Eating and drinking

Good nutritional status is essential to an individual’s health and wellbeing. Many clients have an increased need for nutrients because of the extra demands being placed on the body by illness. Poor nutritional status has been associated with delayed recovery and an increase in mortality, which also increase the cost of providing health care. In addition, adequate nutrition not only promotes growth and repair of tissues but also aids recovery from surgery, disease and trauma.

Unfortunately recent reports have highlighted that many people in hospital are malnourished on admission but also that they often receive inadequate nutrition once in our care. In an attempt to address this problem, ‘Food and Nutrition’ has been included in the first wave of ‘Essence of Care’ documents produced by the Department of Health. These documents outline benchmarks for good practice with the aim of improving the quality of care. In relation to food and nutrition 10 outcomes have been identified (see Table 5.1). It is important that nurses and other health care professionals recognize the importance of their role in the prevention of malnutrition, and be able to identify clients at risk and plan appropriate interventions.

The factors that may affect eating and drinking include:
• physical arising from alteration in the structure, function or processes of the gastro-intestinal tract and associated systems, for example ulcerative colitis, diabetes mellitus, facial disfigurement
• psychological such as depression, anxiety and anorexia
• sociocultural, for example vegetarians, vegan or religious persuasion
• environmental including unpleasant smells, inaccessibility of shops
• politico-economic, for example lack of finances.

This chapter outlines the common terminology associated with eating and drinking and some of the principles and practices when assessing and meeting the nutritional needs of the client. These include assessing an individual’s nutritional and hydration status; assisting clients in selecting appropriate meals/fluids; monitoring nutritional and fluid intake; assisting clients with eating and drinking; feeding dependent clients and clients with potential swallowing difficulties; and providing first aid to a client who is choking. The chapter concludes with references and further reading.

Table 5.1 Benchmarks for practice
Factor	Benchmark for practice
1 Screening and assessment to identify client’s nutritional needs	All clients should be assessed on admission and clients deemed ‘at risk’ should undergo further assessment
2 Care should be planned, implemented and evaluated for all clients requiring further nutritional assessment	Plans of care should be readily available and ongoing, demonstrating evaluation and reassessment of care needs
3 A conducive environment	An environment conducive to eating and drinking should be provided
4 Assistance to eat and drink	Clients should receive any care and assistance they require with eating and drinking
5 Obtaining food	Clients should have sufficient information to enable them to obtain the food and drink they require
6 Food provided	Food provided should meet the needs of the client
7 Food availability	Meal times should be set but clients should be offered a replacement meal if they miss the set timed meal, and snacks should be readily available at any time
8 Food presentation	Food should be presented to clients in an appealing manner
9 Monitoring nutrition	The amount of food and drink a client actually takes in should be monitored and recorded, and should lead to action if there is cause for concern
10 Eating to promote health	Every opportunity should be taken to educate clients about the importance of nutrition in promoting their own health