This article examines and summarises the role of nutrition and the dietitian in the final stages of palliative care. The recent publication of One chance to get it right (NHS England, 2014), highlighted the need for a change in the approach to food and drink, especially when caring for those patients who are at the end of life. There is a clear need for documentation and formulation of clear, patient-centred and effective care plans, as it is vital that food and drink are offered, as long as it remains safe and is not harmful to the patient.
This article examines the role of malnutrition in chronic obstructive pulmonary disease (COPD). Until recently, weight loss was considered an inevitable consequence of COPD, however, modern research has demonstrated that weight gain is in fact achievable and can result in functional improvements. It is important that community nurses are aware of the importance of nutrition in COPD, both in screening for malnutrition and developing appropriate treatment plans, including the use of oral nutritional supplements alongside dietary advice and counselling. The current NHS policy of moving care 'closer to home' is resulting in more complex COPD patients being managed in the community and with this comes the challenge of managing reduced weight and low oral intake. It is, therefore, essential that community nurses develop the necessary skills and resources to deal with this growing group of patients.
In an earlier article in this journal, the author looked at malnutrition in the community from the patient's perspective (JCN, 28(2): 40–4). Here, she examines some practical tips on how community nurses can provide help for patients in danger of becoming malnourished. Malnutrition may have been caused by a chronic problem that has resulted in years of gradual deterioration and prompt action can prevent malnutrition escalating further and affecting the patient’s overall health. In this case, more detailed and supportive treatment from family, friends and healthcare services may be required to help implement changes in a patient's routine. By using some of the ideas highlighted in this article, and with regular monitoring and support, nurses can better help patients in the community to recover quickly from, or avoid, malnutrition.
This article examines malnutrition, a complex issue that has wideranging implications in terms of patient experience and resources - evidence suggests that malnourished people are repeat attendees at GP surgeries, incur higher prescription costs and experience twice as many hospital admissions than well-nourished people. While there have been many hospital initiatives targeted at reducing the risks of malnutrition, in the community the solution remains challenging. Recommendations include arranging services so that health and social care professionals can work together to overcome nutrition issues, making extra resources available to combat malnutrition and improving the monitoring of patients' nutritional state. As healthcare shifts to a more community-based model, there needs to be a reallocation of resources from hospitals to community to ensure that efforts to tackle malnutrition have a more realistic chance of success.
‘It is widely known that there are differences between men and women in the incidence and prevalence of most health conditions. Sometimes there are clear biological reasons for these differences – but often there are not.’ (Mens Health Forum – www.menshealthforum.org.uk)
Although men are starting to realise that their health outcomes could be much better with a bit of effort, they continue to die on average, years earlier than women, and for just about every disease common to both sexes, men still come off worse. It’s only in the last few years that we have started to ask ourselves why is this?
Jane DeVille-Almond, SRN, SCM HV BA(Hons) Independent Nurse Consultant/ Chair of the British Obesity Society http://www.obesitysoc.org.uk/, Senior Lecturer at the University of Wolverhampton.
Article accepted for publication: November 2012
Hydration is an easily overlooked but crucial element of general health that nurses working in the community need to be particularly aware of. Monitoring what people eat and drink is vital if dehydration, as well as deterioration in other conditions such as diabetes, is to be avoided.
Eating well in later life is an essential part of enabling older people to live independently at home for longer. However, with increasing funding cuts to community care services in the context of an ageing society, is enough being done to encourage good nutrition in later life? This article discusses the importance of nutrition for older people and explores how community practitioners are ideally placed to spot the early warning signs of malnutrition and encourage patients to take better care of their diet.
Helen Willis, Dietitian, Wiltshire Farm Foods
This article discusses nutrition in relation to patients in the community who are living with venous leg ulcers. The author explores the complex issues surrounding the care of this patient group, which is predominantly made up of older people who often have several underlying medical conditions and may live alone in their own homes or in supported residential settings. The article covers the physiology and aetiology of venous leg ulcers and explores how nutrition plays a role in the healing process. It advocates a holistic approach, taking into account the many factors involved when considering nutritional status and suggests interventions that are available to nurses and healthcare professionals working in the community.
Jennifer Lunnon is a staff nurse in the Intensive Care Unit, Royal Devon and Exeter Hospital
Obsession with weight has been identified as a significant problem in modern society, particularly among young women. Similarly, the phenomena of weight and shape preoccupation have been recognised as preliminary behaviours to the development of eating disorders. This study aimed to identify the current incidence of, and factors associated with, weight preoccupation, shape preoccupation, and eating disorder risk in female US university students aged 18 to 23 years. An online study was used and the findings demonstrated that 31% of respondents identified themselves as weight-preoccupied and 33% as shape-preoccupied. Overall, the study found that asking students whether they are weight-preoccupied could be an initial step in early intervention for those at risk of developing an eating disorder.
Samantha A Ramsay, Assistant Professor of Foods and Nutrition and Director of the Coordinated Programme
Laurel J Branen, Professor of Emeritus
Miranda L Snook, Research Assistant, School of Family and Consumer Sciences
All at University of Idaho, Moscow, USA
Malnutrition affects one in four acute hospital admissions and one in three admitted to care homes. While many clinical staff may fail to recognise the signs of malnutrition, the use of screening tools such as ‘MUST’ are used in both hospital and community settings. With greater identification of those at risk of malnutrition comes the responsibility of managing these individuals. This article presents the launch of the BAPEN decision trees that are designed to help healthcare professionals manage malnutrition.
Acknowledgements:
The authors wish to thank the members of the Education and Training committee of BAPEN for their creation of the structure and format of the decision trees, and for initial reviews. The core and associate groups of BAPEN have provided great input to the committee and decision tree creation. Finally Mr Pete Turner, Senior Dietitian, Royal Liverpool University Hospital, for reviewing the re-feeding decision tree.
Re-feeding decision tree kindly reproduced with permission from BAPEN.
Dr Sheldon Cooper MSc MD MRCP RNutr, BAPEN Executive officer and Chair of Education and Training Committee, Consultant Gastroenterologist and Nutrition Lead, Dudley Group NHS Foundation Trust
Anne Holdoway BSc RD MBDA, Specialist Dietitian and Chair of the Parenteral and Enteral Nutrition Group of the British Dietetic Association.
Article accepted for publication: January 2013
