Disrupted "Protected" Meal Times - Essay Sample

Introduction

Malnutrition is a common problem that affects hospitalized in-patients. It can also lead to various clinical issues that may be economic sequelae or patient-centred (Palmer and Huxtable, 2015). Enhancing the quality of the mealtime experience, as well as maximizing nutrient intake in hospitalized patients is the main aim of protected meal times. The study aims to measure the mealtime environment, the experience of the patient as well as the nutrient intake after and before implementation of the protected meal program. From the results that were obtained from the study, there were improvements in the three objectives. A good number of sick people were observed employing food or fluid tables (30% vs 41%, p = 0.01). A good number was also given a chance of washing their hands (29% vs 39%, p= 0.03). There was also a good number that, was helped at uncluttered benches (52% vs 62%, p= 0.035). There was no significant variance in the number of sick individuals, who were undergoing meal disruptions (31% vs 23%, p= 0.13). There was also no significant variance in terms of vigour consumption (1077 vs 827 kJ, p= 0.24). As well as a reduction in protein consumption (13 vs 6 g, p= 0.03) after the protected meal program. In the conclusion part, the article noted that there were only minor improvements that were achieved in the mealtime experience after the plan of a protected meal was implemented. This, therefore, shows that there was no improvement in the macronutrient intake. To ensure that there is progress in the meal familiarity, the execution of the sheltered mealtime program has to be evaluated.

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Nutrition Intake in Adult in the Hospital Wards

Undernourishment amid grownups admitted to sanatoriums in the United Kingdom as well as Europe has a prevalence that is estimated to be between 9% and 51% (Laur, 2019). The sick once they are in the hospital their nutritional status continues getting worse especially in the older patients. However, due to longer stays in the hospital together with increased resource utilization, the hospital bill is often enhanced by over 59% in the malnourished patients. Records have it that, the expenditures for malnutrition-related diseases in the United Kingdom exceeds seven billion pounds.

Inadequate nutrient intake is the main cause of malnutrition-related diseases, and the reasons that are provided for this are numerous and diverse. Some of the ideas include; barriers to accessing food, like unpleasant eating environments, and interruptions especially during the mealtimes. These take place in the patients who are advanced in age and those who have co-morbidities. In the UK, these barriers are addressed by PM.

PM are times in a clinic quarter when entire activities that are not crucial in the clinic ends. These are the periods when patients are offered a chance to eat without any interruption with the assistance of the hospital or the clinic staff members. In the council of Europe Perseverance, execution of sheltered meal is one of the main act opinions. In the recent strategy of improving nutritional care, diet, as well as nutritive upkeep in the clinics and sanatoriums, are among the things that have been given the priority.( On the other hand, no consistent evidence can demonstrate, that there is an improvement in the mealtime experiences and if it can increase food as well nutrient intake, even if PM is seen as the most efficient approach of tackling the hospital malnutrition. Some studies conducted previously show that mealtime interruptions are decreased by PM. However, the impact they have on food intake is not yet clear, despite the methodological limitations it has. However, comparing mealtime environment, the mealtime experience of the patient as well as the dietetic consumption after as well as before the execution of protected mealtime in one of the big hospital is the main objective of the present study.

Methods and Materials Used in the Qualitative Study

Before and after the outline of protected mealtime, at Hammersmith Sanatorium together with Charing Cross Hospital respectively, both food intake and mealtime experience were measured using identical methods of baseline (Roberts, 2018). Introduction of PM was done through a guideline document; on the other hand, dissemination was also carried out through the Directorate of Nursing. Establishment of great symbols showing that PM was in development together with notices on the intranet as well as times for meals for all the wards was also provided. Because this study compared the medical exercise with printed principles and needed no proper endorsement, it was registered as an audit. On the other hand, the study was carried out with the moral framework. Therefore it kept the confidentiality of the patient and collected data that was relevant to the learning only.

Quantitative Study

Meal Involvement

A divided form that was planned, to examine the features of the PM goals was used in undertaking the direct observations. The first observation was taken in the ward level real-time environment; here the following points were looked at; the ratio of staff to the patients, removal of distractions, the use of the dining room et cetera (Porter and Ottrey 2018). The second observations were on the individual patient mealtime experience. Here the following aspects were looked at; visitors present, receiving assistance, et cetera. Apart from the intensive care units and the private wards, all the adult wards were eligible. Apart from those patients who were receiving enteral nutrition. All other likely patients who were ineligible wards received an observation on the mealtime environment as well as a measurement of patient meal knowledge was also carried out on qualified patients. Even if the quarter supervisors were not aware of the day the assessment was to take place, they were informed that it was going to take place. The reason why they were not told the exact day was to avoid, interference of the ward activities so that the study could not be biased. Random tables were used to assign wards randomly to experience either a lunch or dinner surveillance. Two researchers were also assigned the wards, one researcher was a dietitian, or a student of dietitian and the other researcher was a nurse who observed each mealtime. These researchers both worked at the word level continuous surveillance, on the other hand, each researcher selected a bay where he or she watched a minimum of five patients, the aim of this was to increase the number of patients observed.

Comparison Between the Qualitative Method and the Quantitative Method

At lunch, a weighed food was undertaken on a subsample of the sick in the wards. The criteria that were used to include the patients is the selection who were at high risk of being attacked by the malnutrition associated diseases. The patients were selected because they benefit more from PM. INSYST nutritional screening tool was used to screen them. The criteria that were used to exclude patients were those patients who were receiving parental nutrition. All the patients who selected were to fit the characteristics of the baseline patient population. The main aim of carrying out this selection was to reduce the perplexing variables like gender, type of the diet as well as the age group.

Analysis of the Studies

From the statistics results and analysis, it was clear that the improvement that was made in terms of patient mealtime experience was minimal after the introduction of protected mealtime. On the other hand, something very important is that PM did not initiate any interruption in the mealtime interruptions (Porter, Haines and Truby, 2017). However, 25% of the minority is still experiencing disruptions. There was little improvement, which is attributed to inadequate implementation, even though there were some minor improvements in patient mealtime experience. Incorporating protected meal into the policy of the hospital, communication, promotion, leadership at all levels as well as organized training for all the staff groups are among the factors that are critical for successful implementation of the protected mealtime. There was no structured education to support PM, and therefore in all the hospitals, it was just used as a guideline with simple intranet notifications together with new ward signage. From the data that was collected from all the hospitals, you realize that the implementation of protected mealtime is crucial.

Discussion

It was not shocking that the nutrient intake did not improve because there was no significant improvement in the ward mealtime environment and the improvements of patient mealtime experience were minimal. However, there is no apparent reason for low protein intake. There is also clear evidence fro from this study that the implementation of protected meal in all the hospitals was not wholly successful. Assuming that, improving nutritional care in hospitals will improve nutrient care is just but a pearl of conventional wisdom. On the other hand, no quality evidence can support the idea. For the Government of the United Kingdom, driving improvements in nutritional care is a very crucial goal. To demonstrate that, the protected meal is made of a route of achieving improved nutritional care as well as nutrient consumption requires further evidence.

For effective evaluation of protected mealtime, future research is required. However, intensive weighed food consumption studies are unlikely to demonstrate improvements in the consumptions if hospitals and their management will not ensure that PM is operational. That is the only time. We can establish if an improved eating environment can translate to improvements in nutritional as well as clinical outcomes. (Truby, H 2017) There is a need to explore alternative strategies of preventing hospital related malnutrition if the implementation of protected mealtime is not in a position of improving the results. On the other hand, for more hospitals to be encouraged to work hard towards the implementation of PM successfully, robust evidence is also required as well.

Limitations of the Policy

There was variability in implementation across different aspects of PM policy components. Even if the study was carried out, in a comparatively short period and with the exercise variations informed by the execution of science works. Protected Mealtimes differ in the scope of application as suggested by fidelity measurements. On the other hand, longitudinal measures of nutritional status that were to be recorded were not shown by the relatively short implementation period. Some errors in the estimation of the dietary intake as well as the conversion of the data nutrients are acknowledged in this study just as it happens in all other nutritional intake studies. On the same note, there are chances that, through estimation of dietary requirements of all the individuals as well as the inter-observer variation, an error might have been introducing at this stage. On the other hand, with the intervention, there might be some variation in the measurement fidelity as well. However, through the pre-study training program that was meant to test the ability of the observers to record the observations, this was reduced.

Recommendations

Every hospital has to evaluate the processes that are required to improve their situation in their setting. They should also ensure that the duties of relevant staff include focusing on supporting food consumption. This is the best move that all hospitals should take, even if there are studies that have shown mixed or even negative results for PM, suggesting that this policy may not be useful in the h...