SKILL

11-1 Assisting With Patient Feeding

Depending on patient’s condition, the physician will order a diet. Many patients are
able to independently meet their nutritional needs by feeding themselves. Other
patient’s, especially the very young and some elderly patients, such as those
individuals with arthritics of the hands, may have some difficulty opening juice
containers, etc. On these occasions, it is necessary for the nurse to provide whatever
assistance is needed. Patients with such conditions as paralysis of the hands and
advance dementia may be unable to feed themselves. This skill is frequently delegated
to nursing assistants. However, the nurse is responsible for the initial and ongoing
assessment of the patient for potential complications related to feeding. Before this
skill can be delegated, it is paramount that the nursing assistant has been educated to
observe for any swallowing difficulties and aspiration-prevention precautions.

Equipment  Patient tray

 Wet wipes for hand hygiene
 Mouth care materials
 Patient’s dentures, eyeglasses,
hearing aid if needed
 Special adaptive utensils as
needed
 Napkins, protective covering or
towel

Assessment Before assisting the patient, the nurse will check the type of diet that has been ordered for
patient. Also, it is important to assess for any food allergies and religious or cultural
preferences, as appropriate. The nurse should check to make sure the patient does not have
any scheduled laboratory or diagnostic studies that may impact whether he/she is able to
eat a meal. Before beginning the feeding, assessment for any swallowing difficulties should
be conducted.

NURSING  Deficient Knowledge

DIAGNOSIS  Anxiety
 Risk for Aspiration
 Risk for Impaired Social Interaction
 Risk for Alteration in Nutrition
 Feeding Self-Care Deficit
 Risk for Impaired Swallowing
 Risk for Adult Failure to Thrive
 SKILL Assisting With Patient Feeding (continued)
11-1

OUTCOME The expected outcome to achieve when assisting a patient with feeding is that the
IDENTIFICATION patient consumes 50% to 60% of the contents of the meal tray. Also, another
AND PLANNING outcome is achieved when the patient does not aspirate during or after the meal.
Additionally, a desired outcome is accomplished when the patient expresses
contentment related to eating, as appropriate.

IMPLEMENTATION

ACTION RATIONALE RATINGS

1. Check the physician’s order for the type Ensures the correct diet for the patient.
of diet.

2. Identify the patient. Identification of the patient ensures that

the right patient receives the correct diet as
ordered.

3. Explain procedure to patient. Explanations provide reassurance and

facilitate cooperation of the patient.

4. Perform hand hygiene. Hand hygiene deters the spread of

microorganisms.

5. Assess level of consciousness, for any Alertness is necessary for patient to

physical limitations, decreased hearing or
visual acuity. If patient uses a hearing aid or
wear glasses or dentures, provide as
needed. Ask if the patient has nay cultural
or religious preferences and food likes and
dislikes, if possible.
swallow and consume food. Using a hearing
aid, glasses, and dentures for chewing
facilitates the intake of food. Patient
preferences should be considered in food
selection as much as possible to increase
the intake of food and maximize the benefit
of the meal.

6. Pull the patient’s bedside curtain. Assess
the abdomen. Ask the patient if he/she has
any nausea. Ask the patient if he/she has
any difficulty swallowing. Assess the patient
for nausea or pain and administer an anti-
emetic or analgesic as needed.
Provide privacy. A functioning GI tract is
essential for digestion. The presence of
pain or nausea will diminish appetite. If
patient is medicated, wait for the
appropriate time for absorption of the
medicine before beginning the feeding.

7. Offer to assist the patient with any Promotes comfort and may avoid
elimination needs. interruptions for toileting during meals.

8. Provide hand hygiene and mouth care as May improve appetite and promote
needed. comfort.

9. Remove any bedpans or undesirable Unpleasant odors and equipment may

equipment and odors if possible from the decrease the appetite of the patient.
vicinity where meal will be eaten.

10. Open the patient’s bedside curtain. Proper positioning improves swallowing
Assist or position the patient in a high ability and reduces the risk of aspiration.
Fowler’s or sitting position. Position the
bed in the low position.
SKILL
11-1 Assisting With Patient Feeding (continued)

IMPLEMENTATION

ACTION RATIONALE RATINGS

11. Place protective covering or towel over Prevents soiling of the patient’s gown.
the patient if desired.

12. Check tray to make sure that it is the Ensures that the correct tray is given to the
correct tray before serving. Place tray on patient. Encouraging the patient choice
the over-bed table so patient can see food promotes patient dignity and respect.
if able. Ensure that hot foods are hot and
cold foods are cold. Use caution with hot
beverages, allowing sufficient time for
cooling if needed. Ask the patient for
his/her preference related to what foods
are desired first. Cut food into small pieces
as needed. Observe swallowing ability
throughout the meal.

13. If possible, sit facing the patient while In general, optional meal time involves social
feeding is taking place. If patient is able, interaction and conversation.
encourage to hold finger foods and feed
self as much as possible. Converse with
patient during the meal as appropriate.
Play relaxation music if patient desires.

14. Allow enough time for the patient to Eating requires energy and disease can
adequately chew and swallow the food. weaken patients. Rest can restore energy for
The patient may need to rest for short eating.
periods during eating.

15. When the meal is completed or the Nutrition plays an important role in healing
patient is unable to eat any more, remove and overall health. If the patient is not eating
the tray from the room. Note the amount enough to meet nutritional requirements,
and types of food consumed. alternative methods need to be considered.

16. Reposition the over-bed table, remove
the protective covering, offer hand hygiene
as needed, and offer the bedpan. Assist the
patient to a position of comfort and
relaxation.
Promotes the comfort of the patient, meets
possible elimination needs, and facilitates
digestion.

17. Perform hand hygiene. Hand hygiene reduces the transmission of

microorganisms.
 SKILL
11-1 Assisting With Patient Feeding (continued)

EVALUATION The expected outcome are met when the patient consumes an adequate
amount of nutrients. In addition, the patient expresses an appetite for the
food, relating likes and dislikes. Additionally, the patient experiences no
nausea, vomiting, or aspiration episodes.

DOCUMENTATION

Guidelines Document the condition of the abdomen. Record that the HOB was elevated
to at least 30 to 45 degrees. Note any swallowing difficulties and patient’s
response to the meal. Document the percentage of the intake from the
meal. If the patient had a poor intake, document the need for further
consultation with the physician and dietitian as needed. Record any
pertinent teaching that was conducted.

Sample Documentation

Unexpected Situations and  The patient state that he does not want to eat anything on the tray:
Associated Interventions Explore with the patient the reason why he does not want to eat
anything on the tray. Assess for psychological factors that impact
nutrition. Malnutrition is sometimes found with depression in the
elderly population. Mutually develop a plan to address the lack of
nutritional intake and consult the dietitian as needed.
 The patient states that she feels nauseated and cannot eat: Remove

tray from the patient’s room. Explore with the patient the desirability of
eating small amounts of foods or liquids, such as crackers or ginger ale,
if the patient’s diets permits.

Special Considerations

General Consideration  For patients with arthritis of the hands, special utensils with modified
handles that facilitate an easier grip are available. Contact an occupational
therapist for guidance on adaptive equipment.
 A visually impaired patient may be guided to feed him or herself through

use of a “clock” pattern. For example, the chicken is placed at 6:00 o’clock;
the vegetables at 3:00 o’clock.
 For patients with dysphagia, suggest small bites of food such as puddings,

ground meat, or cooked vegetables. Advise the patient not to talk while
swallowing and to swallow twice after each bite.