Developing practice: mealtimes and nutrition Belinda Dewar, Senior Nurse

1. Developing practice: mealtimes and nutritionBelinda Dewar, Senior Nurse Dr Stephen Smith, Lead Nurse Leadership in Compassionate Care Programme (LCCP)

2. Aim Aim of presentation • Understand the practice development work within the LCCP programme • Understand the techniques used to explore and develop mealtimes and nutrition with staff, patients and relatives • Consider the challenges and value of developing local practice based theory

3. Aim of LCCP programme Embed compassionate care as an integral aspect of all nursing practice and education in NHS Lothian and Edinburgh Napier University.

4. Theoretical approaches adopted

5. Practice development activities • Beliefs & values clarification groups • Image work • Stories: Patients, Relatives & Staff • Emotional touch points • Observation: informal / formal

6. Practice development activities • Action Learning • Focus groups using RCN Dignity Resources • Role modelling • Development of positive care practices • Facilitating practice development projects

7. Evidence from patients, relatives and staff We did not know where we could get things to eat at night, if we could use the kitchen to make a cup of tea. Some staff were really good about this and others maybe were not happy it was difficult to know. (Relative story) Sharing & moving to action ........ I think it is a bit silly that you don’t know what is for tea tonight as you work here – I wish you could remember (Patient) Sharing & moving to action ........

8. Evidence from patients, relatives and staff One of the nursing auxiliary's was trying to give one of the patients who had a cognitive impairment a choice about what to eat. He said that there was meatballs, pasta or vegetable roulade. After saying this he then went on to say – vegetable roulade is like a big sausage roll but with vegetables in it. Sharing and moving to action ...... CSW sitting alongside a patient who was reluctant to drink, she was having a drink with her to try and encourage her to drink. Sharing and moving to action ........

9. Sharing and discussing the evidence with staff

10. A staff nurse asked a patient who had cognitive impairment what he would like for lunch. She gave him 3 choices, He did not respond. She went over to the trolley and put a little bit of everything on the plate, some tasters she called it, and went on to try to give him some lunch. He did not really respond to any of the food but she had tried hard to offer a range of options. (Observation)

11. One nurse went to give a man who was blind his lunch and said to him your potatoes are at 12 o’clock, your stew is at 4 o’clock and your carrots are at 9 o’clock. (Observation)

12. Developing positive caring practices

13. We make a point of going round after the meals have been given out to check if people need some additional support e.g. opening jam

14. We try to offer patients a choice of where they would like to sit at mealtimes and negotiate with them when this is not possible

15. We all make a commitment to helping out at meal times and if we are unable to do so we will inform others.

16. Offering choice at mealtimes is a priority on this ward. We are creative about how we do this. For example, for those patients who are unable to tell us what their choice is we offer taster plates where they can sample the range of food on offer, to help them to make a decision.

17. We take the time on the ward to find out the things that matter to patients and families at mealtimes

18. Discuss positive caring statements in relation to: How does this make you feel? Does this happen most of the time ? What could help it to happen more of the time ?

19. Changing practice at the coal face ...... • What can we work on / what can wait? • Discuss and decide on action • Share with team • Implement and evaluate Sounds easy but ..........

20. Developing actions and practice .......

21. Welcome to ward 3 Royal Victoria Hospital Nutrition: Patients who are unwell require a balanced diet in order to recover. Their appetite may be affected by interruptions during meal times Patient Dignity: We believe that patients should be able to enjoy their meal without interruption Why is protected mealtimes important to the patients and staff of ward 3? Jossie Pearson , Joyce Malone, Liz Adamson Support: Many patients within the ward require assistance or supervision at meal times. If nurses have to answer the telephone during mealtimes it takes them way from patients

22. The challenges of changing practice The case of the milk jugs

23. Tips for productive meal times (Releasing Time to Care Module) Mobile trolley Display dietary status in kitchen Red tray for those needing help Clear responsibilities at mealtimes Staff ready 2 minutes before mealtimes Define parking space for trolley Plated meals ready to go IMPORTANT but we must focus on this and the patient, staff and family experience to get the balance of quality and efficiency right

26. wheel Outcomes Be curious about practice Work with best practice statements and development initiatives, with eyes wide open and feel brave to integrate local context and make it real Develop local practice theories about mealtimes that are based on experience, where people have ownership, where people are willing to defend

27. wheel Re-invent the wheel ?