Subtainable development. Cooking up a storm

As one of the world's largest organisations, the NHS should make sustainable development a top priority. With a target-driven culture and ongoing financial pressure, sustainable development tends to struggle for a place on the agenda of senior NHS managers. The DoH has signalled its intensions to push trusts on sustainable development, and it may form part of future Healthcare Commission assessments.

Hospital mealtimes: action research for change?

Poor nutritional care within the hospital setting continues despite decades of work chronicling and measuring the problems. To address the problem changes in practice have been attempted to improve the patients’ experience of mealtimes. In order to implement patient-centred mealtimes for older patients by changing the focus from institutional convenience to one that focuses on the requirements of the patients, an action research approach has been used that focuses on action and change, and thus appears to have much to offer those who seek to change practice. The present paper focuses on the first two phases in a three-phase approach. In phase one the nature of everyday mealtime care and the wider context are explored using focus groups, interviews and observations. The data fall into three main themes that all impact on patients’ experiences of mealtimes: institutional and organisational constraints; mealtime care and nursing priorities; eating environment. Following feedback of phase 1 findings to staff and identification of areas of concern a model of practice development was selected to guide the change process of the second phase. Changes to mealtime nursing practice and the ward environment have been made, indicating that action research has the potential to improve the mealtime care of patients.

Malnutrition in hospitals. What can you and I do?

We all require food and fluid to survive and good nutrition plays an important role in recovery and rehabilitation from illness. Along with these physical properties, eating and drinking contributes to our quality of life by being a source of great pleasure with important social, cultural and religious functions. It would be reasonable, therefore, assume that when individuals are sick — at their most vulnerable in hospital — the provision of adequate food, fluids and nutritional care is a high priority on the agenda of managers, healthcare professionals and all those responsible for providing care.

Mealtimes in hospital ? who does what?

AIM

This paper describes the findings of a descriptive study about what nurses do at mealtimes in relation to monitoring/assisting the eating practices of older patients in an acute care facility.

BACKGROUND

The prevalence of under nutrition is known to be high in hospitalized older patients and insufficient dietary intake is regarded as a major cause. However, most of the research tends to concentrate on the nursing home setting. Little is known about the situation in acute care facilities.

METHODS

Two medical wards participated in the study. Ward 1 had introduced a change of nurses' meal break time and ward 2 continued with normal practice. Convenience sampling was used. Fifty nurses and 48 patients were observed at different mealtimes during two weeks. Four nurses and four patients who were observed were also interviewed. Data were analysed using descriptive statistics and thematic analysis.

RESULTS

Kitchen staff delivered all meals and collected the majority of the meal trays. Older patients did not receive enough assistance during mealtimes. Interruptions happened frequently and social interaction was neglected. About one-third of patients observed left more than two-third of their meals.

CONCLUSION

Nutrition issues appeared to receive less priority in the ward than other nursing care activities and nurses' assistance was generally insufficient and not provided in a timely manner. Relevance to clinical practice. Findings highlight the deficiency in practice that should suggest to nurses that they examine their practice and put into place strategies to ensure older patients are properly/adequately hydrated and receive sufficient nutrient intake.

Nutrition and Exercise Environment Available to Outpatients, Visitors, and Staff in Children's Hospitals in Canada and the United States

BACKGROUND

Children's hospitals should advocate for children's health by modeling optimum health environments.

OBJECTIVES

To determine whether children's hospitals provide optimum health environments and to identify associated factors.

DESIGN

Telephone survey.

SETTING

Canadian and US hospitals with accredited pediatric residency programs.

PARTICIPANTS

Food services directors or administrative dietitians.

MAIN OUTCOME MEASURES

Health environment grades as determined for 4 domains quantifying (1) the amount of less nutritious food sold at cafeterias (cafeteria grade), (2) the presence of fast food outlets (outlet grade), (3) the amount of nutritious food alternatives available (healthful alternative grade), and (4) the presence of patient obesity or employee exercise programs (program grade).

RESULTS

The overall response rate was 87%. Compared with Canadian hospitals, US hospitals had more food outlets (89% vs 50%) and more snack/beverage vending machines (median, 16 vs 12) (P = .001 for both), despite equivalent consumer numbers. External companies managed more outlets at US vs Canadian hospitals (65% vs 14%; P = .01), and, generally, US hospitals recuperated more revenue from their outlets. Worst cafeteria grade was associated with US hospital location (odds ratio [OR], 8.9; 95% confidence interval [CI], 1.6-50; P = .01) and lower healthful alternative grade (OR, 0.016; 95% CI, 0.002-0.15; P<.001). Lower grade in any domain was related to whether hospitals received more revenue from noncafeteria food outlets (OR, 1.7; 95% CI, 1.06-2.72; P = .03) and the presence of more internally operated cafeterias (OR, 2.3 per cafeteria; 95% CI, 1.53-3.36; P<.001).

CONCLUSIONS

Children's hospitals provide suboptimal health environments. Reliance on revenue may be an important motivating factor encouraging the adoption of outlets that serve less nutritious food.

The aesthetic dimension in hospitals--an investigation into strategic plans

BACKGROUND AND RATIONALE

The underlying assumption was that the aesthetics of the hospital surroundings are often neglected.

AIMS

This article is the first part of a larger study into the aesthetics of general hospitals. The aim of the study is to throw light on the influence of aesthetics on the health and well-being of patients and the professional personnel, and to examine how aesthetic considerations are dealt with. We present a survey of how the aesthetic dimension is planned and it is considered important in the strategic plans of Norwegian general hospitals.

METHODS

Data were sampled by analyzing the strategic plans of somatic hospitals. Sixty-four of 86 hospitals responded (74%). Concepts were categorized in a matrix of 11 main categories, each with subcategories. The method was quantitative, in that the analyzed material was amenable to counting.

RESULTS

Very few concrete guidelines or directions for the aesthetic dimension have been included in written documents. This indicates that the aesthetic area is a neglected field in the directions for the daily management of hospitals.

CONCLUSIONS

The research available today on the contribution of environmental aesthetics to health, rehabilitation, and well-being suggests that it is important to have concrete guidelines recorded in strategic plans. This field concerns the maintenance of high quality in the caring professions.

Service upgrade challenge met

Ipswich Hospital's traditional kitchen prepared hot meals for patients twice a day but the healthcare facility's unusual layout often meant that meals arrived with patients some time after the food had been cooked. Ipswich Hospital wanted to improve its service to patients and called in support services company OCS.

Improving patient nutrition through simple initiatives

Nutrition is an important aspect of patient care and sometimes simple changes can make a significant difference. Initiatives such as Essence of Care and protected mealtimes can be used to improve patients' nutritional intake. While simple initiatives can often involve more work than expected, the final outcome and benefits for patients justify the time spent.

[The management of nutritional care in hospitals: comparative study Brazil-France]

This study had as its proposal a comparative analysis, with the support of anthropotechnology, the management of nutritional care in hospital food and nutrition services both in Brazil and France. Data was obtained from documents, designed interviews and direct observation. The results with respect to France show that the characteristics observed offer conditions which are more favourable for dieticians. In Brazil, the low investment in health and education is even more challenging to dieticians. The recommendations to qualify the management of nutritional care were formulated in relation to the following aspects: the technology of management of nutritional care, strategies of interaction and organisation between clinical-nutritional attendance and the production of meals and background of dieticians.

[Intervention programs in hospital nutrition: actions, design, components and implementation]

Metabolic, Nutrient and Feeding Intervention Programs must become the methodological tool for dealing with the health problem posed by disease-associated-malnutrition on one side, and the "Bad Practices" affecting the nutritional status of the patient, on the other one. Programs like these ones should prescribe clear policies and actions in the three domains of contemporary medical practice: assistance, research and education. The fullfillment of these Program's objectives, and the relization of the implicit benefits, will only be possible if a methodological platform that armonically integrates elements of Continuous Education, Cost Analysis, Recording and Documentation, and Quality Control and Assurance, is created. The experience acumulated after the inception and conduction of the Intervention Program at the Clinical-Surgical "Hermanos Ameijeiras" Hospital (Havana City, Cuba) has served to demostrate that it is feasible not only to create a theoretical and practical body to satisfy the aforementioned goals, but, also, to export it to another institutions of the country, in view of the fact that minimal investments for adquiring the resources needed to deploy such Program, as well as for training and capacitation of medic and paramedic personel in the corresponding Recording & Documentation and Feeding & Nutrition Good Practices might result in short-term economical and medical care benefits.

Improving the nutritional care of patients in hospital

The provision of good nutrition has long been recognised as essential for hospital patients and ensuring patients received adequate food used to be a key nursing responsibility. However, changes in the preparation and delivery of hospital food and in the nurse's role. have reduced nurses' control over their patients' diet. This article reports on the progress of the Better Hospital Food programme, which was implemented to improve food services and give back more control over food to nurses.

Regards sur l’alimentation des personnels hospitaliers

The question concerning the food of the hospital staff has drawn attention only tardily. However, food is a faithful mirror in which the knowledge, the capacities, the values and the imaginary ones of an institution are reflected. It is in 1905 that the reform made by the "Administration générale de l'Assistance Publique de Paris" is specifically concerned, for the first time, by the food of the hospital staff. It is a change in the practices, founded until then on the principle of equality in food treatment, resulting probably from the monastic form of the hospital in the earliest times. The introduction of the system into force today was done gradually in the years 1930. From now on, hospital staff pay their meal to the administration which establishes the account of it on the basis of a refectory card. At the end of this evolution, nothing is similar any more in the hospital on the ground of the hierarchical relations between the administration and its staff. The era of self-service restaurants has open, transforming the consumer into an autonomous active and participative individual, in an institution converted into the play of democraty company.

Mealtime messages: reaching hospital patients in need of home care

It's always disappointing when a friend chooses a competitor over you for services, but when that friend looks you straight in the eye and says that he or she never even knew you offered such services... that is a wake-up call. It happened to me as a public relations director for a hospital, and I hear the same story from other hospitals, home health care agencies, hospices, rehab units, and others.