PAEDIATRIC COMMUNITY
SUPPORTING A FOOD-FOCUSED FUTURE WORKFORCE Evelyn Newman Nutrition and dietetics advisor: care homes NHS Highland
In December 2012, NHS Highland took the lead agency role for adult care services, overseeing all services previously managed by Highland Council. This included responsibility for the 73 care homes and a number of independent and inhouse care-at-home teams.
Award winning dietitian, Evelyn Newman, is well known throughout the profession for her writing, volunteering with the BDA and innovative work. She currently holds a unique role in The Highlands.
By April 2014, I had been appointed to my current role, working within the corporate senior social work team. The expectation was that I would work with care home managers and owners to support both catering and care staff to assist residents and service users to receive safe, nutritious, high quality meals and mealtimes. Health and care standards1 provide broad guidance about a number of aspects related to eating and drinking, which service users should be able to expect when living in any care home. It became clear to me, however, that many care staff were not as well informed about food, fluid and nutritional care as their health service counterparts. I carried out a training needs analysis to be clearer about how staff might feel better equipped to best support residents’ needs, using a personcentred, asset-based approach. Many staff had historically received little or no formal nutrition training and contact with healthcare staff had usually been via 1:1 consultations. It wasn’t unusual for them to look to (unevidenced) articles on the web, or in magazines and newspapers, for nutrition information. Very few care catering staff were familiar with therapeutic diets, except perhaps diabetic and weight management (often from personal experiences). The key to engaging the workforce was to understand what would work best for them, in whatever location or situation they found themselves. Conventional training in one central
@evelynnewman17
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location was certainly not going to work, given the very remote and rural landscape of the largest health board, by geographical area, in Scotland. Eighty percent of our care home residents have a degree of cognitive impairment and with that comes the prospect of dysphagia, which can result in a 70% risk of dehydration and a 50% risk of malnutrition. I like to make use of educational games, such as the Dysphagia game2 to support informal, fun, interactive learning for staff, residents and relatives. Highland care homes were also used to test the Hydration game,2 which I helped to develop in 2016/17. Since August 2014, I have coordinated quarterly texture modification training sessions, in a variety of locations across the north Highlands to maximise attendance. These are very practical, interactive and always positively evaluated. SLT, OT, dental colleagues and a professional chef contribute to these, demonstrating the impact of poor positioning and the dangers of not assisting someone to eat safely. Hundreds of care staff have attended to date and have experienced first-hand, the vulnerabilities of residents being fed by them, especially when food looked very unappetising. When we first started this work, it wasn’t uncommon to hear that meals were being liquidised, or that residents were taking up to 40 minutes to eat an ultimately cold meal. A number of staff left the session close to tears as they realised how they had been