Nutrition is considered to be the intake of
food in relation to the body’s dietary needs. (Nutrition, 2017). Patients who
cannot eat for themselves often need help and encouragement to eat and drink as
nutrition is vital for good health and wellbeing (ageuk.org.uk, 2017). Food
provides human bodies with energy, vitamins and minerals, proteins and
essential fats in order to live, grow and function properly (Nhmrc.gov.au,
The Department of Health (DH) (2012) state
that the science of nutrition is the study of all processes of growth,
maintenance and the repair of the living body that depend upon the digestion of
food and the study of that food. Nurses should have the relevant skills and
training in nutrition support is able to determine the nutritional sufficiency
of a patient’s dietary intake via nutritional screening (nice.org.uk, 2017).
Nutritional screening is the first step in
identifying individuals who may be at risk of malnutrition and who may benefit
from appropriate nutritional intervention. A nutritional assessment would be
carried out, this involves the nurse carrying out a physical assessment, taking
a diet history and calculating the BMI of the patient. Science underpins
identification of some nutritional deficiencies, i.e. iron levels can be
identified by measuring haemoglobin levels. Iron helps the body make red blood
cells and is included in foods such as greens, red meat and egg yolks (Stewart,
Patients with poor appetite or dysphagia may
not be able to ingest enough food to meet nutritional needs; therefore oral
nutritional supplements between meals may be prescribed (Alexander et al,
2012). These nutritional supplements consist of drinks, puddings or powders
that are mixed with milk or water that have added kilocalories and other
Ethical challenges can come into the
procedure when assisting someone to transfer food or drink into their mouths
when they are unable to do so themselves (Schwartz, 2012). This requires
considerable skill and the consent of the patient is required. It should be
recognised that having to be fed by someone can be a threat to the individual’s
integrity and self-esteem, so every effort should be made to minimise the
negative aspects. The nurse should sit level with the person and encourage a
relaxed social atmosphere (Alexander et al, 2012).
Ethical challenges are all about informed
consent, as by law patients and families have the right to know what kind of
treatment and care will be given to them. The patients’ preferences would need
to be taken into consideration, such as their beliefs and their religion as it
would have an effect on their diet (Shintani, Shuzo, 2013). Some religions have dietary guidelines that
may need to be followed to varying extents such as fasting, the premises of
which foods are sold and prepared (Jewish kosher laws) or dietary exclusions
such as alcohol or certain types of animal flesh (Rucker and Rucker, 2017). If an individual’s intake is poor, it is
important to “make every mouthful count” (Meritt et al, 2012). It is important
to respect religious beliefs and work with the patient to identify appropriate
foods and supplements. This can be achieved through strategies such as encouraging
the person to choose high-energy foods to eat and increasing the nutritional
values of foods by adding butter or cheese to vegetables and ice cream to
puddings and milk in drinks.
The main principle of assisting to feed a
patient is to make sure that they are treated with respect and dignity.
Examples of this would include protecting the patient’s clothes with a napkin
and removing any particles of food or drink from the patient’s face in order to
maintain dignity and cleanliness (Dougherty and Lister, 2015). The essential
equipment that is needed before feeding an adult patient is to have a clean
table or tray, equipment that is required to assist the patient such as
adequate drinking water, adapted cups, cutlery and napkin and a chair for the
nurse to sit with the patient (Mishra, Ruchika, 2016).
Carper’s (1978) articulation of the
“aesthetic” pattern on knowing was a development within nursing that opened a
space for qualitative methodology. Carper stated that it’s a nurse’s ability to
respond to the patient in the fullness of their situation and argued that this
form of knowledge had a unique character and it could not be expressed in the
empiric pattern (Nursing Knowledge, 2017).
Artistry is the creative skill and ability in
nursing. If nurses were to suspect or detect malnutrition, they can protect
patients against illness and disease by enhancing their quality of life by
understanding how illness and medication affect appetite and nutritional needs.
They would need to become food aware as meals are just as important as
medication and assess patients for signs and risks of malnourishment (Bender,
David A, 2014).
Equally, providing an appropriate diet for
the age of the patient – this would all be considered when feeding a patient
because as a nurse you would need to know what patients recommended intake is.
Encouraging hydration also plays a huge part as water helps to transport
nutrients to give humans and energy and to keep them healthy. If humans are not
hydrated, they may begin to feel tired, dizzy, and have muscle cramps or other
serious symptoms. How the nurse treats and speaks to patients has an effect on
the care they are receiving also (Gorse et al, 2012).
Good nutrition is vital for the health and
well-being of someone receiving care. Nurses have a pivotal role in supporting
patients with nutritional needs within acute and community settings. By nurses
giving the best of their assistance and guidance in giving the patient their
food, would then, in turn, help them to have a fulfilling and healthy
lifestyle. It can also be achieved by applying Carper’s 1978 four fundamental
pattern of knowing in nursing practice which are science, knowledge, ethical
and artistry. This fundamental theory is also supported by the Nursing and
Midwifery Council, which is conveyed in the fundamental of care code of
practice that states to help and support patients (NMC, 2015).