When assisting a patient with eating one of the first things the nursing assistant should do is which of the following?

As people age, it is common to require more assistance during mealtimes. Losing the ability to eat and drink independently can have a huge impact on overall nutritional intake and quality of life. There are a number of ways we can assist those in Residential Aged Care Facilities (RACF) with eating and drinking to maintain a sense of dignity and promote adequate nutritional intake.

There are a variety of reasons that residents may need assistance with their meals, such as dementia or impaired cognition, weakness in hands (e.g. arthritis), poor vision, poor appetite, swallowing difficulties, or general weakness and fatigue. Whilst it is important to encourage residents to eat independently where possible, some residents will require assistance with their meals. The level of assistance that residents will need can vary, and may range from:

• Supervision, prompting and encouragement

• Setting up the meal (removing lids, placing cutlery, pouring drinks)

• Cutting up the meal

• Providing full feeding assistance

The amount of assistance a resident needs can change from day to day, even meal to meal. Careful observation of residents at mealtimes can give you an indication as to who might need some extra assistance, for example those who do not complete their meal or who have trouble using their utensils.

If you are providing full feeding assistance, it is important to keep the following points in mind to promote good oral intake and ensure that the resident is comfortable during mealtimes:

1. Check your position: the resident you are assisting should be alert and sitting upright. Sit down in a chair so that you are at eye level with the resident, rather than standing over them.

2. Ensure that the resident has any necessary aids: dentures, glasses or hearing aids.

3. Use appropriate utensils: this may vary depending on the individual, however, generally a teaspoon is most comfortable for the resident.

4. Before starting the meal: check that the meal is what the resident ordered and that the temperature of the meal is correct. If the resident requires extra time with their meals, reheating may be required. Taste diminishes with age, so extra seasoning should be offered.

5. Take the time to explain to the resident in detail what they are eating: having a positive attitude can assist in improving meal satisfaction.

6. Serve one course at a time: eating should not be rushed, avoid hovering with the next mouthful whilst the resident is still eating, as this can promote swallowing difficulties. Whilst it is acceptable to include different components of the meal (e.g. meat, sauce, vegetables) in the same spoonful, smooth puree or minced moist meals should never be mixed together on the plate or bowl as this leads to poor presentation and may combine flavours that the resident does not enjoy.

7. During mealtimes, talking to the resident and taking your time makes mealtimes more enjoyable.

8. If the resident refuses or does not complete their meal it is important to find out why: there may be potential to offer an alternative, offer the meal at a later time, reheat the meal, or offer extra seasoning or sauces. If oral intake remains poor, this should be reported to the nurse in charge or clinical coordinator for monitoring.

Although mealtimes can be busy, taking the time to help residents who require assistance can lead to improved oral intake and resident enjoyment. For more information regarding mealtime assistance or to arrange staff education sessions, please speak with your Dietitian from the Eat Well Nutrition team.