Posted at 11.29.2018
For my reflective account of my caring skill of helping somebody to consume I am going to use "A style of reflective practice" Gibbs, G. (1988). My practice was at a home home with sixteen everlasting residents and two respite rooms and so the health and amount of treatment needed by every individual mixed. Some are mobile and independent, some need the help of carers for only a few activities such to be forced in a wheelchair, whereas a few are completely determined by the carers to do day to day activities such as eating. Before I began my placement I browse the NMC code of professional conduct and the NMC guide for students of medical and midwifery. This is so that I was alert to my accountability, responsibility, confidentiality and the wants of the patients. I also explored into nourishment and feeding, to help me to understand my clients' needs and emotions, so that my caring skill was far better.
Every cell requires an energy source for growth, development as well as for cell activity. The body obtains its energy source from eating and drinking alcohol and so they are crucial to existence (Roper, Logan & Tierney, 2000). Therefore nutrition performs an important role in health and I have to know very well what a nourishing diet contains and the consequences a wholesome and poor diet can have.
A nutritious diet consists of all the nutrition the body needs to function. A nutrient is "a compound that must definitely be consumed within the diet to provide a source of energy, material for growth or substances for regulated expansion or energy creation. " (Oxford Research Dictionary for Medical, 1990). I came across that these are proteins, which supply the body with the essential proteins for building and repairing body tissues, carbohydrates to provide temperature and energy and excess fat that can be broken down to essential fatty acids and glycerol and provide high temperature and energy. The body also uses fatty deposits to protect and keep maintaining delicate organs, such as the kidney. The body also requires small amounts of vitamins and minerals. Vitamins are necessary for many various things. Many of them have a catalytic function in metabolic reactions. They are really needed for energy regulation, rules of tissue synthesis and the overall health of tissues. Minerals are the "the different parts of body tissue and fluids, and of several specialised chemicals such as human hormones, transport substances and enzymes. " (Roper, Logan & Tierney, 1991). Although fibre is not found in any area of the body's structure and it is excreted in the faeces, it continues to be needed for a healthy diet plan because it provides large, which helps defaecation by stimulating muscular movement in the top intestine, and therefore stops constipation. Finally, water is extremely important for the body because it makes up around 2/3 of bodyweight, is the primary element of all body liquids and many body techniques be based upon it. Therefore your body is severely deprived of drinking water it will expire. Holmes (1986, cited by Roper, Logan & Tierney, 1991) found that "food and liquid intake is controlled by complicated biochemical processes. There are centres in the brain which are delicate to changes in the level of nutrients and track elements in the bloodstream thereby controlling urge for food and thirst".
The levels of these nutrients needed differ for each and every specific and vary throughout the different periods of life (Chern & Rickentsen, 2003). These nutrients have to be ingested, digested and then assimilated. The digestive system includes the oral cavity, oropharynx, oesophagus, abdominal and the intestines. The enzymes that facilitate digestion are stated in the salivary glands, pancreas, liver and gall bladder (Waugh & Give, 2004)
There are multiple reasons why somebody might need help with eating. "It is essential that nurses have knowledge of factors and exactly how they effect activities of living". The model of nursing helps nurses to comprehend, assess, plan and put into action relevant interventions and evaluate the effects. (Roper, Logan & Tierney, 2000)
The client which i helped with eating was an older man who was simply completely determined by the carers because he previously possessed a cerebrovascular crash (heart stroke) and he was paralysed down his still left area (hemiplegia). He also couldn't use his right arm much due to rheumatoid arthritis. However many people with physical disabilities like an arm defect can still drink and eat independently by using mechanical assists and specialised equipment or even just having the food taken off its wrapping. One client on my placement who got a stroke could use his right arm and used equipment such as a plate officer and another client used a specialised spoon so she could supply herself. The usage of these aids help to keep up with the person's dignity and self-esteem. (Child & Higham, 2005)
My client was still in a position to chew up his food and produce the saliva and mucus to soften and bind it into a bolus and he still experienced the reflex to swallow it. A lot of the clients could eat without or with very little assistance if given the correct handling products. Other clients, who cannot swallow properly due to a health problem such as cerebral palsy or a stroke, had had a Percutaneous Endoscopic Grastrostomy (PEG) for enteral feeding (a surgical procedure where an beginning is manufactured in the stomach wall structure and a tube is handed through in to the stomach directly). Different ways of enteral feeding are an Esophagostomy (placed at the level of the cervical vertebrae to the side of the neck of the guitar) or a Jejunostomy which is located in the duodenum or a Naso-gastric pipe which really is a tube handed down through the nose down the oesophagus and into the abdominal. (Williams, 1994)
My client got already been assessed and he did not need any natural supplements to go with his meals. The Body Mass Index shows healthy amounts for body weight, it depends upon their weight with regards to their level and National Screening process Tools are used to identify people vulnerable to malnourishment and nurses should become aware of honest issues and the influences of faith and culture when performing a care intend to meet up with the individuals' needs. (Walsh, 2002)
The carers within my placement already understood my clients' personal preferences and healthy needs and that he could chew his food therefore the consistency of the food did not have to be changed.
"Needing to be given can threaten dignity so nurses should make every effort to minimise any negative aspects". (Isaacs & McMahon, 1997)
Before I started to assist my customer I asked for his consent and ensured that I washed my hands extensively, to reduce the chance of disease and was using protective clothing which the surroundings was suited. The Section if Health (2001) claims, "the surroundings is conductive to allowing the individual patient/client to consume". At my placement, when possible, all the clients ate in the dining area where there are no interruptions, the tables were placed properly and almost everywhere was clean and tidy.
I offered my client a choice of two meals and I ensured it was ready to his liking and presented within an appropriate way. This is because if the meals is not provided appropriately for your client and does not look tempting to consume then feeding will be inhibited, giving them a choice offers them back some of their freedom when they may be being helpless and prone and their self-esteem could be reduced. (Child & Higham, 2005)
It is important to be sure that your client is comfortable and laid back to help make the interaction far better (Williams, 1994). I think I achieved this quite nicely because I ensured that my consumer was relaxing up in his couch, which also lessens the risk of choking. I taken up a couch next to my consumer so that we was closer to him and was at a similar eye level. This also shows your client that you will be not in a rush and he is not being an inconvenience for you. My body vocabulary was laid back and I used positive cosmetic expressions because easily had been tense and negative, my consumer wouldn't normally have liked his food and could have felt uncomfortable and rushed and therefore the interaction could have been inhibited and he might not have wished to eat anything.
I attempted to ask my client if he had any personal preferences to the order that he wished to eat his food but he didn't really respond verbally or none verbally. This made me feel quite uncomfortable and I just fed him the meals in the order i thought he might have liked it and he appeared happy with that. I used ordinary cutlery and slice the food up into what I thought were appropriate bite measured servings for my customer and adjusted the scale if I thought I had put too much on the fork.
After my customer possessed swallowed his first mouthful I asked him if it was too hot and he said no so I carried on nourishing him. I waited until I thought he had completely swallowed each mouthful before I provided him another. Once my client had ingested his whole main course I asked if he required a drink and I presented the cup up to his mouth. I did this so that he'd not still have the flavor of his main course while he was eating his dessert. I cleared away the soiled equipment before I gave him his dessert and I once again lower it into bite-sized parts and after his first mouthful asked if it was alright and if he liked it.
Once my client has done his dessert I cleared the dish away and asked if he desired a glass or two. I motivated him to try to hold the cup along with his right side and I reinforced the other side and tipped it up somewhat further when needed. After he had done everything I asked if he required anything else and when he was happy. I then gave him a clean so that he could wipe his mouth but he cannot do it so I asked if he wished me to do it for him and he i want to. Then I asked him where he wanted to go and took him there and asked if he needed the toilet or anything else but he said he didn't. Then i went and recorded how much he previously consumed in his records.
I have the interaction travelled well because even though I felt a bit uneasy initially I soon laid back and I think that I used good body language and facial expressions and it was good that we sat in the seat next to him and didn't just stand over him. My client was laid back and happy to have me nourishing him. The dining room was clean and tidy and there were no distractions. I did find it very difficult to speak to my consumer because I did not need to ask him too many questions because he was eating and other than requesting him if everything was alright I did not really discuss much. It had been good which i used a fork to nourish my consumer because easily possessed used a spoon it may have made him feel just like a child and lower his self-esteem.
A negative factor of the conversation was that I put a newspaper bib on my customer, that could have lowered his self-esteem and dignity. I also used a plastic material beaker with a lid so that I did not spill his drink down him and this could also have made him feel like a child. At some items I did so put another forkful up to his oral cavity before he had completely swallowed the previous one and although I apologised and put the fork down again and waited until he previously completely finished, I did feel as if he might have thought I used to be rushing him a bit.
Next time I am supporting to nourish someone, I'll use a napkin instead of a bib and when possible a normal glass. I will also try to talk to your client a lttle bit more without requesting way too many questions so that they don't have to talk with their mouth full. I am going to also ask if they want to clean their teeth or clean their mouth in order that they feel more comfortable and it'll also help prevent dental care decay or any sores from developing around the gums. I spoke to my coach about how she thought the discussion proceeded to go and whether she thought I possibly could improve on anything and she was happy with it.
In conclusion, Personally i think my caring skill went well. This is because we were both comfortable and comfortable, no problems occurred and I'd do most things the same again. Despite the fact that I felt as if I may have rushed him a little at times unintentionally plus some of the equipment I used may well not have been appropriate, my customer was happy and ate everything. He also said he'd feel comfortable with me at night assisting him again and I now feel confident and comfortable enough to aid nourishing people.