The Royal Marsden Hospital Manual of Clinical Nursing Procedures - Lisa Dougherty [266]
Procedure guideline 8.9 Feeding an adult patient
Essential equipment
A clean table or tray
Equipment required to assist the patient such as adequate drinking water, adapted cups, cutlery and napkin
A chair for the nurse or carer to sit with the patient
Preprocedure
Action Rationale
1 Ensure the patient is comfortable, that is, they have an empty bladder, clean hands, clean mouth and if applicable clean dentures. Ensure that there are no unpleasant sights or smells that would put the patient off eating
To make the mealtime a pleasant experience (Age Concern 2006, E).
2 Ensure that the patient is sitting upright in a supported midline position, preferably at a table.
To facilitate swallowing and protect the airway. E
3 Protect the patient’s clothing with a napkin.
To maintain dignity and cleanliness. E
Procedure
4 Assist the patient to take appropriate portions of food at the correct temperature but encourage self-feeding. Tailor the size of each mouthful to the individual patient.
To make the mealtime a pleasant experience. To ensure that swallowing is not compromised if the patient feels that they must hurry with the meal (Samuels and Chadwick 2006, E).
5 Allow the patient to chew and swallow foods before the next mouthful. Avoid hovering with the next spoonful.
To maintain the dignity of the patient. E
6 Avoid asking questions when the patient is eating, but check between mouthfuls that the food is suitable and that the patient is able to continue with the meal.
To reduce the risk of aspirating, which may be increased if speaking whilst eating. E
7 Use the napkin to remove particles of food or drink from the patient’s face.
To maintain dignity and cleanliness. E
8 Ask the patient when they wish to have a drink. Assist the patient to take a sip. Support the glass or cup gently so that the flow of liquid is controlled or use a straw if this is helpful. Take care with hot drinks to avoid offering these when too hot to drink.
To give the opportunity for the patient to swallow. Hot liquids may scald the patient. E
9 If the food appears too dry, ask the patient if they would like some additional gravy or sauce added to the dish.
To facilitate chewing and swallowing (Wright et al. 2008, E).
10 Observe patient for coughing, choking, wet or gurgly voice, nasal regurgitation or effortful swallow. See Table 8.6 for details of problems that may be experienced by patients.
May indicate aspiration, laryngeal penetration or weakness in muscles required for swallowing (Leslie et al. 2003, E).
11 Encourage the patient to take as much food as they feel able to eat, but do not press if they indicated that they have eaten enough.
To improve nutritional intake but also maintain patient dignity and choice (Wright et al. 2008, E).
Postprocedure
12 After the meal assist the patient to meet hygiene needs, for example, wash hands and face and clean teeth.
To maintain cleanliness and dignity. E
Table 8.6 Difficulties that may be experienced by patients during eating and drinking and their potential implications
Difficulty experienced Implications
Coughing and choking during and after eating and/or drinking Wet or gurgly voice quality
Indicates laryngeal penetration or aspiration (Smith Hammond 2008) Indicates laryngeal penetration or aspiration (Leslie et al. 2003)
Drooling/excess oral secretions Indicates less frequent swallowing and is associated with dysphagia (Langmore et al. 1998)
Nasal regurgitation Indicates impaired velopalatal seal (Leslie et al. 2003)
Food/drink pooling in mouth Indicates lack of oral sensation from intraoral flaps or may be a sign of cognitive impairment (Logemann 1998)
Swallow is effortful May indicate weakness in muscles required for swallowing (Logemann et al. 2008)
Respiration rate