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Wardipedia – 56. Mealtimes made special

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Food for thought. And feelings. And health

Introduction

“Donuts. Is there anything they can’t do?” – Homer Simpson

Warmly endorsed by Marion and, in particular, Buddy.

And it’s not just donuts. Not even just fried treats. And even, not just food. Mealtimes can be really special occasions in hospital, with the nutritional aspects almost a bonus! Stand by for the bullet points for the potential loveliness of mealtimes:

  • Companionship
  • Interest, variety, stimulation
  • Choice, autonomy, individuality
  • Comfort, familiarity
  • Experimentation
  • Nutrition

It’s not surprising that food is very often the most passionately discussed issue in ward community meetings.

Particular issues on mental health inpatient wards

There are some challenges which are long-term, for the individual patient (eg eating disorders) or the ward (the quality of the food provided by the hospital, the physical lay-out of the ward etc.) and there are on-going demands which require continuous staff patience, time and empathy.

Giving patients choice based on an understanding (and availability!) of the options is the starting point, and then the full gamut of issues with which nurses are very familiar. Motivating people to eat more, motivating people to eat less, explaining the impact of nutrition on mental health, summoning up endless patience to enable a  patient with dementia to eat at the pace they can manage…..

But there are small details, borrowable from other wards, the catering industry, kids’ parties, posh parties, which can make a real difference to a patient’s experience of eating and mealtimes and which take little or no extra effort. They’re exemplified by the creative possibilities of the humble sandwich. Check these out:

There’s even a noticeable ‘hospitality’ difference between the way the catering industry usually present sandwiches. And how, for some bizarre reason, many of us find it hard to stray from the straight down the middle method when we’re at home.

Same kit, same sarnie, same effort….. and smarter result! Patients often notice these thoughtful touches that staff provide, even if they don’t always express this!

These are some small things which can make a big difference:

  • Information eg clock, menus and mealtimes’ notices
  • Less noise
  • More light, natural light
  • Patience
  • A conscious decision about having appropriate music or TV programme on in the background, ideally made in discussion with patients about their preferences. A safe rule of thumb is that no background music/programme is a safer bet than something which some people might find aversive.
  • Nice crockery
  • Tablecloths
  • Fresh flowers
  • Homely, comforting and welcoming touches
  • Printed/drawn/painted menus
  • How meals are served
  • A choice of seating arrangements and company

Ward examples

Individual needs

  • Catering staff listen to patients’ individual preferences
  • Balance between ‘task’ and relational aspects for staff feeding patients who have dementia
  • Staff knowledge of eating difficulties and nutrition for people with dementia. (Speech and language therapists are knowledgeable about swallowing and related issues.)
  • Choice and variety is improved by providing cultural / ethnic meals.
  • While the social aspect of meal times is important, some patients prefer to eat alone.
  • Our mealtimes are person-centred, individual and non-standard
  • Patients’ individual preferences, routines and dietary requirements are taken into account

Making it special

  • Protected mealtimes introduced to prevent interrupted meals
  • We celebrate special events and festivals with accompanying meals.
  • Supporting privacy during mealtimes.
  • The ward switches the TV off during meal times and displays a sign to inform patients about this.
  • If requested patients can cook a meal for family / friends before a visit.
  • Designed colourful posters to promote special meal nights.
  • Create an attractive notice board just for meals – displaying information on meals.
  • OT ran Breakfast clubs and lunch clubs, a neat embellishment of a special evening
  • A patient-prepared curry night (food hygiene certificate required)
  • Patients attend food hygiene course and obtain certification.
  • Design a Placemat competition. The patients’ art was then printed with added information – eg local resources, 5 a day, puzzles, TV listings and mentioning that you can have a copy of your care plan.
  • No oven so OT brings 2-ring camping stove. (Fantastic, simple, classically OT improvisation!). Had to make it start earlier because so popular that would sometimes stretch to lunchtime!

Involvement

  • Patients suggesting/designing/cooking dishes
  • Patients council pre-testing
  • Staff on duty eat with patients
  • Friends invited
  • Visitors are welcomed to the unit during the day and evening except during protected mealtime periods, although if arranged beforehand, relatives and carers can visit during mealtimes to share a meal with the patient, either in the dining room or privately.
  • Volunteers utilised to help make mealtimes more sociable
  • Volunteers utilised to help assist patients with eating
  • Senior managers (including commissioners!) invited
  • Patients are motivated and encouraged to cook
  • Carers are listened to and supported
  • They provide a choice of seating arrangements. Group some dining tables together for large groups and make some single tables available too.
  • Keep meals on the agenda in ward forums and community meetings.
  • All patients have ‘shop and cook’ sessions booked with them on a weekly basis, they are encouraged to prepare meals for themselves and for their friends as their skill base increases.
  • Therapy Kitchens are open throughout the day.

Quality

  • Food quality is monitored by volunteers at mealtimes
  • Surveys are used to gain feedback about meals and to find out how they can be used
  • Wards produce their own best practice guidelines
  • Food provided is tasty as well as healthy
  • Run regular Food Focus Groups.

Nutrition

  • Wards have yearly ‘nutritional awareness weeks’
  • A ‘nutrition support’ information pack is produced alongside dieticians, speech and language therapists and medical staff.
  • One member of staff is trained and supported as food nutrition link nurse.
  • Display nutritional facts and information about meals served.

Patient examples

  • I didn’t always feel like breakfast so I would eat a banana as it is easy and light to eat.
  • I was encouraged to make poached egg on toast, it was great to be able to concentrate and start cooking for myself.
  • Food has always been my enemy but I started cooking on the ward to fight my fear and now I can bake and eat a slice of cake without feeling guilty.
  • Feedback on meals is appreciated and it is nice to have a say in what meals are available.
  • We always celebrate special occasions with food and drink. It is no different on the ward 🙂
  • My mum brings in home cooked food for me.
  • Getting a takeaway now and then gives us something to look forward to and breaks up the predictable menu.
  • Access to home comforts – like a morning coffee and a croissant.
  • At home my partner and I have an Indian takeaway on Friday nights. We’ve continued to do this throughout my admission. She brings one in each week and the staff are okay with this. It’s helped give me a sense of familiarity.
  • I thought the food on the ward was delicious and homely. Nice puddings with custard!
  • ” I found I had a craving for extra food because of my medication so it was good that the ward provides healthy snacks like cereal, yoghurt and fruit.

 

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