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You must provide answers to each question that allow your assessor to properly assess what work duties you are doing or what role you have within your work. It expected that you would need approximately 300 words per question. The more detail you provide the less likely your account will be sent back for more clarification.
You must answer each question in your own words and written in the first person meaning “I do this”. A tip is always to keep in mind the “who, why, how, where and when” in each answer.
Learning Outcome 1-Understand the nutritional needs that are unique to individuals with dementia
1.1 Describe how cognitive, functional and emotional changes associated with dementia can affect eating, drinking and nutrition Symptoms associated with dementia, can have a harmful effect on individuals, if they are not addressed and resolved. In my workplace if the resident’s cognitive ability is impaired they could forget to eat and drink, as well as think that they haven’t been fed, I might also think they had a drink or eaten their food where as they might have tipped their drink down the sink or thrown their food away.
If the functional ability changes it could mean that they can’t hold cutlery or hold a drink, therefore they are unable to feed themselves properly. When the emotional state changes they may become stressed and not want to eat or drink and may also forget that they need to eat and drink.
For example, Miss K was a big lady who had mixed dementia.
She was able to talk and hear but needed full support at meal times due to her nutritional needs. At meal times she would normally sit at the table but she loved talking to herself most of the time. To divert her attention, as it was already lunchtime, first, I used to greet her in an appropriate manner and explained that it’s already time to eat. She used to look at me and smile. She accepted her meal with happiness and excitement on her face, as she was already hungry. I placed her food and drink in front of her on the table and after a while I left her on her own, I then noticed that she stared at her drink and I could tell that she didn’t actually know what she was doing as she had forgotten what to do with the items in front of her.
Read more: The Nutritional Requirements
She used to play with her food and after a few seconds she would usually tip her drink onto the floor and throw her food onto the curtains hanging by the window. In order for her to stop this behaviour I always tried to calm her down in the gentlest way possible. After calming and settling Miss K down I carried out the cleaning and sanitising of the floor as well as the curtains to ensure proper hygiene and cleanliness thus avoiding any potential infections or contaminations. I always made sure that I documented the status of Miss K so that all events were on record for future reference. I also made it a priority to mention any changes of Miss K to the senior member of staff on duty so that they were kept up to date with her condition. After a few reports from the carers she was eventually given one to one care during mealtimes to assist and support her during eating and drinking.
1.2 Explain how poor nutrition can contribute to an individual’s experience of dementia. Poor nutrition can result Miss K becoming more confused and stressed as she is not getting all the nutrients she needs, and because of her becoming more confused which may result her in forgetting to eat and drink more then she became more distressed which made her more ill. Good nutrition helps the way all human beings look, feel and think and if someone with dementia that doesn’t get enough nutrition, it will certainly show by them losing weight and not feeling very well. Due to Miss K’s lack of interest in eating and drinking her mobility was affected. She became unsteady on her feet, which made her use the wheelchair from time to time. I always tried to give her motivation and encouragement to drink and eat as well as other staff members.
It also important for me and other staff members to maintain good nutrition to prevent ill health whilst at workplace. I made sure that I am physically fit, had ate and drink well before going to work because sometimes if carers are unwell and have not eat or drink the level of patience and passion to care for the service users were affected which could make them becoming more agitated and distressed.
1.3 Outline how other health and emotional conditions may affect the nutritional needs of an individual with dementia An example of how other health and emotional conditions could affect the nutritional needs of an individual with dementia is depression, as this could lead to a loss of appetite and also a lack of interest in food and drinks. For example, Mrs B has been depressed for quite sometime due to the death of her husband. She would prefer to be on her own most of the time. As a result of her lack of socialisation she became socially isolated. This affected her nutritional needs, as she didn’t feel like eating. It took a long time until she agreed to go to the dining room at meal times.
Once dinner was served she would lose interest in eating and tended to return to the lounge without touching the meal. I consistently done my best to try and encourage her to eat. I offered her the choice of what she wanted to eat in the hope that she would choose something she desired rather than not eating at all. I noticed that she became frustrated and anxious when questioned several times. When this became apparent to me I would leave her in the lounge and I would ask other staff members to try and talk to her to see if they could help. I updated her records so that other staff members could see that she hadn’t eaten. I also had to report the matter to the manager so that they were kept in the picture too.
1.4 Explain the importance of recognising and meeting an individual’s personal and cultural preferences for food and drink It is important to recognise an individual’s personal and cultural preferences to food and drink as this can make people feel like they are respected and included. This will encourage individual to eat and drink, but also it will increase their emotional and physical well-being. Asking people with dementia about their mealtime preferences, when and where they like to eat and what foods they enjoy is vital to ensure all staff provide food and options at mealtimes that are familiar to them. People may have different views about foods depending on their cultural background. Providing range of familiar foods can help make individual feel at home, safe and welcomed.
An example, Mrs E, a Spanish lady who has no dementia, is self-centred and has her own eating and drinking preferences from time to time. It is very important for me to identify what Mrs E likes to eat and drink and what she doesn’t like because she tends to shout at carers if these are unmet. If I don’t recognise these I am not meeting her preferences and that will cause her to not eat and drink instead of realising that it is something she doesn’t like. This will then make her feel unhappy, anxious and stressed. If all members of staff know what she likes the management always assure that there is always something available. Due to her nationality it is also important to identify her cultural needs e.g. religion, various times of the year where she may not eat or will only eat certain foods. Every time I am unsure and have questions regarding her diet I always double check with her care plan or I ask one of the members of staff who are more aware of her dietary needs.
1.5 Explain why it is important to include a variety of food and drink in the diet of an individual with dementia It is very important to include a variety of food and drink in the diet of residents with dementia, as they may forget what they didn’t like before and suddenly start eating it. For example, Mr M has suffered from a bowel cancer and other health problems. He was under the palliative care due to his severe condition. He was unable to chew and swallow normal food but still able to drink properly. After few weeks of not eating well Mr M had lose weight. He was checked by his GP and prescribed an Ensure drink for him, which contains the right amount of nutrients that will serve as alternative to his food.
I also made sure to ask Mr M if he had any preferences of food and drink e.g. any flavour of drink or soup. He then told me that he likes chocolate flavour drinks. I then informed the senior regarding his wishes, this was immediately passed on to his GP and products were dispatched after a day. It is important that there is always a variety for Mr M and other residents to make sure that they are always eating something and getting the right nutrients in their bodies. After giving Mr M his drink and food I then recorded it in his observation sheet so that other members of staff would be aware how much fluid intake he had and to continue to monitor Mr M’s condition.
Learning Outcome 2-Understand the effect that mealtime environments can have on an individual with dementia 2.1 Describe how mealtime cultures and environments can be a barrier to meeting the nutritional needs of an individual with dementia Mealtime cultures such as meal sizes, number of courses, specific meal times, order of food etc., may not be conducive to the needs of an individual with dementia. In my workplace, cultures can be a barrier because some of the residents may not know how to eat the food that is in front of them and in the correct order. Please see example 1.1. There are some residents who don’t want to eat with other residents at the same time as everyone else in a noisy, busier environment such as communal dining rooms.
Communal areas can be a distraction for an individual with dementia as they can become overwhelmed. For example, a resident who requires assistance to eat, I always make sure to ask him if he would prefer to stay in the main dining room or in a separate, more private room where he feel he won’t be watched. I always ensure that the environment for residents is calm and relaxed in order for them to be able to concentrate on the food they eat. This could avoid them becoming agitated, anxious and stressed due to distraction of other residents. Also, all staff was trained to the right standard to deal with mealtimes so that they run as smoothly as possible to avoid conflicts.
2.2 Describe how mealtime environments and food presentation can be designed to help an individual to eat and drink In my workplace, when I was assigned the kitchen duty I made sure I washed my hands thoroughly before and after entering the kitchen and before and after handling food. Before mealtimes it was my responsibility to ensure that all dining areas were neat and clean, cutlery was set on the table and that a variety of drinks were prepared and ready for the resident’s. I also checked the floor to look for any spillages on the carpet to avoid cross contamination and tripping hazards. Furthermore it was my responsibility to distribute all the trays to the residents that remained in their bedrooms as well as the food trolley for the residents in the lounges.
I made sure that the food was served in a relaxed and unhurried manner. I checked with my colleagues to make sure that all residents were ready for their meals, allowing them to feel calm and relaxed in order to focus on their meals. The presentation of each dinner table and the presentation of the food itself were important too. Prints on plates and tablecloths can be very confusing for residents with dementia, especially if they have visual perception difficulties. Foods had to be easily identifiable; plain cream plates were used and were useful in helping to show up colourful foods. The presentation of the food itself had considered colour, texture, smell, and overall appeal. No one wants to eat a plate of unappealing food, and residents with dementia respond well to sensory stimulation.
2.3 Describe how a person centred approach can support an individual, with dementia at different levels of ability, to eat and drink There should always be a person centred approach to food and nutrition to all individuals receiving care, as well as those with dementia. In my workplace, there are various courses provided to all members of staff regarding person centred approach, food hygiene and communication to make sure that they are knowledgeable and skilled enough to support individual’s nutritional needs. Ensuring that mealtimes are sufficiently staffed to provide assistance to those who need it is also greatly important when providing a person centred approach.
For example, Mrs R had undergone a nutritional screening prior admitting in the home that was carried out by the line manager. This involved records of her dietary needs and preferences and any assistance she needs at mealtimes to ensure that members of staff act on this. Based on her care plan Mrs R had a normal diet, could eat and drink well but needed encouragement from time to time due to her condition. When assisting Mrs R I always ensure to respect her rights and dignity through providing assistance discreetly e.g. giving her serviettes to protect clothing, provide adapted crockery and cutlery to enable her feed herself where appropriate. Making sure that food looks appetising and keeping foods separate to enhance the quality of the eating experience is also important.
Whilst socialising during mealtimes should be encouraged, I also offer privacy to those who have difficulties with eating, if they wish, to avoid embarrassment or loss of dignity. I made sure that I give Mrs R and other residents time to eat because they should not be rushed. I made sure to not to make assumptions about their preferences on the basis of their cultural background- I ensure to ask them what their preferences are. My communication skills were also important when supporting Mrs R and others because some of them were unable to understand properly due to their dementia.
I always made sure to approach and interact them in a nicest and in a properly manner. Visual aids, such as pictorial menus, and non-verbal communication were also used to help to make choices. I also ensure to record food and fluid intake of those resident’s who were monitored due to poor nutrition. As needs and abilities change, these requirements will require review, to make sure that nutritional needs are consistently met. Also knowing Mrs R, and how, where, what times, and by which method she can best consume food and drink will help to support her and her needs.
Learning Outcome 3-Be able to support an individual with dementia to enjoy good nutrition
3.1 Explain how the knowledge of life history of an individual with dementia has been used to provide a diet that meets his/her preferences I was off at work when Mr O was first admitted in the home. I had no idea about his personal life, health condition, nutritional needs and preferences. When I came back to work I made sure to check his care plan and daily report form to gain knowledge about his life history before dealing with his personal needs. Having knowledge of his life history has helped me and other staff members provide a diet that meets his preferences.
This helped me to find out what he likes to eat, what are his favourite foods, what he don’t like to eat and if he has any allergies to foods. By reviewing the care plan I found out that Mr O was diabetic, liked blackcurrant juice and black coffee but needed a carer to remind him to eat and drink during meal times as he used to forget them and only sleeps if not encouraged and supervised. By using his preferences shows that I am sticking onto his care plan, wishes and desires when meeting his needs. Recording any changes on his preferences was also recorded in his daily report form and I also handed in information to the senior in charged so that other staff would be aware.
3.2 Explain how meal times for an individual with dementia are planned to support his/her ability to eat and drink In my workplace, meal times are planned according to the individual’s condition and choices, some residents will sit at the table and eat with others and some will not eat at all if they are in the company of others- these are residents who preferred to stay in their bedrooms. My colleagues and I always ensure that residents are in the most comfortable place they want to eat and drink, and that they are happy with it. In between mealtimes my colleagues and I offered them snacks with various drinks and food e.g. tea, coffee, hot chocolate, Horlicks, Ovaltine etc., biscuits and cakes whilst staying in the living room or their bedroom.
There are also residents who are unable to feed themselves. I always make sure that I assist them with feeding and drinking and also be planned to make sure that they are comfortable and to know what they are going to be eating or drinking in case there is something that they do not want. Any changes on residents nutritional preferences I always checked it with my manager or other staff before giving them other choices because they may have a special diet or allergic to something.
3.3 Explain how the specific eating and drinking abilities and needs of an individual with dementia have been addressed Getting to know the specific needs and the eating and drinking abilities of an individual should be addressed when helping the individual to make a choice in what they want to eat and drink. Also knowing the individuals abilities should also be in their care plan. I always ensure to check each individual’s care plan before providing them food or drink especially when he/she is first admitted in the residential home. I also double check their dietary needs with my manager or senior care staff to avoid errors that may affect resident’s behaviour and health.
In my workplace, most of the resident’s changed their mind from time to time although there was a specific preference listed in their care plan. This will depend on their situation because some residents were unable to decide for themselves and were able to. I always made sure to consult them as they may forget of what they want or they may get fed up of sticking to one drink or food all the time. For example, based on Mr O’s care plan he likes orange juice but when I offered him the drink he refused to accept it. He asked me if he could have a blackcurrant juice instead. I respected his choice and gave him the blackcurrant juice. I also passed my experience to the other staff members for them to become aware of his new preference but he might also change his mind in other time.
It was also important to observe and monitor a resident before taking an action to address them in eating and drinking. Another example, Mrs C had a normal food and drink diet, as her dementia progresses, she has developed a difficulty in swallowing and drinking. When I saw her suffered I immediately called the attention of my Senior to check and observe Mrs C’s condition. She then called the GP to further assess her and also speech language therapist was involved. After few assessments Mrs C was then changed onto liquidised meal and 1 scoop of thickener in every 200mls drink. Her care plan was reviewed and this information was also documented in her daily report so that other members of staff will be informed regarding her nutritional changes.
3.4 Explain how a person centred approach to meeting nutritional requirements has improved the well-being of an individual with dementia The person centred approach to meeting nutritional requirements has improved the well-being of an individual by improving their state of mind and their physical health. Based on 1.1 examples, by giving Miss K a one to one assistance during mealtimes she was able to eat and drink properly. Her ability to stand and walk was developed and I have noticed that she was calmer, polite and gentle when responding to carers.
She also took her medication without any refusal or problem. The care and support my colleagues and I have given to Miss K has improved her sleep patterns, reduced confusion and anxieties as well as infections making her live a happier and healthier lifestyle. I always ensure to record any changes and important information regarding her physical and emotional condition to help further assessment and also this will serve as an evidence practice for future observation and findings.
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