The patient presents with dementia, poor posture (her chin close to her chest) and dislikes solids, there for has to be assisted to feed and chooses only to consume liquids. Her communication skills are also poor and doesn’t have the capacity to engage in a flowing conversation but has the ability to answer a question using the words ‘yes’ or ‘no’ or by saying individual words. I was given the task of feeding the patient at lunch time as she requires one to one support at meal times due to her lack of willingness to consume solids and fluids.
It is extremely important to maintain good fluid intake to reduce the chance of dehydration which could contribute to increased confusion in a dementia patient. To prevent this, patient H has a daily fluid chart which is filled in every time fluids are consumed as a way of effectively monitoring her intake of fluids. I informed patient H it was meal time and directed her to her chair by her bedside, supporting her to sit and positioned a bedside table over her chair.
H expresses distress and agitation when sitting in the dining room at meal times with the other patients therefor patients H’s preferences are respected by supporting her to feed at her bed area. I put a plastic green apron on her to protect her clothes and maintain her dignity, washed my hands and put a green apron over my own clothing for hygiene purposes in accordance with my wards food hygiene policy. As the patient only consumes fluids I got a Fortisip drink from the fridge, poured it into a handled plastic cup and added a straw.
Fortisip drinks have a high nutritional and energy value and are used as meal replacement in cases such as this patient. I communicated with the patient verbally in an encouraging manner and held the cup and directed the straw to her mouth. I did this at several intervals, making sure I left a sufficient time in between sips to enable her to swallow the contents of the liquid, encouraging conversation throughout. After drinking three quarters of the cup the patient refused to open her mouth to take the straw and shouted ‘no’ and got up out of her chair which at this point I praised the patient and relocated the cup on the table.
I chatted in general conversation with her to give her sufficient time to digest her intake then offered her further fluids to which she stated ‘no more’. Satisfied she had had enough, I removed her apron and directed her to the lounge area and then discussed the task with my mentor. Feelings/thoughts Before I started this task I felt slightly anxious as it was the first time I had supported this patient on a one to one basis.
I was unsure of how she would react to me as I was an unfamiliar face to her in relation to her feeding and I had previously witnessed her being very verbally aggressive, trying to leave her chair and showing signs of frustration during meal times with other trained, experienced staff on the ward. Throughout the task I felt my confidence increased as the patient was fairly compliant with what I was trying to achieve, this made me become more relaxed and less anxious which I feel eased the mood of the whole experience.
After completing the task I felt satisfied that I had achieved what was required whilst undertaking a person-centred personalised approach to meet the needs of the patient. Evaluation I felt that I achieved the desired outcome which was to ensure the patient consumed an adequate volume of fluids during meal time whilst promoting a person – centred approach to their care as I ensured the patient enjoyed and consumed her meal through liquid form with a suitable aid which is her preference to enable easier consumption.
In order to meet patient’s needs I required a straw, cup, appropriate meal supplement and syringe which are all aids I used during the task. If I hadn’t prepared her meal in liquid form then the patient would have been unable to consume her meal which would result in dehydration, hunger and lack of sufficient nutrients absorbed into her body to enable her to function normally.
I felt I could have been more organised with the task as I felt I interrupted the flow of the task by leaving the table on a couple of occasions to retrieve required items. I should have had the meal supplement already poured in the cup with straw to hand at the table along with the oral syringe before directing the patient to get seated in her chair. If I had done this I feel I would have been much more focused on the patient which would have been a more positive experience for the patient. Analysis
In order to reduce my anxiety of the task I feel it would have been beneficial to have spent more time interacting with the patient on a general basis before supporting her with feeding. This would have provided a more natural transition into the task effectively creating a more relaxed experience for the patient. This would enabled me to have an even better person centred approach as I would have known what works well and what doesn’t work so well in regards to feeding the patient concerned. Conclusion
I feel that the patient received a good standard of person centred care in regards to her mealtime. It is important that the patient feels included and valued within the ward and I feel this is met by ensuring she has one to one support during mealtimes in an area where she feels most comfortable. However, it is also important to note that there may be occasions where the patient would rather not be situated at her bed area and her behaviour of standing up and removing herself from the chair may indicate this.
I understood this behaviour was the patient’s way of expressing that she didn’t want any more intake, where in reflection it could have been an indication that she was unhappy with the current surroundings or the temperature for example. My mentor was satisfied that I had taken a person-centred personalised approach to the task as I had met and taken into account the patient emotional, metal and physical needs by tailoring her meal time experience using appropriate aids and the environment to create a positive experience which took her preferences into consideration.
Action plan In future I will aim to forward plan more and ensure I have all required resources to hand to enable me to dedicate my time and use my time with the patient more effectively. This will ensure that I make the best use of my time which will allow me to support my team effectively and also ensure that the patient feels completely valued and display to them that I am competent and focused on the task I am supporting them with.
It would also be beneficial for me to interact with the patient if possible before undertaking a task which would relax the patient and help them feel at ease. I have had previous experience of this skill as I have worked in the social care sector for many years but have found having this opportunity to reflect on my practice through the use of the Gibb’s model of reflection valuable and given me awareness of how I can develop this skill further to benefit the patient.