Dignity factors - Eating and nutritional care: Ideas you could use

Use a 'discreet sign' for people who need assistance with meals

Use a discreet signal to indicate that someone needs assistance with eating, for example a different coloured tray. This saves people the embarrassment of having to ask, or of being asked, if they need help.

This idea can be used in different settings – so seeing how someone else has done it can be useful to you, even if they work in a different area of care.

For example, this idea has been put into practice in hospitals, where using a red tray provides an effective signal to staff without compromising the patient’s dignity. The system is being monitored and refined, but has been found helpful in promoting individual care.

A daily updated list of patients due to receive food on red trays can be included in shift handovers and provided for kitchen staff. A red tray is also a simple reminder to staff to check the patient’s notes for guidance on any specific help or nutritional needs. In several hospitals, the red tray system has been linked with protected mealtimes.

Use the 'knife and fork' symbol

Placing a knife and fork symbol near someone's bed is an easy way to help staff identify which people need support during mealtimes.

This idea can be used in different settings - so seeing how someone else has done it can be useful to you, even if they work in a different area of care.

For example, this idea has been put into practice by United Bristol Healthcare NHS Trust.

For further information contact Toni Williams, Food Policy Manager, United Bristol Healthcare NHS Foundation Trust. Email Toni.WilliamsOsmane@UHBristol.nhs.uk.

Introduce a range of measures to improve nutritional care

There are a number of things you can do to promote a better mealtime experience for people using your service. For example protected mealtimes (link to section on this subject) can prevent interruptions to meals, ethnic menus can improve choice and better meet cultural needs, nutritional screening can identify people at risk of malnutrition and a red tray system (link) can identify people who need support with eating. Use of volunteers at mealtimes can help to monitor food quality, relieve pressure on staff and improve the experience for the person eating the food. Use of posters, information videos, sessions with the public and staff training can all help to raise awareness of good nutritional care

This idea can be used in different settings – so seeing how someone else has done it can be useful to you, even if they work in a different area of care.

For example, this idea has been put into practice by Heatherwood and Wexham Park Hospitals NHS Trust.

Their ‘Eat Well, Feel Well’ project has implemented all the ideas listed above to improve nutritional care.

For further information contact Gay Lewis, Clinical Development Facilitator. Tel 01753 633764. Email Gay.Lewis@hwph-tr.nhs.uk.

Use a survey to get feedback about the food – and other aspects of care

Use a survey to find out how satisfied people are with various aspects of the service you provide – you could get feedback on your catering or on any recreational facilities you provide, for example.

This idea can be used in different settings – so seeing how someone else has done it can be useful to you, even if they work in a different area of care.

For example, this idea has been put into practice by the University Hospital of South Manchester NHS Trust, who designed the Patient Catering Survey (80kb PDF file) to help assess whether people were satisfied with the standard of food and support during mealtimes.

In addition to the survey, nutritional awareness training was made mandatory for all new staff, and a newsletter, Essence of Care News, was produced outlining the work and improvements made. The changes were carried out as part of Department of Health Essence of Care benchmarking on Food and Nutrition.

For further information contact Sheila Wilkinson, Improving the Patient Experience Project Manager. Tel 0161 2912761. Email Sheila.wilkinson@smuht.nwest.nhs.uk.

Improve the mealtime experience

Improving the mealtime experience could include:

This idea can be used in different settings – so seeing how someone else has done it can be useful to you, even if they work in a different area of care.

For example, this idea has been put into practice by Methodist Homes for the Aged (MHA), who have introduced a range of initiatives across their care homes and housing schemes to improve the experience of mealtimes.

For further information contact George Sampson, Head of Hospitality. Tel 0773 4151988. Email George.Sampson@mha.org.uk.

Produce your own Best Practice Guidelines

Develop your own standards of Best Practice for various aspects of the care you provide.

This idea can be used in different settings – so seeing how someone else has done it can be useful to you, even if they work in a different area of care.

For example, this idea has been put into practice by the Harrogate Neighbours Housing Association, who have produced their own Best Practice Guidelines 212kb PDF file) for catering in residential homes and sheltered housing.

Ask people how their mealtimes could be improved

Ask the people who use your service for their ideas about improving mealtimes – and put their suggestions into practice.

This idea can be used in different settings – so seeing how someone else has done it can be useful to you, even if they work in a different area of care.

For example, this idea has been put into practice by St Michael’s Community Hospital, Aylsham. The ward housekeeper, together with a healthcare assistant, spoke to patients about mealtime practices and asked for ideas as to how they could be improved. Following patients’ suggestions, mealtimes were protected and made more of an event, with new cutlery and tablecloths improving the dining environment. Since the changes were made, patients have reported enjoying mealtimes more. Regular audits ensure the practices are still effective.

For further information see Essence of Care Eureka! Protecting Patients’ Mealtimes at St Michael’s Community Hospital. Call 01263 732341.

Recruit volunteers to improve mealtimes

Create a pool of volunteers to hep make mealtimes more sociable and assist people with eating where needed.

This idea can be used in different settings – so seeing how someone else has done it can be useful to you, even if they work in a different area of care.

For example, this idea has been put into practice by University Hospitals Bristol NHS Foundation Trust. The Trust has a Volunteers and Mealtimes project, which was established on one ward to provide more assistance to elderly patients. The project set out to recruit volunteers to make mealtimes on the ward a more social occasion. Following its success, more mealtime volunteers were recruited, each one attending a multi-professional half-day programme of training. The Hospital is considering extending the idea to other wards.

For further information contact Jayne Weare, Occupational Therapy Manager. Email Jayne.Weare@UHBristol.nhs.uk.

Make sure the food you provide is delicious as well as nutritious: join the Cooking with Care campaign

Enter the Chef Competition, hosted by Barchester Healthcare which is part of the Cooking with Care initiative and celebrates cooking talent in care homes.

This idea can be used in different settings – so seeing how someone else has done it can be useful to you, even if they work in a different area of care.

The competition is hosted by Barchester Healthcare and supported by the celebrity chef Paul Rankin. The aim is to improve mealtimes, ensuring they are enjoyable, dignified and fun. Chefs spend time in the dining room with residents to ensure that food is beautifully presented and to find out about residents’ likes and dislikes. To ensure that chefs are fully trained to support individual needs and tastes, Barchester Healthcare has developed the Barchester Chef Academy to offer training for all levels, from apprentice to Master Chef. The group has also introduced a system of 5 Star Dining to improve dining standards, particularly for patients with swallowing difficulties and those unable to feed themselves. Standards include offering the resident a choice of meal at their table (rather than pre-ordering), presenting food for people on soft diets just as beautifully as other dishes, and providing assistance in cutting up food discreetly.

For further information contact Terry Tucker, Director of Learning, Development and Hospitality, Barchester Healthcare. Tel 07718 582139. Email terry.tucker@barchester.com

Read about the competition on the Barchester Healthcare website.

Have a ‘nutritional awareness week’

Raise awareness about nutrition amongst staff and people who use services.

This idea can be used in different settings – so seeing how someone else has done it can be useful to you, even if they work in a different area of care.

For example, this idea has been put into practice at Southampton University Hospitals NHS Trust, where having a ‘nutritional awareness week’ helped raise the understanding of how important it is for patients to receive good nutritional food. Guidance was also given to all wards on nutritional supplements.

For further information contact Julie Dawes, Associate Director of Nursing. Tel 02380 798435. Email julie.dawes@suht.swest.nhs.uk

Related documents

Make nutritional screening part of your assessment process

Include nutritional screening as part of the initial assessment process, so difficulties are identified right away and support can be arranged immediately.

This idea can be used in different settings – so seeing how someone else has done it can be useful to you, even if they work in a different area of care.

For example, this idea has been put into practice at Caterham Dene Community Hospital, where all patients are nutritionally screened on admission as part of the assessment process, using the Malnutrition Universal Screening Tool (MUST) (328kb PDF file).

This screening immediately identifies any difficulties a patient may have so that appropriate support can be arranged through the dietitian. All meals are supervised by the nursing staff, and the hospital is due to implement protected mealtimes to ensure that mealtimes are uninterrupted and that those with specific needs are easily identified.

For further information contact Eileen Clark, Service Manager. Tel 01737 214846. Email eileen.clark@eastsurrey-pct.nhs.uk.

Develop a ‘nutrition support’ information pack

Put together a pack of information to support staff in providing the highest standards of nutritional care. Draw on the advice of professionals such as dietitians, speech and language therapists and medical staff to ensure that the pack promotes best practice.

This idea can be used in different settings – so seeing how someone else has done it can be useful to you, even if they work in a different area of care.

For example, this idea has been put into practice at Surrey and Borders Partnership NHS Trust, where a practice development nurse worked with a number of professionals to develop a nutrition support pack containing information on:

For further information contact Jill Ruhomutally, Practice Development Nurse. Email Jill.Ruhomutally@sabp.nhs.uk.

Improve nutritional care

Carry out nutritional screening regularly. Ask people about their likes and dislikes and amend menus accordingly. Involve people in meal planning and preparation.

This idea can be used in different settings – so seeing how someone else has done it can be useful to you, even if they work in a different area of care.

For example, this idea has been put into practice by Dorset County Council. Adults with learning disabilities in residential care are now involved in developing their own care plan as part of Dorset County Council’s dignity in care at mealtimes. Residents are nutritionally screened on admission and at monthly intervals, and are surveyed regularly about meals and mealtimes so that menus can be adapted accordingly.

For further information contact Sue Hawkins, Catering Services, Adult and Community Services. Email s.hawkins@dorsetcc.gov.uk.

Take a person-centred approach to mealtimes

Make mealtimes as non-standardised as possible – take people’s individual preferences, routines and dietary requirements into account.

This idea can be used in different settings – so seeing how someone else has done it can be useful to you, even if they work in a different area of care.

For example, this idea has been put into practiceat Hyndburn short break service for people with learning disabilities. Staff spend time with the person, their family and any other professionals involved at induction to establish the person’s dietary requirements, preferences, usual routines and any individual guidelines. Before the person’s stay, staff refer to their person-centred plan and ensure their preferences are included in shopping for that week.

Staff support individuals who require assistance during their meals. Main meals are eaten around a table in a 'family’ atmosphere unless a need or preference requires different support.  

For further information contact Rebecca Toman, Short Breaks Manager, 98/100 Gloucester Avenue, Accrington, BB5 4BG. Tel: 01254 395060.

Become a model of good practice in care catering

Achieve best practice in catering by preparing fresh food on the premises and sourcing as much produce as possible from local and organic suppliers.

This idea can be used in different settings – so seeing how someone else has done it can be useful to you, even if they work in a different area of care.

For example, this idea has been put into practice by the Royal Brompton Hospital in Chelsea, which has been identified as a model of good practice in care catering.

Meals for both patients and staff are prepared fresh on the premises and 20 per cent of the produce is from local and organic sources which supports local farmers and suppliers (National Health Executive, 2008a). The Royal Brompton is keen to help colleagues around the country to follow their model.

Source food locally to improve quality and nutritional value

Aim to source as much food as possible locally. This not only improves the quality and nutritional value of the food, it supports the local economy.

This idea can be used in different settings – so seeing how someone else has done it can be useful to you, even if they work in a different area of care.

For example, this idea has been put into practice by the Royal Cornwall Hospital Trust, which has ‘responded to patients’ comments that they want to see fresh, locally produced ingredients in their meals’ (National Health Executive, 2008b).

In 2002 they made the decision to implement a sustainable approach to food provision in hospitals across Cornwall aiming to source as much as possible locally. The next phase is to open a new food production unit that will supply local hospitals with freshly prepared food. The food will then be transported to local hospitals to be cooked on the wards and served along with steamed vegetable and salads.

Use pictorial menus to help communicate food choices

Use menus with photographs of the food and titles in large print. This can help people with a range of communication difficulties to understand the choices on offer.

This idea can be used in different settings – so seeing how someone else has done it can be useful to you, even if they work in a different area of care.

For example, this idea has been put into practice by the Royal Berkshire Hospital, which has developed a set of pictorial menus with photographs, food symbols, and the food name written in large print. There is additional information describing special food types such as puree and easy chew diets and thickened drinks.

This resource can improve meal choices of patients with communication or sensory difficulties, dementia and people who do not speak English as a first language. Consequently, their nutritional status is improved. Staff found they had to spend less time ascertaining patient choices using the new menus and 95 per cent of patients surveyed said they found the menu helpful.

Food symbols were sourced from: www.mayer-johnson.com

For further information contact claire.harrison@royalberkshire.nhs.uk

Motivate and encourage people to cook

Support people with gaining the skills and confidence to make simple meals for themselves.

This idea can be used in different settings – so seeing how someone else has done it can be useful to you, even if they work in a different area of care.

For example, this idea has been put into practice by the Leicestershire Home Care Assessment and Reablement Team (HART). This is a specialist team that undertakes a six-week assessment and reablement programme with people who are newly referred for Home Care. The assessment can include observation of nutritional wellbeing (weight/body condition), diet and cooking skills as well as all other daily living tasks.

The team has had success in motivating people to start cooking again or develop the confidence to use equipment such as microwaves. For example, an ex-miner had never made himself a cup of tea or cooked a meal. When his wife died his family thought that would be unable to cope and were considering residential care for him. The HART team went in and encouraged him to use the kettle and the microwave and to make himself simple meals – starting with beans on toast. They encouraged him to go out and he now has his main meal in a local café, he is coping well, to the surprise and delight of his family. HART withdrew as he is now independent.

For further information contact claire.harrison@royalberkshire.nhs.uk

Find alternatives to 'meals on wheels'

Look at alternatives to standard ‘meals on wheels’ – consider how people’s preferences could be taken into account, perhaps by involving neighbours or local restaurants.

This idea can be used in different settings – so seeing how someone else has done it can be useful to you, even if they work in a different area of care.

For example, this idea has been put into practice by Dorset County Council, which is trying to develop local alternatives to provide more flexible, choice based services. The project endeavours to source local people and services that can provide alternatives, such as local food outlets and even neighbours.

For further information contact Sue Hawkins, Care Catering Services Manager s.hawkins@dorsetcc.gov.uk.

Encourage kitchen staff to listen to people's individual preferences

Ensure that kitchen staff and volunteers engage with people to get feedback on the quality of the food and people’s needs and choices.

This idea can be used in different settings – so seeing how someone else has done it can be useful to you, even if they work in a different area of care.

For example, this idea has been put into practice by the Hospice of St Francis. The aim was to deliver personalised, quality, home cooked, nutritious meals for all patients, enhancing the mealtime experience. The chef was able to demonstrate knowledge of food relating to different illnesses such as diabetes and wheat intolerance. The chef and volunteers meet with people and meal plan to ensure that they understand people’s needs and preferences. The volunteers listen to the cues, such as ‘the meat was lovely, but slightly salty’ and feedback to the chef. The concept of a chef leaving the kitchen to discuss food in the patient’s individual bedroom and then go back to the kitchen to prepare food caused concerns about infection control. Issues were resolved through detailed discussions and training with the infection control team. Confidentiality was also an issue. The education team at the hospice organised a training package for the chef and the team of volunteers so that they could understand the importance of confidentiality.

For further information Chris Took.

Listen to and support carers

Using a questionnaire to understanding their needs, develop care and support programmes tailored to each carer. This idea can be used in different settings – so seeing how someone else has done it can be useful to you, even if they work in a different area of care.

For example, this idea has been put into practice by Cambourne Redruth Community Hospital. The aim was to offer better levels of information and support during the admissions process, which can be an extremely frightening and confusing time for all concerned. Carers were asked to fill in feedback questionnaires and a support forum was set up; stronger links were also developed with existing carer support networks.

Engaging with carers has a beneficial effect on the people using the service giving a better understanding their individual needs and the needs of their families. The good feedback has also boosted staff morale.

For further information contact Alison Morris.

Aid communication for hearing impaired people through text

Introduce an emergency texting service for people with hearing or speech impairment. This will engage the emergency services and promote recognition of the needs of this group. This idea can be used in different settings – so seeing how someone else has done it can be useful to you, even if they work in a different area of care.

For example, this idea has been put into practice by Middlesborough Deaf Centre. A need for the emergency services to consider the needs of those with hearing and speech impairment was identified. Not having to rely on a third party to contact services on your behalf promotes empowerment. The emergency texting service is potentially life-changing, and life-saving. The idea was positively received and emergency services were key stakeholders in development. Experts from companies that specialised in texting services were brought together with the emergency services to develop the system.

This work encourages trial and use of a technology that is sometimes feared amongst people with hearing and speech impairments. Telecommunications systems are often perceived as alien and become barriers because of people’s reluctance to try something new. The work aims to promote independence and build confidence.

For further information Gill Marshall.

Use the single assessment process to deliver person-centred care

Using the single assessment process, talk to people on admission about what they want to achieve and how they would like their care to be delivered. Gather personal details such as how the person likes to be addressed, how they wish their privacy to be respected and issues of consent for information sharing with other organisations and partnerships.

This idea can be used in different settings – so seeing how someone else has done it can be useful to you, even if they work in a different area of care.

For example, this idea has been put into practice by Leasowes Intermediate Care Centre in Smethwick. Leasowes is a bespoke 20-bed unit where people (predominantly older people) can be assessed and rehabilitated. Often, people come in with complex needs and multiple medical conditions that may have culminated in a fall and they may have had difficulty managing at home. By building strong relationships with colleagues in the community staff help to ensure that good quality, person-centred services continue after the person has been discharged.

For further information contact Marian Long.

Improve practice using the Essence of Care benchmarking tool

The ‘Essence of Care' benchmarking tool was designed to support hospitals to measure quality and improvement. The benchmarking process helps practitioners to take a structured approach to sharing and comparing practice, enabling them to identify the best and to develop action plans to remedy poor practice.

This idea can be used in different settings – so seeing how someone else has done it can be useful to you, even if they work in a different area of care.

For example, this idea has been put into practice by Derbyshire Mental Health Services where they have used the benchmarking factors of privacy and dignity to measure practice in each clinical area. This includes how staff converse with patients and carers and what information is given; it also provides a check that information is in a format that the person is able to understand.

For further information contact Mark Ridge, Head of Patient Experience, Tel: 01332 362221. Ext.3771.

Train key staff to improve nutritional care

Select staff for training on nutritional care. The staff can then share knowledge and raise awareness within the service to improve standards.

This idea can be used in different settings – so seeing how someone else has done it can be useful to you, even if they work in a different area of care.

For example, this idea has been put into practice by the Royal Liverpool and Broadgreen University Hospital. Inspired by the Help the Aged ‘Hungry to be Heard’ campaign, healthcare assistants from 54 hospital wards have been trained.

Three-monthly follow-up meetings are held with all the trained staff to feed back comments and to provide each other with support and advice. The experiences of the Patients’ Council representatives were used to inform the training. The additional responsibilities have given healthcare assistants new status in a job that traditionally had little or no career structure.

For further information contact Deborah Morris, deborah.morris@rlbuht.nhs.uk

Encourage kitchen staff to listen to people's individual preferences

Ensure that kitchen staff and volunteers engage with people to get feedback on the quality of the food and people’s needs and choices.

This idea can be used in different settings – so seeing how someone else has done it can be useful to you, even if they work in a different area of care.

For example, this idea has been put into practice by the Hospice of St Francis. The aim was to deliver personalised, quality, home cooked, nutritious meals for all patients, enhancing the mealtime experience. The chef was able to demonstrate knowledge of food relating to different illnesses such as diabetes and wheat intolerance. The chef and volunteers meet with people and meal plan to ensure that they understand people’s needs and preferences. The volunteers listen to the cues, such as ‘the meat was lovely, but slightly salty’ and feedback to the chef. The concept of a chef leaving the kitchen to discuss food in the patient’s individual bedroom and then go back to the kitchen to prepare food caused concerns about infection control. Issues were resolved through detailed discussions and training with the infection control team. Confidentiality was also an issue. The education team at the hospice organised a training package for the chef and the team of volunteers so that they could understand the importance of confidentiality.

For further information Chris Took, chris.took@stfrancis.org.uk

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