Archive for the ‘Uncategorized’ category

Esential Standards Outcome 5c – Nutrition

February 29, 2012

 Promote rights and choices

5C Where the service provides food and drink, people who use services can make decisions about their food and drink because they:

 

●● Have accessible information about meals and the arrangements for mealtimes.

 

●● Have a choice for each meal that takes account of their individual preferences and needs, including their religious and cultural requirements.

Do your menu’s offer the client a choice in meal or dictate what they will have?

Are there vegetarian, vegan or halal choices as appropriate for  someone?

Do you have clients with special diets that require them to be nut-free, gluten-free, lactose-free etc.?  

 

●● Have access to snacks and drinks throughout the day and night.

 

●● Have mealtimes that are reasonably spaced and at appropriate times, taking account of reasonable requests including their religious or cultural requirements.  

Meal times are perhaps easier to plan for and accommodate in residential and nursing care than within domicilary care. Never the less, the client should be eating at times that are reasonably spaced and should have an idea of when those times are. Particulary relevent at the moment are religious and cultural requirements as we go into a fasting time for many muslims for Ramadan. 

 

●● Have information on what constitutes a balanced diet to help them make an informed decision about the type, and amount, of food they need to address any risk of poor nutrition and/or dehydration.

 This information is equally relevent and important for the care team as well as the clients themselves. All too often we hear that carer’s preparing food for client’s that is not well balanced because they do not understand what a balanced food intake is either. 

 

Here’s some useful information about healthy eating and malnutrition taken from the leaflet produced by Leeds NHS:-

 

What is malnutrition?
Malnutrition is when a person is not eating enough of the right foods. This means they don’t get all the nutrients, such as proteins,
vitamins and minerals, they need.
Being malnourished can make you ill as your body does not work as well as usual. Being ill can also lead to malnutrition as this often
results in poor eating habits. Malnutrition is not just something which happens as you age. It is important that you don’t dismiss the signs as being a part of ‘old age’. There is much that can be done to
help prevent malnutrition. The key is to ensure that the underlying causes are assessed.


Who is at high risk?
· those with reduced mobility which affects shopping / cooking;
· if you are housebound;
· if you are living alone;
· if you are showing symptoms of depression; and
· those with dementia.


Dental / mouth problems can cause malnutrition because they can make eating difficult and painful –

Spotting the signs and symptoms:
· losing weight unintentionally;
· eating/ drinking less than usual;
· experiencing any choking or swallowing problems;
· constipation or diarrhoea;
· unable to keep warm;
· loss of muscle;
· dizziness (prone to falls);
· difficulties recovering from illness;
· pressure ulcers, dry skin;
· recurrent infections;
· difficulties chewing or swallowing; and
· sore mouth, or tongue, bleeding or swollen gums. 

 

What to do if you are concerned?
You can help prevent malnutrition in yourself or others:
· recognising the early warning signs;
· supporting access to both social and health services;
· planning visits around mealtimes to get a sense of what you / they are eating and if you / they have any difficulties eating;
· sitting down and eating socially with friends or relatives;
· having a look in the fridge or cupboards. A lackof food, too much of the same foods or foods past their sell by date may signal a problem;
· encouraging extra snacks and drinks; and
· keeping active, as it stimulates an appetite and maintains muscle mass.


How can you improve access to food?
· Sharing meals with others / going to relatives or informal carers.
· Attending local cafes / pub lunches /visiting voluntary, community or faith organisations with luncheon clubs.
· Using private shopping services and / or meal preparation services.
· Using online supermarket home delivery services (including frozen meals).

 

Well worth sharing some of this information with your care teams. Maybe copy and paste the bullet points where useful as reminders for staff. How many of thier suggestions could you  adopt or adapt to meet  the needs of the people you look after?

 

 

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What CQC outcomes say about Eating and nutritional care pt 2

February 22, 2012

What CQC outcomes say about Eating and nutritional care:

 

What should people who use services

experience?

 

People who use services:

  • Are supported to have adequate nutrition and hydration.

This is because providers who comply with the regulations will:

  • Reduce the risk of poor nutrition and dehydration by encouraging and supporting people to receive adequate nutrtion and hydration
  • Provide choices of food and drink for people to meet their diverse needs, making sure the food and drink they provide is nutritionally
    balanced and supports their health.

Prompts for all providers to consider
The following prompts relate to all registered providers where they prepare,
or support people who use services to prepare, food and drink. The term
‘provide’ means the preparation of food and drink and includes where the
service gives support to people to eat and drink. The food and drink used may
be purchased either by the provider or by the person using the service. These
prompts do not cover the administration of artificial hydration which may be
essential to maintain hydration.

Moving on this week to Outcome 5B

 

5B Where the service provides food and drink, but not when this is in the
person’s own home or Shared Lives arrangement, people have their care,
treatment and support needs met because:
●● A nutritional screening is carried out to identify where they are at risk of
poor nutrition or dehydration when they first begin to use the service and
at regular intervals.

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 was included in the newsletter Nutrition part 2

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.
●● Where a full nutritional assessment is necessary because the nutritional
screening identified risk of poor nutrition and dehydration, this is carried
out by staff with the appropriate skills, qualifications and experience.
●● They have their food and drink intake monitored when they are at risk of
poor nutrition or dehydration and action is taken as necessary.
●● They are not expected to wait for the next meal if their care, treatment and
support means they missed a planned mealtime.

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
●● The person can choose a balanced diet that is relevant to them as an
individual, taking account of their nutritional status and previous wishes.

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.

 

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

What CQC outcomes say about Eating and nutritional care:

February 15, 2012

A reminder from last time….. 

What CQC outcomes say about Eating and nutritional care:

 

What should people who use services

experience?

 

People who use services:

  • Are supported to have adequate nutrition and hydration.

This is because providers who comply with the regulations will:

  • Reduce the risk of poor nutrition and dehydration by encouraging and supporting people to receive adequate nutrtion and hydration
  • Provide choices of food and drink for people to meet their diverse needs, making sure the food and drink they provide is nutritionally
    balanced and supports their health.

Prompts for all providers to consider
The following prompts relate to all registered providers where they prepare,
or support people who use services to prepare, food and drink. The term
‘provide’ means the preparation of food and drink and includes where the
service gives support to people to eat and drink. The food and drink used may
be purchased either by the provider or by the person using the service. These
prompts do not cover the administration of artificial hydration which may be
essential to maintain hydration.

Outcome 5A had so much to think about we split it it down further so here is the rest of 5A to explore further…….

5A Where the service provides food and drink, people who use services
have their care, treatment and support needs met because:

●● They have food and drink that:
— are handled, stored, prepared and delivered in a way that meets the
requirements of the Food Safety Act 1990
— are presented in an appetising way to encourage enjoyment
— are provided in an environment that respects their dignity
— meet the requirements of their diverse needs
— take account of any dietary intolerances they may have.
●● They can be confident that staff will support them to meet their eating and
drinking needs with sensitivity and respect for their dignity and ability.

Here’s a suggestion from Social Care Institute for Excellence…

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.
●● They are enabled to eat their food and drink as independently as possible.

There are lots of eating and drinking independent living aids available that will really support this type of independence.

●● All assistance necessary is provided to ensure they actually eat and drink,
where they want to but are unable to do so independently.

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.
●● They have supportive equipment available to them that allows them to eat
and drink independently, wherever needed.
●● They are helped into an appropriate position that allows them to eat and
drink safely, wherever needed.
●● They are not interrupted during mealtimes unless they wish to be or an
emergency situation arises.
●● They will have any special diets or dietary supplements that their needs
require arranged on the advice of an appropriately qualified or experienced
person.
●● They have access to specialist advice and techniques for receiving nutrition
where their needs require it.
●● The service takes into account relevant guidance, including that from the
Care Quality Commission’s Schedule of Applicable Publications (see
appendix B).

Weighty Words

March 5, 2008

scales Weight Loss and dieting are something that will be on the minds of many of you as the weather starts to get better and our thoughts turn to those summer holidays. There are hundreds of diets and exercise programs out there to choose from yet it’s more a function of how we think than what we eat. ‘Yo-yo’ dieting is an all too common occurrence. Why do we eat foods we KNOW add weight and inches to our waist and hips? Why do we sit in front of the tube for hours at a time instead of going for that wonderful walk in the park? The answer lies in our MINDS.

You’ve all heard of the saying “You are what you eat”

WRONG!

You are what you think.

It’s not just what you put in your mouth that affects how you look, it’s the words that you put in your head that does it. We all have conversations with ourselves though we don’t all like to admit it and how often do you take the time to really analyse that self talk? Stop and notice, are the words positive or negative? Do they make us feel fantastic or faulty? Do we tell ourselves how great we are? How awesome we feel? Do we tell ourselves “Hey – I love you, you’re amazing!!”

Take a minute now and tell yourself what you like about yourself. You will be amazed how difficult it is to do. We’re just not used to it. We’re used to putting ourselves down instead. “Look at me still fat” “I can’t believe I can’t lose the weight” “I can’t believe I put it all back on again, I’m hopeless.”

If you talk to yourself in a positive way, what do you think happens to your state? What happens to your confidence? It soars doesn’t it? Your unconscious mind then hears how great you are and must do what ever it takes to be congruent with your identity, therefore it has to do what it takes to make you great. If it hears that you’re a failure, it has to make you a failure.

So the words that you speak to yourself with are absolutely key in every area of your life, including your body shape and weight.

The unconscious mind needs to be spoken to in the positive as it does not recognise negatives. Let me demonstrate that to you really quickly. Right now don’t think of a pink elephant. Don’t think of it. What did you immediately think of? Yep, right before you switched your thoughts you thought of a pink elephant! So, when setting targets be sure to tell it what you want not what you don’t want otherwise what you don’t want is what you’ll get.

Set clear goals for your health and weight. For instance I want to be Xstone and Ylb instead of I want to lose xxxx lbs. I want to be able to run this distance instead of I don’t want to be tired any more. Get the idea? Great. Along side those clear goals write down what it means to have achieved those goals, as if you already have. What has it given you? How do you feel? How does it affect those around you?

Equally, if you don’t reach them what will it cost you in terms of who you are, how you feel? How you look? How is your self-esteem now? Really get some leverage on yourself here.

Finally, only share your goals with people who will support you through the ups and downs, cheer you on and challenge you, remind you why you’re doing it and tell you how proud they are of you. You become the people that you spend the most time with so pick your peers carefully.

There is so much more to learn about how your unconscious mind can support you in reaching your health and weight goals. I hope that you’ll look out for more information here and ask me about it if we meet.

For further information about this subject, coaching on health issues or training events contact:-

Tracey Dowe

Email Tracey.dow@momentumpeople.co.uk

www.momentumpeople.co.uk

Tel: 01793 700929

Learn and Let Go

March 5, 2008

j0341950.jpg It’s just coming up to two years since I moved to Swindon. I lived in a four bedroom house with lots of cupboard space, wardrobe space, attic space and a big garage. All that space is great to have, you can fill it with everything you collect over the years and hardly notice it’s there. And I filled every space to full rather than throw stuff out. How many of you have spaces just like these that you fill with all kinds of stuff you don’t know what to do with? Maybe you keep your old bicycles and cans of paint or whatever it is. Often times I never took the time to go inside and find out what was in there. However I was forced to when it was time to move forward as I had decided to move house. When life said that I had to move forward I had to go inside, and I went inside and I looked at all the stuff I had accumulated over time.

There were lots of things that I wanted to keep as I really liked them and there were lots of things that I wondered why on earth am I holding on to this? Why am I holding onto clothes I haven’t worn for years and gifts that I was given that somebody thought was a gift that makes no sense to me. And it made me think how often do we hold on to stuff that we get from other people instead of just deciding to let it go? Especially if it doesn’t fit. For example how many of you have got that Christmas sweater from a crazy aunt with a polar bear on the front and you put on that smile and say “thank you so much” and you never wear it but you hold onto it because you think you have to, you think that now you own it. You think that just because somebody gives something to you that you have to hold on to it.

Now I was moving to be with my sweetheart to the house that he already lived in. There was no way that I could take all of this stuff with me even thought we would be looking for a new house after I got there, all of this stuff wouldn’t fit into his space. And I realised that the cost of storing all of this stuff would be expensive and that I really had to prioritise what was important to me to keep and what I could not afford to pay that high price for to hold on to it.

At night as I would fall asleep I would think about what was inside all around me. Even in my dreams I would start to go inside and look and see what stuff doesn’t make sense any more? What stuff have I been holding on to that it’s simply time to let it go? Because the cost of moving forward with all that stuff was so high. How many of you have moved before and you find you keep on moving and you bring all of that stuff with you. And you keep on telling yourself “I’ll get rid of it one of these days, I’ll get rid of it or lose it or something” but you keep on holding on to it?

How many of you have ever been travelling and your bags didn’t come with you? All your stuff is lost and it’s painful but inside there’s that little part of you that’s say “Ooh! This is great” Why? Because I get to get something what?

That’s right, I get to get something new. So you go out and you buy new clothes and you try on new things and you want to see what fits you because obviously you were always growing, stuff is always fitting us at different times. Things that used to fit us obviously no longer fit us. It’s a bit like nappies, we all wore nappies as a baby but are we still wearing nappies now? No!! Why not? Because we out grew it. So sometimes as we out grow things we have to let them go.

So this one time I went out and I bought this whole new wardrobe, it was great. Excellent! New skirts, new tops, everything. And then the airline called and guess what? That’s right, they had found my bags. And it was interesting, when the bags showed up, all beat us as I’d been lugging these things all around the world, I took the clothes out and I compared them to the new things that I was wearing and the new things just seemed to fit a little better. I had to decide, did I was to lug all of this stuff around and I looked at the old stuff and I thought you know what? They served me for a while. They kept me protected from the cold or from whatever, and I realised that it had served it’s purpose. I had something better and I valued this new stuff much, much more. It was simply time to just let it go.

Once I let it go, donated it, I felt so free and I thought to myself “Gosh! I could have got rid of that stuff a long time ago” but sometimes right now seems like a much better time to simply let stuff go if it no longer fits you. I realised that I can get rid of stuff any time I want to I don’t have to wait for life to come and take things away from me I can simply say “You know what? This no longer fits, I’m growing up, it’s time to let the old stuff just go.

Some of the things I decided not to let go of though was all the knowledge or all of the learnings because over my life I’ve been learning so much I’ve been learning from my friends, from my parents, from my colleagues and so on, and I realised that as long as I hold on to the learning that’s always going to serve me going forward. So I keep the learnings in side to use when ever I need them and simply let the stuff go.

29th August 2007

October 11, 2007

Following up…..



This morning I met with the training manager at the Sure Start Childrens centre. She was lovely (I was a little apprehensive as she had been a bit defensive on the phone) She was familiar with NLP and so could see the potential benefits. I let her do lots of talking first, telling me about the extensive work that the centre does – very impressive too, I have to add. At the end of her explanation she asked how I saw myself fitting in, was it with parents, or children or staff. Definitely staff I told her, that was where I could see the most benefit. I explained together how rapport skills and anchoring, perhaps a little conflict management would really benefit them in working with the parents in particular. This was obviously the right answer! as she relaxed and agreed and became more open with me. She is very interested and told me that the timing was great. The team hadn’t had any communication skills training for about 3 years and there were many new staff. She told me that they do have a budget for training to use and that this would be very valuable. She would put it to her superior and suggest that he meets me to discuss options. She also gave the names of 2 other people who might be very interested, one in the Swindon Sure Start Partnership and one in Swindon Borough Council.

Didn’t get chance to do anything with that today but will be following those leads up next week.

Called Andrea re: the training opportunity with Tesco and got further details. This is an interesting project and I’m giving it some serious thought. Thank you Andrea – you are so lovely for thinking of me and I really appreciate it. It was so Good to speak with you today and hear about all of the ways you are using what we learned in your training role. You ROCK!

Had further correspondence today with the Nursing Home – the inspectorate have said no CRB check needed. I just have to put together a protocol for them about what I’ll be doing there. Cool

I have two presentations to give at 2 different groups tomorrow so have been polishing them up and practising them through out the day. I’m very excited about both.!

When you find your Passion – Life becomes a Pleasure!

August 22, 2007

j0426587.jpg

16th August 2007


Soooo true!

I had managed to work myself in to massive frustration by lunch time because I felt as though I was busy getting nowhere quickly. As I listened to myself get annoyed with myself I decided to step in and sort myself out!

 

I reminded myself of one of my favourite quotes:-

Our deepest fear is not that we are inadequate. Our deepest fear is that we are powerful beyond measure. It is our light, not our darkness, that frightens us. We ask ourselves, who am I to be brilliant, gorgeous, talented and fabulous? Actually, who are you not to be? You are a child of God. Your paying small does not serve the world. We were born to make manifest the glory of God that is within us. It’s not just in some of us; it’s in everyone. And as we let our light shine, we unconsciously give other people permission to do the same. As we are liberated from our own fear, our presence automatically liberates others.

Beautiful.

The parts in bold echoed around my head, heart and soul. Your playing small does not serve the world. And as we let our light shine, we unconsciously give other people permission to do the same

AWESOME!

For me it was a call to action to get off my whinging backside and DO some thing!

So – I got off my whinging backside and DID something!! 🙂

I took myself down to the local estate agents office and asked to speak to the branch manager. He immediately appeared and I explained that I was looking to work with companies who were interested in increasing their sales. Did he have 5 minutes to chat? Of course he said Yes….so we chatted……for about half an hour as I explained to him the technologies that I had learned, use and teach and how they could impact on sales for the business. I appreciated that he was not the decision maker – head office arrange training…but what kind of training did they provide….and would his team find it useful…..and did he thing the company would be interested?
Now, it didn’t bring me any work….yet…..but he did give me a valuable chance to practice my pitch, elicit their training strategy and have an insight in to where my training would be most useful in this business. Now, when I call head office, I can say that I’m calling on recommendation and sound knowledgeable about the business! 🙂

Then

I popped over the road to the Primary Care Trust. I buzzed the intercom and a little voice asked if she could help. I said ” Could I come in and pick your brains for a minute?”
She said “yes! Come on in!”
So I did 🙂
A lovely lady on reception listened to my ramblings about who I was and what I was looking to do, a little confused about who to put me through to she chose some one who dealt with GP referals.
Along came another lovely lady who also listened to my story about wanting to work with GP’s – referring patients to me who had chronic health problems or obesity issues that they were unable to resolve with them….and she said…..”I’m not the right person but I think I know who is……bear with me a minute and I’ll see if they’re in”
Off she disappeared and along came another lovely lady 🙂
She again listened patiently to my tale and gave me the name of the gentleman (her boss) in commissioning that I need to speak to. Unfortunately he was in a meeting this afternoon, she would give him all the details. Would it be ok if I needed to to come back another day?
Of course!!
So she took my business card and I hope to hear from him soon to progress my goal!

Then……

Next door to the Primary Care Trust is a division of the Business and Learning Department for Swindon College. Hmmmmm………….I wonder……
So I popped in there….nothing to lose……and yet another lovely lady asked if she could help me. I don’t know I said – let me tell you why I’m here…….I was just passing and thought I’d pop in on the off chance……I do blah, blah, blah…….and I wondered if there was an opportunity for us to work together .
Igot a really positive response and much interest about what I do which was lovely. Again the lady I needed to talk to wasn’t there ….holiday season isn’t it…..but they gave me her email address and telephone number and told me that she’s back in work on Monday. Email her and she would get back to me next week. So I have 🙂

I came home – did a belated Hour of Power and then emailed two other people with regards to giving a talk in schools – the lady who does my cold calling for me, her husband happens to be a school teacher and she sent me the contacts for his school and another.

Cool 🙂

And….

This evening a gentleman I met through networking came round to give us some mortgage advice with regards to buying another property to improve and sell on.

Gosh, it’s all go with this making dreams come true lark isn’t it! And I feel SOOOOO much better than I did by lunchtime this morning!!

So – time to go and chill a little!

Stay AMAZING out there!

Love and Blessings


TeeJayj0426587.jpg