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Hospitals and feeding policies

My nana has been in hospital for four months now after a pretty bad stroke. She cant walk, hasnt the energy to talk more than one word answers and needs to be fed. Yesturday I spoke to my grandad and he said that she wasnt eating cos she kept saying no. I went in to see her around dinner time to make sure she eats cos I'm used to feeding old stubburn women who say no to food.

My nan did say no to the food at first but when I put it up to her mouth she ate it. Then when I went to give her another spoonful she said no again, but I noticed that she was forgetting to swollow after she'd chewed, so I reminded her to and when she had (about a min later) she ate some more of her dinner. In the end it it took me an hour and a half to get her to eat all her dinner and during that time I had to explain twice to the nurses that she was going to eat all her food and not to take it away.

It worries me that after half an hour of my nan eating her dinner (she's just about finished her soup which is the first course) the nurse's tried to take the food away from her, if I hadnt told them no (or been there at all) my nana wouldnt have had any food that day. And they wonder why she's not improving :rolleyes: How is she ment to have the energy to do her physo if they arnt helping her to eat her food. She's getting tired from just chewing so it takes her a while. I cant be expected to go in twice a day everyday, not only do I have to help my mum pack up the house cos were moving next week but I seriously cannot afford to go in that often when its £3 parking a time. Also arnt there Health Care Assistants who are paid to do this kinda thing?
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    Former MemberFormer Member Posts: 1,876,323 The Mix Honorary Guru
    i agree with you to an extent, but feeding someone who keeps saying `no` when you try and put it to her mouth, is technically assault. Its one thing for a patients relative to do it, but most nurses wont. You need consent for everything, including feeding, and if a patient refused to be fed by me, there wouldnt be much I could do. I could encourage, but actually putting it in her mouth while she was saying no, and not even swallowing it - well I dont think id do it. I know some old dears just dont eat much and do require a lot of encouragement and help, and it should be there if required, but that doesnt include forcing them to eat.
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    Former MemberFormer Member Posts: 1,876,323 The Mix Honorary Guru
    Sorry what I ment was put it up to her mouth, like so the food was just by her mouth so she could smell it properly. I dont mean shoving it in her gob.
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    Former MemberFormer Member Posts: 1,876,323 The Mix Honorary Guru
    oh right. I do that all the time. Is she on a food chart?
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    Former MemberFormer Member Posts: 1,876,323 The Mix Honorary Guru
    Yes but half the time they dont fill it in. I spoke to the nurse about it and she said they never fill it in at the time it all gets done at the end of the day, which seems silly to me considering how many people are in a ward. I'm considering filling it in myself, or at least making my own food chart for her.
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    Former MemberFormer Member Posts: 1,876,323 The Mix Honorary Guru
    they sound sloppy to me then, and thats not best practice.
    I would consider speaking to ward sister rather than a staff nurse.
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    Former MemberFormer Member Posts: 1,876,323 The Mix Honorary Guru
    surely though it wouldn't be right for a nurse to go along with a patient constantly refusing to eat... when if you consider whats best for the patient, they have to eat; or else they won't get better, they will more than likely get worse from malnutrition?! i can understand the ethics of not physically forcing someone to eat against their wishes too. but ultimatly if someone constantly refused to eat anyting, it would eventually come down to a life or dealth decision - and then the nurses must surely force them to eat just to keep them alive whetehr its against their wishes or not?! i do think though Zella, you should perhaps have a word with someone in charge of your gran's care.
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    Former MemberFormer Member Posts: 1,876,323 The Mix Honorary Guru
    otter wrote:
    surely though it wouldn't be right for a nurse to go along with a patient constantly refusing to eat... when if you consider whats best for the patient, they have to eat; or else they won't get better, they will more than likely get worse from malnutrition?! i can understand the ethics of not physically forcing someone to eat against their wishes too. but ultimatly if someone constantly refused to eat anyting, it would eventually come down to a life or dealth decision - and then the nurses must surely force them to eat just to keep them alive whetehr its against their wishes or not?! i do think though Zella, you should perhaps have a word with someone in charge of your gran's care.

    I think in this instance they would take to feeding her artificially through feeding tubes to maintain her life.
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    Former MemberFormer Member Posts: 1,876,323 The Mix Honorary Guru
    otter wrote:
    surely though it wouldn't be right for a nurse to go along with a patient constantly refusing to eat... when if you consider whats best for the patient, they have to eat; or else they won't get better, they will more than likely get worse from malnutrition?! i can understand the ethics of not physically forcing someone to eat against their wishes too. but ultimatly if someone constantly refused to eat anyting, it would eventually come down to a life or dealth decision - and then the nurses must surely force them to eat just to keep them alive whetehr its against their wishes or not?! i do think though Zella, you should perhaps have a word with someone in charge of your gran's care.
    It would depend whether they considered her mentally capable of making an informed decision not to eat. If you or I decided we didnt want to eat any more, they couldnt legally force us unless we were sectioned under the mental health act I think.
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    Former MemberFormer Member Posts: 1,876,323 The Mix Honorary Guru
    The whole NHS is severely over budget & in debt, so it wouldn't supprise me if there was some cost cutting and short cutting in various departments to be honest. Because of the staff shrotages, the current staff will not go out of there way to put in extra effort to do more for patients, simply because the funding is not there...
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    Former MemberFormer Member Posts: 1,876,323 The Mix Honorary Guru
    Do you think an auxiliary has an hour an a half to feed one patient? Regularly I feed up to 10 patients at dinner time. I hate it because I have no time to interact with the patient - basically shoving the food down their throat. And Rainbow is right - if a patient refuses anything we cannot force it.

    "and then the nurses must surely force them to eat just to keep them alive whetehr its against their wishes or not"

    No we musn't! Would you force someone to have surgery or take a medicine? It is their bodies and can do whatever they please. Unless they are sectioned under the mental health act or deemed incapable of making decisions - only then can they be forced to do anything against their wishes.
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    Dr PirateDr Pirate Posts: 8,303 Legendary Poster
    This is one of the many reasons that the hospital your nan is staying in scored 0 stars ;(

    I've had to stay there and as you know the staff are useless.
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    Former MemberFormer Member Posts: 1,876,323 The Mix Honorary Guru
    Dr Pirate wrote:
    I've had to stay there and as you know the staff are useless.

    Bit of a generalisation there...
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    Dr PirateDr Pirate Posts: 8,303 Legendary Poster
    Panthro wrote:
    Bit of a generalisation there...
    You've not been there.
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    Former MemberFormer Member Posts: 1,876,323 The Mix Honorary Guru
    Not really, they are a bit crap. I went in at lunch time to feed my nana yesturday and Spoke to the meds man about getting something done about her ulcers. Not only did he tell me off for being in the ward out of visiting hours but he tried to tell me that my nana had eating all her food when it was blatantly still sitting in front of her getting cold. I didnt get chance to go up to feed her at dinner time but my grandad said that their not even trying to feed her. They just put in down and then take it away half an hour later.
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    Former MemberFormer Member Posts: 1,876,323 The Mix Honorary Guru
    Dr Pirate wrote:
    I've had to stay there and as you know the staff are useless.

    I really feel for Zella's nana but I honestly think that comments like this are unhelpful. As a collective hospital staff do an amazing job under strict time and monetary pressures that they are forced to deal with my management. Individual staff may not be up to much on occassion but it's like that in any organisation.
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    Former MemberFormer Member Posts: 1,876,323 The Mix Honorary Guru
    From Dr Pirates experiance with this particular hosptial, he has every right to feel that the staff are crappy. When he was admitted they were nothing but overly rude to both him and I. They on several occations left me on my own to deal with his black outs and I had to remind them to do the ob's checks they were ment to do after each black out.
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    Former MemberFormer Member Posts: 1,876,323 The Mix Honorary Guru
    Zella wrote:
    From Dr Pirates experiance with this particular hosptial, he has every right to feel that the staff are crappy. When he was admitted they were nothing but overly rude to both him and I. They on several occations left me on my own to deal with his black outs and I had to remind them to do the ob's checks they were ment to do after each black out.

    Although I am not condoning that...and don't know the full story- they have other patients to deal with. I work in many different wards throughout a large general hospital. The qualified nurse to patient ratio is uniformly 1:12 and once I worked in a ward where it was 1:24

    Shite - yes but what can they do? If someone takes unwell - or someone is at the end of their life - they are their priority.

    The sad reality is that wards are understaffed and the staff that are there are doing their best [I hope] under this situation.

    But as with all walks of life - you blame the person you can see and not the cause of the problem - management and government.
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    Former MemberFormer Member Posts: 1,876,323 The Mix Honorary Guru
    Does your nana have a social worker, or a Care Plan? I'm just thinking maybe she needs to have her needs reassessed? Could you talk to her doctor about it? Maybe the powers that be are unaware of her problem with eating? Or am I just being stupid?
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    Former MemberFormer Member Posts: 1,876,323 The Mix Honorary Guru
    She's does have a socail worker yes. There was a big meeting about her last week. At the moment her care plan is for her to get medicaly well before they can reintroduce her physo and rehab. When she gets out of hospital she'll be given the full care package.

    She ate ok today, kinda...She tried to eat the plate :s
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    Former MemberFormer Member Posts: 1,876,323 The Mix Honorary Guru
    Zella wrote:
    She's does have a socail worker yes. There was a big meeting about her last week. At the moment her care plan is for her to get medicaly well before they can reintroduce her physo and rehab. When she gets out of hospital she'll be given the full care package.

    She ate ok today, kinda...She tried to eat the plate :s
    bless her. does she have alzheimers?

    You know you could put a complaint in writing or ask for a talk with the ward sister/manager.
    Be best if your mum/dad was with you as her next of kin though.
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    Former MemberFormer Member Posts: 1,876,323 The Mix Honorary Guru
    No disrespect to nurses/care assistants because they do a fab job, but they just rush all the time. When my grandad was in hospital, there was a man next to him on the ward, he couldnt feed himself. So when it came to dinner time, they plonked the dinner on his trolly thingy, and left it..... my grandma ended up feeding the poor man.

    I'd suggest you get onto the nurses all the time, even if you feel like your being a pain! Ring them up every dinner/tea time if you have to.
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    Former MemberFormer Member Posts: 1,876,323 The Mix Honorary Guru
    Briony wrote:
    No disrespect to nurses/care assistants because they do a fab job, but they just rush all the time. When my grandad was in hospital, there was a man next to him on the ward, he couldnt feed himself. So when it came to dinner time, they plonked the dinner on his trolly thingy, and left it..... my grandma ended up feeding the poor man.

    I'd suggest you get onto the nurses all the time, even if you feel like your being a pain! Ring them up every dinner/tea time if you have to.

    Oh we don't like that.

    To try and get most of our tasks completed - they have to rush around. How long was that man waiting? When dinners are given out I start where they start and work my way around... this means that they may be waiting a wee while, while I feed the other patients.
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    Former MemberFormer Member Posts: 1,876,323 The Mix Honorary Guru
    wouldnt it be nice to have one HCA or nurse for every patient.
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    Former MemberFormer Member Posts: 1,876,323 The Mix Honorary Guru
    wouldnt it be nice to have one HCA or nurse for every patient.

    Wouldnt it be great...never gonna happen but it would be great not only for the overworked staff but for the patients... I feel that when a patient is talking to me... I am edging away because I have a hundred and one other things to do... would be great to sit down and talk to them.
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    Former MemberFormer Member Posts: 1,876,323 The Mix Honorary Guru
    Panthro wrote:
    But as with all walks of life - you blame the person you can see and not the cause of the problem - management and government.

    Actually, you chose the easiest target. For the patient it's the person they see in front of them.

    For nurses its management.

    Seldom does either actually look at their own responsibility to make sure that they are doing all they can to make things easier...
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    Former MemberFormer Member Posts: 1,876,323 The Mix Honorary Guru
    wouldnt it be nice to have one HCA or nurse for every patient.

    Actually it would be better if we practiced preventative medicine, rather than reactive medicine...
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    Former MemberFormer Member Posts: 1,876,323 The Mix Honorary Guru
    Not Hillingdon was it ?, I was there for a day under observation for concussion the food was so bad I couldnt eat it, I mean it was literaly the worst food Iv ever had, I mean that, as it was only one day I was OK.
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    Former MemberFormer Member Posts: 1,876,323 The Mix Honorary Guru
    Replicant wrote:
    The whole NHS is severely over budget & in debt, so it wouldn't supprise me if there was some cost cutting and short cutting in various departments to be honest. Because of the staff shrotages, the current staff will not go out of there way to put in extra effort to do more for patients, simply because the funding is not there...

    It is widely known that cost cutting is rife in the NHS...but please do not make the generalisation that just because of this the majority of staff are not willing to put in the effort to do the best for their patients. I'm a staff nurse and i know that everyone on my ward, despite us being short staffed, will always go the extra distance to ensure the best patient care. To be perfectly honest, we may be overworked, but even so, if a nurse cannot be bothered to put the extra effort in to do more for their patients, they probably shouldn't be in this profession. Funding will always be an issue, but, in my personal experience, it does not effect the nurses attitude towards their patients care. Funding is way out of the control of nurses, it may effect the patient to nurse ratio, but not their attitude...we get the funding we get and make the most of it...if you have an attitude like this, I'd advise you not to go into nursing :shocking:
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    Former MemberFormer Member Posts: 1,876,323 The Mix Honorary Guru
    Panthro wrote:
    Oh we don't like that.

    To try and get most of our tasks completed - they have to rush around. How long was that man waiting? When dinners are given out I start where they start and work my way around... this means that they may be waiting a wee while, while I feed the other patients.

    He was there a long time, very long time. Put it like this, my grandad wasnt eating fast, he was on his pudding when my grandma decided she would feed him. The nurses saw the man struggling - trying to pick his fork up and they did sweet F.A. :impissed:
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    Former MemberFormer Member Posts: 1,876,323 The Mix Honorary Guru
    In Uganda the patients have 'attendants' who are usually spouses/ children/ relatives who provide the food and personal care for each patient. Thankfully in the UK, we are able to provide 3 square meals a day on the NHS. You grandmother should have been seen by a dietician though and you should check that she has. They can suggest other ways to get calories into her, such as the Ensure build up drinks (you can also buy these from Boots).

    And the Mental Health Act only applies to mental illness. It can't be used to provide any other treatment, including feeding or surgery. Patients deemed incapable of informed consent can be treated under common law for emergency treatments, and with the consent of the NOK for other therapy.
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