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Assisting Demented Patients With Feeding: Problems In A Ward Environment. A Review Of The Literature

4709 words - 19 pages

INTRODUCTIONNursing which promotes mental health demands the maintenance of dignity and independence of patients. There must be an element of intimacy, good communication and a degree of advocacy (Dexter & Wash 1995). Nowhere is this more apparent than in assisting another human being with feeding themselves. Yet assisting dementia patients with feeding problems is an area of nursing care in which intervention is, in many cases, inadequate, sometimes casual and, in some cases, potentially life-threatening for the patient. This is a comparatively under-researched area of nursing, despite the compelling need for research-based practice.The intention of this paper is to:review the available literature on assisting demented patients with feeding difficulties;consider the implications for nursing and any improvements or changes in nursing practice suggested by the literature; andbriefly outline the process of change, which may be required to realise the implications for nursing, and also the further research still needed to scientifically underpin these recommendations.For the purposes of the study, Watson's (1993) definition of the term 'feeding' to mean the act of moving food from the plate to the mouth and then swallowing it and 'difficulty' as any aspect of feeding that might lead to reduced intake of food, has been adopted.REVIEW OF LITERATUREThis review is based on a search using Cumulated Index of Nursing and Allied Health Literature on CD ROM. Relevant articles were selected from the list produced and from the reference lists of these articles.A range of changed eating habits is observable in dementia including eating to excess, pica and coprophagia (Fairburn & Hope 1988, Morris et al. 1989). In the later stages of the disease a marked decline in feeding ability to the point of having to be spoon-fed by a caregiver is evident (Singh et al. 1988, Sanders 1990). This can give rise to practical problems for caregivers (Norberg et al. 1988).Van Ort & Phillips (1992) carried out a field study in an American dementia-care facility to characterize and describe nursing activities, patient behaviours and caregiver-patient interactions during feeding to examine their effectiveness or otherwise in increasing functional and decreasing non-functional behaviours at mealtimes. They discerned no clear organizational pattern or consistency in feeding arrangements and inconsistency in interaction initiated by caregivers. From their observations, they formulated examples of sustaining and extinguishing behaviours from both patients and caregivers, which they felt could be used to develop nursing interventions to promote functional feeding.Van Ort & Phillips (1992) used a descriptive design for the study and videotaped meals to facilitate a comprehensive analysis of the data. The findings are credible from the point of view of a qualitative study and the Hawthorne effect (awareness of being studied) in relation to caregivers is acknowledged (Holm...

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