows staff
to give patients that extra bit of
individual care in a less formal,
calmer setting.
The lounge enables patients to
interact socially while engaging
in activities that stimulate
conversation. ‘The work that the
trust has done on nutrition and
communication-friendly menus
june 15 :: vol 25 no 41 :: 2011 23
Debbie Slack
socialises at her
memory club,
above, and enjoys
a cuppa, opposite
Good nutritional care
4Identify malnutrition through screening
and assessment.
4Implement appropriate care pathways for
all identified as being at risk of malnutrition.
4Train all front line staff in the importance of
nutritional care.
4Ensure management structures are in place
to support best nutritional practice.
p22-23w41_Features copy 2 13/06/2011 10:35 Page 23
... Citations were classified as multicomponent if the intervention involved several individual activities to support food intake. The first citation was a description of a ''memory club'' for older patients in acute care wards in a single hospital (66). Afternoon tea was served using home-like dishware and decorations. ...
... Mealtime studies were more common than foodservice and dietary intervention studies, although the dietary interventions were the most consistent in their findings and amenable to RCT designs. Future work needs to focus on developing and evaluating innovative strategies to improve food intake such as tea=snack clubs that get patients out of their room to socialize (66). ...
Malnutrition is common in acute care hospitals. During hospitalization, poor appetite, medical interventions, and food access issues can impair food intake leading to iatrogenic malnutrition. Nutritional support is a common intervention with demonstrated effectiveness. "Food first" approaches have also been developed and evaluated. This scoping review identified and summarized 35 studies (41 citations) that described and/or evaluated dietary, foodservice, or mealtime interventions with a food first focus. There were few randomized control trials. Individualized dietary treatment leads to improved food intake and other positive outcomes. Foodservices that promote point-of-care food selection are promising, but further research with food intake and nutritional outcomes is needed. Protected mealtimes have had insufficient implementation, leading to mixed results, while mealtime assistance, particularly provided by volunteers or dietary staff, appears to promote food intake. A few innovative strategies were identified but further research to develop and evaluate food first approaches is needed.
... tea's effects on 'work performance' (Bryan et al., 2012) or on mood (Steptoe and Wardle, 1999). A more clinically oriented literature is evident too, which engages with issues around using the making and drinking of tea as both an assessment tool (Fair and Barnitt, 1999) and a therapeutic intervention (Hannam, 1997;Penfold, 2011). Finally, we can discern a culturally focussed literature, which can historicise tea's role in specific societies (Fromer, 2008;Murcott, 2013) or highlight the functions it serves in particular contexts and the meanings that attend these (Lee, 1999;Lee, 2001;Stroebaek, 2013). ...
Full-text available
Purpose As part of a wider ethnographic project that examines the significance of the public interest across three public and private sector UK planning organisations, this paper uses tea-drinking as a lens to understand structural forces around outsourcing and commercialisation. Reflecting across the five case studies, the analysis supports Burawoy's (2017) recent critique of Desmond's Relational Ethnography (2014). Using Perec's (1997[1973]) notion of the “infra-ordinary” as an anchor, it highlights the insight that arises from an intimate focus on mundane rituals and artefacts. Design/methodology/approach The data were gathered through participant observation, chronicling the researchers' encounters with tea in each of the sites. A respondent-led photography exercise was successful at two sites. Up to 40 days of ethnographic fieldwork were carried out in each site. Findings The tea-drinking narratives, while providing an intact description of discrete case study sites, exist in conversation with each other, providing an opportunity for comparison that informs the analysis and helping us to understand the meaning-making process of the planners both in and across these contexts. Originality/value The paper contributes to critical planning literature (Murphy and Fox-Rogers, 2015; Raco et al. , 2016), illuminating structural forces around outsourcing and commercialisation. It also generates methodological reflection on using an everyday activity to probe organisational culture and promote critical reflection on “weighty” issues across study sites.
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