Individual Client Need example essay topic

The purpose of this assignment is to discuss the knowledge that underpins assisting a client with eating and drinking. I will begin by introducing a service user, who in order to maintain confidentiality and anonymity will be referred to as Dot. An attempt will be made to look at different factors that can influence the nutritional requirements of the individual. I will then discuss the principles applying when assisting a client with eating and drinking with references to experience gained during a practice placement. Dot is a fifty-year-old female with severe physical and learning disabilities. She lives in the nursing home for people with learning disabilities.

Dot depends on others to assist her with all daily tasks and activities. Roper at al (2001: 26) defined nutrition as ^aEUR~the study of food and related physiological processes of growth, maintenance and repair of body tissue., Food is a main source of energy needed for all bodily activities and metabolic processes (Roper at al., 2001; Malik at al. 1998). Energy balance depends on individual,'s energy expenditure and determines the amount of food required. Basal metabolic rate (BMR) is the energy needed ^aEUR~to maintain the basics for survival - heartbeat, circulation, breathing, body temperature and muscle tone, (Sandy, 1997: 102). It can be affected by various factors such as age, growth, height, sex, body temperature, stress, exercise, food intake, environmental temperature, fasting, malnutrition, hormones (Malik at a 1, 1998).

In general, irrespective of client,'s physical or mental ability, nutritional needs will always be determined by age, gender, life style and state of health, and depending on ability, disability or long term illness the level of nutrients required will differ (Sandy, 1997). Nutrients responsible for maintaining body,'s normal functioning are extracted from the food and absorbed from the alimentary tract. They can be divided into six classes: water (which accounts for about 60% of total food consumption), carbohydrates, proteins, lipids, vitamins and minerals. Essential nutrients, such as certain amino acids and fatty acids, have to be included in the diet as the body is unable to synthesize them.

(Solomon at al, 1990). Through metabolism the absorbed nutrients are broken down (catabolism) or build up (anabolism) into various substances that are either used immediately for energy, maintenance and repair or are stored for future use. (Heath, 1995). The required quantity of nutrients will differ, depending on developmental stage of an individual, gender, age, and pregnancy for women. (Malik at al, 1998; Heath. ed, 1995).

It can also be influenced by: illness, drugs, surgery, disability, inherited metabolic disorders and environmental pollution. (Sandy, 1997). Apart from physical intake of food and fluid there are many other factors that will determine people,'s eating habits. Roper at al (2001) suggested that the certain level of intelligence and intellect is required in order to gain necessary skills that allow a person to eat and drink whilst also understanding the concept of hygiene, safety and nutrition when preparing food. Emotional state often affects what, and how much, an individual consume, for example grief, stress, excitement or anxiety might reduce the usual intake. Prolonged loss of appetite, or lack of interest in food, could indicate a deeper emotional disturbance and consequently manifest itself in the form of anorexia nervosa.

On the other hand, food can be used as a source of comfort resulting in overeating or overdrinking, which could lead to various health conditions such as bulimia nervosa and alcoholism. Although the principles applied when assisting a client with eating and drinking in the in the Hospital, nursing home or community will remain the same, it will require different approaches and adaptability. During nursing assessment it should be established why, and to what extend, the client will need assistance (Heath, 1995). There can be a number of reasons such as: physical disability affecting, for example posture, coordination, vision, speech, mobility; mental health state or learning disability. Investigating client,'s history should determine medical conditions that may affect diet, for example diabetes mellitus, current medication or history of constipation. This is also useful for special preferences or aversions, food restrictions, cooking and processing requirements, preferred meal times, prayer times specific to religious or cultural background.

(Malik at al, 1998; Sandy, 1997). Religion, cultural background and social habits can also determine different type of food that the individual may choose to eat. (Sandy, 1997). Information gathered during assessment should be used as guideline for planning meals with the aim to meet the necessary requirements. In community settings it may be appropriate to provide the client with the necessary information and advice, ensuring active involvement in planning a diet suited to personal limitations and financial means (Malik at al, 1998).

While on placement I had the opportunity to apply some of my theoretical knowledge in residential settings. In the first instance I obtained important information from Dot,'s personal file and care plan. Conversations with my mentor and support staff proved adequate in further assisting me with her dietary requirements. Dot has medication to control her epilepsy and persistent problems with bowel movement. I was also able to gain access to her family history and glean general information concerning behaviours and daily activities. Whilst observing Dot, and actively communicating and interacting with her by means of body language and comprehension of specific sounds and gestures, I became increasingly competent in the task of assisting her.

A mutual trust was established and, as a direct result of our mealtime contact, other daily activities that required her willingness and cooperation became more easily achievable. Various aspects of individual need must be considered when assisting with eating and drinking. These include a person,'s ability to chew and swallow (no dentures or incorrectly fitted dentures, loss of muscle tone etc. ), impairments affecting manual dexterity (use of cutlery, lifting food to the mouth), ability to communicate (ensuring accurate estimate of what client wants) (Sandy, 1997). Although Dot can swallow without risk of aspirating, her facial muscles are laxed. She does not have teeth and refuses using dentures, hence problems with sucking and chewing.

She tends to swallow unchewed pieces of food that are harder to digest, thus frequent gut problems. Dot ^aEUR~s left arm is constricted and immobile. The right arm has limited movement with deformations to the hand and fingers, which limit her ability to grasp. A cup of tea is lifted to the mouth at the wrong angle, resulting in considerable spillage.

I encouraged Dot to use her abilities within her own limitations but offered reassurance and guidance, advising her to slow down when drinking with explanations as to why this would be beneficial. Dot is making great progress, which is stimulated, I am certain, by my close attention and friendly disposition. Although she doesn, t need to be fed she enjoyed having company and I used the time to gently direct and advise her, offering short snippets of helpful information to improve her personal eating techniques (such as the benefits of keeping clothes dry and stain-free whilst attending a day centre! ). It became quite obvious that Dot is capable of understanding advice and then chooses whether to apply it or not. Implementation always involves close consideration of client comfort and a conscious effort to maintain the dignity of the service user at all times.

The surrounding environment must be clean and quiet with appropriate room temperature. All task related to feeding must be carried out in adherence to Hygiene as well as Health & Safety Guidelines. The food must be served at the correct temperature and, to prevent food from getting cold, the trolley or tray should be prepared beforehand with the appropriate utensils, drinking cup with spout or straw and napkins. It is very important to gain client,'s consent and cooperation when assisting with eating and drinking and particular attention must be applied to ensuring that the correct posture is achieved and maintained by both parties. Becoming familiar with the client, offering time and friendly conversation whilst providing the opportunity to set the pace as well as giving choice, e.g. allowing the client to decide the order of consuming his food and drink. (Jamieson at al, 1992).

During my time with Dot I always applied these factors to every mealtime and ensured I gave careful consideration to every aspect that I have outlined. Heath (1995) suggests that nursing evaluation should determine if the client actually enjoyed the meal. Consideration should also be given to whether nutritional intake was adequate and, if any shortcomings become apparent, the menu must be open to review. Positive and negative responses must be noted and close attention must be applied for future encouragement and promotion of client independence. Whilst in the nursing home I found this practice to be apparent and actively participated as required.

Sometimes the process needed adapting according to individual client need. Within an environment that catered for people with challenging behaviours there were various factors worthy of consideration and adaptation to ensure that mealtimes were both successful and rewarding for all concerned. I found my active involvement in the serving of meals, appropriate arrangement of seating and participation in menu selection to cater for individual preference a highly rewarding and most enjoyable experience. To conclude, eating and drinking is an essential daily activity; therefore the task of supporting and assisting a client must be tailored to suit individual requirements, with emphasis placed on ensuring that mealtimes remain as pleasurable and stress-free as possible.

It is imperative that this activity is approached with sensitivity and understanding whilst remaining a satisfying social event. 1998). 1998). 1998).