Louise Brady is the Clinical Nurse Development Lead supporting the Royal British Legion’s six care homes. She tweets @louisebrady17.
When I commenced my Clinical Lead role at the Royal British Legion in January of this year, one of the first challenges presented to me by my team was to sample a ‘puréed meal’ in one of our care homes. This was a poignant experience that helped me to understand how our veterans with swallowing difficulties/dysphagia receive meals presented, and to gain a little appreciation of what it may feel like for those residents with neurological conditions. The meal presented was full of flavour, colourful in presentation, palatable and tasty, but it made me reflect on the challenges of nutrition and care against the backdrop of Covid-19, and indeed caring for a population of citizens with multiple complex health issues.
That day I spent time with one of our chefs and the catering team. They put so much creative effort into the dining experience, the planning of nutritious meals, the sourcing of local produce and enabling our residents to have a voice at every turn, which supports real choice when it comes to quality care provision. In the spirit of appreciative enquiry, and in conversation with families and care staff, I wanted to find out: what are the essential ingredients of good nutritional care?
Nutritional standards care across UK care homes
As we get older it is important to continue to eat well. Changes in physiology with age mean that some residents need less energy (calories) but still require the same amounts of protein and important vitamins and minerals to maintain good health and well-being - a ‘nutrient-dense diet’. Good nutrition and regular physical activity play a critical protective role in several conditions that are more common as we get older. Cardiovascular disease and cognitive decline with impaired nutritional status can lead to hospital admission, while good food and great care can help to protect oral dental health, bone and joint health in later life.
I know I am not alone in my quest for improvements. Last month I met an inspirational Nurse Manager Karen Davis who manages Rose Court care home. As fellow Mancunians we talked about our struggles as the Covid-19 pandemic descended back in March. At the time, there was no access to resident testing, but Karen and her team came up with a brilliant idea to support residents living with dementia, who could not articulate their potential Covid symptoms - the ‘brown sauce test’. Karen, her team and her carers used brown sauce as the condiment to identify absence of taste and smell in those with communication difficulties. Through observations with resident interaction at mealtimes, Karen was able to execute a simple but brilliant plan to keep her residents safe. Nurse leadership in action!
In recent months, I have been in conversation with an industrious team of dieticians who will become part of our care home quality improvement group. Lisa Lovell and her team from Berkshire have created a suite of resources to support residents and staff in supporting better nutritional standards across care homes. Their visual work and webinars are a great learning tool for all staff, who are working incredibly hard across homes each day.
Good food and excellence in nutritional care are the ingredients that bind us all together. As Virginia Woolf once said:
‘One cannot think well. sleep well nor love well if one has not dined well’.
I am extremely proud of how all our staff are working towards enhanced nutritional standards throughout our homes. As a team, we may not yet have the recipe for success, but we are heating up the ideas, taking action, mixing it with skill, desire and belief with a dash of perseverance and several ounces of the best care we can.
With thanks to care home residents of the Royal British Legion for inspiring this blog, with the ingenuity and skill of both Karen Davis at Rose Court, and Dietician Lisa Lovell.
References and Resources