Stroke patients in nursing homes: eating, feeding, nutrition and related care

Abstract

The purpose of this study was to explore eating, feeding and nutrition among stroke patients in nursing homes as described by their nurses and by assessments. Registered Nurses were interviewed about an individual stroke patient's state of health, care needs and nursing care received and nursing records were reviewed. Information on eating, feeding and nutrition was extracted from the interviews and nursing records. A comprehensive instrument, the Resident Assessment Instrument, was also used to assess these patients' state of health. The domains of eating, feeding and nutrition were focused on in this study. Manifest content analysis was used. The results showed that more than 80% of the stroke patients in nursing homes were assessed as having some sort of dependence in eating. According to the Registered Nurses, 22 out of 40 patients demonstrated different eating disabilities. The number of eating disabilities in individual patients ranged from 1 to 7, which emphasized the complexity of eating disabilities in stroke patients. Dysphagia was reported in almost one-fourth of the patients and 30% were described and/or assessed as having a poor food intake or poor appetite. The Registered Nurses' descriptions of the eating disabilities, nutritional problems and their care were often vague and unspecific. Only six weights were documented in the nursing records and there were no nutritional records. The findings highlight the importance of making careful observations and assessments, and of maintaining documentation about eating and nutrition early after a patient's arrival in the nursing home to enable appropriate care and promotion of health.

Eating Difficulties, Nutrition, Meal Preferences and Experiences Among Elderly A Literature Overview From a Scandinavian Context

“…Westergren and Karlsson et al (2001) found that 80% of the patients exhibited eating difficulties after a stroke pertaining to: 1) eating three-quarters or less of the food served, 2) difficulties manipulating food on the plate, 3) transport of food to the mouth, 4) sitting position, 5) aberrant eating speed, 6) manipulating food in the mouth 7) swallowing difficulties, 8) opening and/or closing the mouth, and 9) alertness. Kumlien and Axelsson (2002) showed that the majority of stroke patients living in nursing homes required some kind of help with eating, due to swallowing problems, pneumonia, forgetting to eat and poor appetite. The help needed was described as feeding assistance, adjustment of food and liquid consistencies, cutting up the food as well as supervision of the eating process.…”

Raising a beautiful swan: a phenomenological-hermeneutic interpretation of health professionals’ experiences of participating in a mealtime intervention inspired by Protected Mealtimes

“…Perry et al (2013) emphasize that Kirkevold (1997) describes a specific therapeutic dimension in stroke nursing in which there are an interpretive function focused on nurses helping patients and their relatives understand the ramifications of a stroke, and a counselling function focused on the provision of emotional support. This is related to the argument of Kumlien and Axelsson (2002), who argue that the recognition of the provision of emotional support for eating difficulties is crucial, since it regards eating as a psychosocial function and enhances quality of life post-stroke (Medin, Larson, Von Arbin, Wredling, & Tham, 2010; Perry et al, 2013a). Taking this into account, provinding the intervention Quiet Please, Protected Mealtime care is not only a matter of stopping all non-acute activity and providing patients the opportunity to eat without interruptions but also a way of getting back to basic nursing as it was defined by Nightingale and providing specific nurse-led supportive care to patients hospitalized with a neurological disease (Kirkevold, 1997; Van Ort, 1995).…”

The evidence-base for stroke education in care homes

“…In Kumlien & Axelsson's (2002) study, 80% of stroke residents in nursing homes were identified as having some form of dependence in eating and yet nursing assessment of these problems was 'vague'. In this study, although it was not the most frequently cited educational need, 63.0% of care home nurses expressed a need for more input regarding nutrition and swallowing, underlining the importance of accurate observation and care planning in terms of nutritional needs (Kumlien & Axelsson 2002).…”