Home-cooked care

Hospital patients undoubtedly benefit when visitors bring in home-cooked meals. Patients are more likely to be well-nourished if they can eat food they enjoy. But it can present practical difficulties. Banning such food can prevent visitors from showing they care and present nurses with a dilemma.

Hospitalfoodie: an interprofessional case study of the redesign of the nutritional management and monitoring system for vulnerable older hospital patients

BACKGROUND

To date, a solution to the problem of hospital malnutrition in older patients in the UK has not been found through previous approaches using isolated interventions.

AIMS

To identify opportunities for, and to develop and prototype a new food and nutritional management system able to meet individual patients' daily requirements.

METHODS

Using an interprofessional team approach, design researchers worked alongside food scientists, dieticians, medical sociologists, ergonomists, computer scientists, technologists, key stakeholders and a 'food family' (those concerned with nutrition management, and food supply and delivery in hospital, i.e. food producers, caterers, ward staff, nurses dieticians, physicians, speech and occupational therapists), as well as with older people representatives. Through ethnography and workshop-based methods, major opportunities for service improvement were identified. An iterative design and development process was deployed using mixed methods including ethnography, mapping, personas, storyboarding, role-playing, enactment and narratives. Prototypes of interactive interfaces were developed to test the workability of an electronic nutritional management and monitoring system linked to a nutrition composition database. In parallel, new food products were developed, led by food scientists, and a catering supply and delivery system for ward-based food provision was also developed. The methods used to facilitate interprofessional collaboration, the engagement of the food family, and to develop the food and nutrition service concept are described.

RESULTS

A demonstration prototype was displayed in exhibition format at a series of conferences to gather further feedback.

CONCLUSION

Early responses to the 'hospitalfoodie' demonstration prototype were favourable and indicate that, with further development, the prototype may offer the means for improving nutritional care standards in hospitals and be adaptable for use across other patient groups.

Transforming care at the bedside: Patient-controlled liberalized diet

A 2003 partnership between the Institute for Healthcare Improvement and the Robert Wood Johnson Foundation created an initiative to redesign medical-surgical inpatient care - Transforming Care at the Bedside (TCAB). TCAB is intended to transform the elements that affect care on medical/surgical units by rapidly creating, testing, and measuring new ideas. TCAB began as a pilot with three hospitals nationwide, including the University of Pittsburgh Medical Center (UPMC) Shadyside in Pittsburgh, Pennsylvania. UPMC Shadyside initiated its TCAB efforts with an interdisciplinary initiative, involving registered nurses (RNs), nursing assistants, registered dietitians (RDs), and medical doctors (MDs), to transform nutritional services for medical-surgical inpatients. The Patient Controlled Liberalized Diet Program, piloted in late 2003 and rolled-out house-wide in August, 2004, puts the patient in control. The goal is to improve nutritional status and satisfaction among inpatients by empowering them to make menu selections and providing individualized nutrition education. Positive quantitative and qualitative outcomes have resulted, leading to plans for system-wide (19-hospital) spread and further programmatic evolution.

Older people's care experience in community and general hospitals: a comparative study

Community hospitals are an important component of the post-acute care pathway for older people. The objective of this study was to describe and contrast patients' and carers' experiences of community and general hospitals. Interviews with patients and carers revealed similarities in the perceptions of care between the two settings. These included appreciation of staff sensitivity, a sense of security, encouragement of independence and lack of activity. The community hospital was appreciated for its location, atmosphere, accommodation, greater sense of freedom, quality of food and staff attitudes. UK health policy promotes the development of community hospitals. This should be progressed in a way that retains key strengths of the specific service they offer.

Safety of patient meals in 2 hospitals in Alexandria, Egypt before and after training of food handlers

We assessed the food safety knowledge and food handling practices of 23 food handlers in 2 hospitals in Alexandria, Egypt [Gamal Abdel Nasser (GAN) and Medical Research Institute (MRI)] before and after a food safety training programme, and also the bacteriological quality of patient meals and kitchen equipment. There was a significant improvement in all knowledge-associated parameters except for personal hygiene in GAN. There was an improvement in the food safety practices in both hospitals. The bacteriological quality of most patient meals and food preparation surfaces and utensils improved after training. The bacteriological quality of patients' meals served in GAN was generally better than that in MRI.

[The role of the public health personnel in the Prevention Department (in the Hygiene Services and Public Health Care and Hygiene of Food and Nutrition): proposal for the future of public health care]

A global and local discussion on Public Health relevance is taking place, including the future role and organization of its services. Noteworthy becomes the role played by Public Health Specialists. This work presents the results of a workshop, carried out following the Guilbert methodology, whose aim was to define Public Health Doctors functions and their related activities. The programme involved 30 professionals from Triveneto area (North Eastern Italy), working in Prevention Departments at National Health Service and Universities. The key-functions identified were: 1) Health status assessment and identification of community risk factors, 2) Health Promotion, 3) Prevention, 4) Protection, 5) Planning, 6) Communication, 7) Professional Training, 8) Alliances and resources for complex Public Health programs, 9) Crisis management in Public Health, 10) Research. For each function activities were identified, meaning concerning areas and contents that must be warranted by professionals. This experience allowed to share existing attitudes and experiences present in Triveneto area, and it can stand as a feasible instrument for different settings. Nevertheless, it appears mandatory explaining at each level in the society role and functions of Prevention Departments.

Nutrition now. Ripe for reform

Levels of nutritional care for patients in the community are difficult to gauge, but community nurses can make a difference to those at risk.

Something for everyone

Providing food in hospital that complies with patients' religious and cultural sensitivities can improve wellbeing and reduce time in hospital.

Keeping food local

Procuring NHS food from local producers can be cost effective and increase patient satisfaction by offering patients more choice and better food.

Time to share. Interview by Adele Waters

The RCN's Nutrition now campaign, supported by Nursing Standard, is giving nurses the resources to stop patients becoming dehydrated and malnourished.

Developing the role of a ward housekeeper within a multidisciplinary team

The implementation of a housekeeper induction competency programme demonstrates the innovative way that the clinical standards facilitator has led the development of the housekeeping service at one NHS Trust. This service has been developed to ensure that there is sufficient training, support and opportunity to share best practice for the housekeepers. A Trust-wide approach using the multidisciplinary team (including dieticians, catering and facilities managers) has contributed to the raising of standards in meeting the patients' nutritional needs, as well as improving the ward environment. NHS Estates guidance (DH, 2001b) relating to the housekeeping service and the Essence of Care benchmarks for nutrition (DH, 2001a) were used to provide this framework for continuous quality improvement.