Changing the culture around hospital-based nutrition

Following a serious incident and inquest after the death of a patient due to choking at Sheffield Teaching Hospitals NHS Foundation Trust, the Trust put in place an action plan and implemented strategies to reduce the risk of recurrence. Four key actions were identified as essential to try to reduce the risk of a similar event: introduction of a standard operating procedure for mealtimes that included a pre-meal safety 'pause'; use of an electronic communication icon to indicate modified diet/fluid requirements, from emergency department and onward as a patient is transferred; job-specific mealtime safety training; and use of bedside posters with specific dietary requirements (in line with the International Dysphagia Diet Standards Initiative Framework). A new role of Lead Educator for Nutrition was introduced to support the changes and provide training. Changes were also made to the incident reporting system to ensure easy identification of events relating to dysphagia, so that these could be monitored, themes identified and lessons shared. A series of audits following the changes have shown that more staff across disciplines and teams have accessed training on nutrition and hydration practices, wards have increased the use of the icon and posters, and successfully implemented pre-meal safety pauses. The Lead Educator for Nutrition has helped embed learning, and increased awareness and knowledge about nutrition and hydration.

Practising mindfulness

What was the nature of the CPD activity, practice-related feedback and/or event and/or experience in your practice? The article examined the use of mindfulness techniques and how by learning to care for themselves, nurses can enhance the care they provide for patients. The concept of mindfulness has had widespread publicity, from meditation courses to adult colouring books, but I wanted to learn how mindfulness can be applied to nursing.

How to promote patients' sleep in hospital

Rationale and key points Disturbed or disrupted sleep is associated with adverse effects on physical and psychological health. This article explores the importance of promoting patients' sleep in hospital, although some of the principles can be applied to other healthcare settings. Sleep is essential to recovery and well-being, and nurses are well placed to support patients to achieve and sustain sleep. » Sleep has a restorative function and is particularly important in maintaining patients' health and well-being. » Sleep deficit has been linked to obesity, type 2 diabetes, cardiovascular disease and some cancers. » Assessment of patients' sleep routines and patterns, and consideration of environmental factors enables nurses to identify that which assists and limits sleep, and take appropriate action. Reflective activity 'How to' articles can help you update your practice and ensure it remains evidence-based. Apply this article to your practice. Reflect on and write a short account of: » How you think this article will change your practice when promoting sleep in patients in your care. » How you could use this article to educate your colleagues.

Nursing interventions to alleviate insomnia

Insomnia or disturbed sleep is experienced by many older people and has adverse effects on physical and psychological health. Nurses should be aware of insomnia and how they can help patients to get a good night's sleep. This article first examines normal sleep patterns and then insomnia. It discusses what nurses can do to assess sleep disturbances and suggests practical strategies to promote quality sleep in inpatients and care home residents.