Eating and drinking
A good place to start our thinking about promoting health is eating and drinking. Both are fundamental to life, both are activities people usually take part in every day, and both present great opportunities for health benefits and health harm.
People who are unwell can face big challenges in eating and drinking properly at a time when their bodies need fluids and nutrition to help them overcome their illness, as can people who have disabilities that affect their ability to feed themselves or who are frail. These all too often lead to a state of undernutrition (you might hear people speak of it as malnutrition, but malnutrition also includes the opposite of undernutrition, which is obesity).
We can recognise undernutrition in a patient/client by his or her:
- loss of appetite
- weight loss (clothes, rings, jewellery and dentures may become loose)
- tiredness, lack of energy, lethargy, poor concentration
- lack of ability to perform normal tasks
- in children, poor growth.
There is much we can do to help people with undernutrition to eat and drink appropriately for their needs, but first of all, we have to recognise that the problem is there. Tools such as MUST can help us with this. MUST – the Malnutrition Universal Screening Tool – has been developed by BAPEN as a five-step screening tool to identify adults who have, or are at risk of developing, undernutrition or obesity. It can be used in hospitals, community and other care settings by all care workers. Visit the RCN’s clinical topic pages on nutrition and hydration for more information.
Among the simple measures that can be taken to help people who are having difficulty eating and drinking are making sure:
- the person has the opportunity to use the toilet and wash his or her hands before eating
- his or her mouth is clean and moist
- the person is sitting comfortably and the immediate environment is clear of mess, clutter and, if possible, noise
- the area is well lit, the person has his or her glasses on (if used) and dentures are in place
- the food is presented attractively, not in huge portions, and is arranged and cut to enable the person to eat it easily
- a glass of water or preferred drink is easy to hand
- you offer gentle encouragement and praise as he or she progresses through the meal
- you record what the person has eaten and drunk on the appropriate charts; if you are concerned about an apparent change in the person’s appetite and food/fluid intake or ability to chew and swallow, report it straight away to your manager or supervisor.
If you find you need to help the person, make sure that you, too, wash your hands beforehand and are sitting comfortably – most people will find it awkward to have a person standing over them to help them eat and drink. Progress entirely at the person’s pace, not overloading the cutlery with food and gently encouraging as you go along, offering frequent sips of water of other fluids. You should receive training in safe food handling as part of your induction – if you haven’t done so, speak to your manager or supervisor.
Dehydration – insufficient fluids – is a common problem among ill, older and frail people and can often lead to a person having to have fluids given by a drip into a vein. We should do all we can to avoid this by encouraging the person to drink, but only if this has been highlighted as part of his or care plan. There are occasions, particularly in hospitals, when patients should not take any food or drink by mouth. For the vast majority of patients/clients, however, you will be encouraged to help them to drink well – ideally pure or flavoured water and not gassy high-sugar drinks that can create health problems of their own. For people who are frail or ill, encouraging small drinks – even as little as 15-20 ml – frequently (perhaps every 15 minutes) can be effective in building up the total amount of fluid taken over time, and will be much easier for the person to tolerate.
Beyond helping people who may be ill for relatively short periods of time to eat and drink, we also have a responsibility as health care workers to help people understand how a healthy balanced diet works. We’ll look at the principles of promoting health for patients/clients in the next part of this programme, but one of the most effective ways of doing this is to adopt healthy eating behaviours ourselves.
An RCN survey of over 3500 nurses in 2014 found, however, that many of the nurses had developed unhealthy eating habits – taking high-fat convenience foods, eating too quickly and at unusual times of day – primarily because of the shift patterns they were working. We need to be aware that the pressures we sometimes work under and our working conditions can cause us to forget about our own health, and potentially troublesome eating, drinking and smoking patterns can result.
By adopting and keeping to a healthy, balanced diet, even at times of high stress, you will not only be supporting your own health, but also promoting healthier habits among the patients/clients and colleagues you work with. We will return to this in looking after yourself. In the meantime, to find out more about a balanced healthy diet and to have a look at the ‘eat-well plate’, which shows the recommended daily proportions of different kinds of foods, visit the NHS Choices website.