2.1.1 What is good nutritional care?
Good nutrition is an essential part of care, and it includes ensuring that the right people receive the right nutritional support at the right time during their care, regardless of whether that care is delivered in hospital, in an institution or in the person’s own home. Good nutritional care starts with ensuring that people have access to appetising and nutritious food that meets their preferences and nutritional, cultural and religious needs, and that they are supported to either provide this for themselves or to be able to avail themselves of it when it is provided by others, e.g. through assistance with shopping or cooking, lunch clubs, meals on wheels or assistance with eating and drinking.
Good nutritional care also includes ensuring that people who are malnourished or at risk of malnutrition are identified through screening programmes, and that action is taken to ensure that they receive appropriate and timely nutritional support. As outlined in Figure 2.1 nutritional support may take many forms, e.g. dietary counselling, food fortification, oral nutritional supplements (ONS), enteral tube feeding (ETF) and parenteral nutrition (PN).
The central factor in the development of malnutrition is that nutritional intake is insufficient to meet requirements. This can arise due to a number of different reasons related to disease and disability, impacting on food intake, losses of nutrients and/or increased requirements. Although in some cases improvement of the quality or quantity of food supplied can ameliorate the problem, in many cases, the person concerned is simply unable to consume sufficient normal food to meet his or her requirements and maintain a healthy nutritional status. In this case, it is vital to consider other options to improve nutritional intake i.e. nutritional support.
Principles underlying intervention with nutrition support (NICE 2006)1
‘Good nutrition should benefit both those who are already overtly malnourished in terms of BMI or recent unintentional weight loss and those who are developing nutritional risks by having eaten little or nothing or be likely to eat little or nothing for over 5 days. In addition, nutrition support can often provide simple direct benefits by:
- Keeping patients who are eating inadequately, alive for long enough for specific medical or surgical interventions to take effect
- Making malnourished patients feel better, improving their ability to cope with ill-health
- Maintaining strength through patients’ illnesses so that their recuperation is shortened and they are less susceptible to further problems
- Providing long-term support for those patients with chronic inability to eat, drink or absorb adequately’