Transcript Dining assistant

Dining Assistant- Feeding
Techniques
Swallowing process
• The teeth chew by cutting it, then chopping
and grinding it into smaller pieces.
• Saliva softens and moistens the food and
begins chemical digestion
• The tongue pushed the food around between
the teeth, making it ready for swallowing,
then pushed it to the back of the mouth
triggering a swallow reflex
• The swallowing reflex passes the food through
the pharynx. This connects the mouth to the
esophagus. At the same time the larynx
closes and breathing stops to prevent food or
liquid from entering the lungs.
• The esophagus’ muscles move the food along
through contractions called peristalsis(takes
about three seconds) into the stomach.
Making dining enjoyable
• Check the environment. Comfortable
temperature, no unpleasant odors, keep noise
levels low.
• Encourage use of dentures, glasses, hearing
aides. If dirty or damaged or missing, notify
the charge nurse.
• Residents should be clean and well groomed,
have been offered trip to the bathroom, and
also an opportunity to wash their hands.
• Residents should be properly positioned.
Correct height of table, sitting upright. If
resident is slouching or falling, notify the
nurse. Resident should be at 90 degrees.
• Seat residents near their friends, encourage
conversation.
• Be cheerful, positive and helpful. Make
simple conversation.
Serving meal trays
• Depends on the facility as to the manner:
trays or carried on plates from the kitchen
• Work quickly so it doesn’t cool, and residents
aren’t waiting.
• Serve all residents at one table before serving
another.
• Wash your hands first.
• Identify the resident to make sure they get the
proper meal/diet order.
Preparing the food
• Only do what the resident is unable to do for themselves.
• Remove the food and drink off of the tray and set it out on
the table.
• Cut meat and vegetables if necessary, if possible do this
prior to taking it to the table.
• Open cartons and put in the straw if they use one, or pour
into a cup.
• Butter roll, bread and vegetables if desired. (don’t touch,
use gloves or hold with a fork)
• Open condiment packets. Offer to season the food.
• Offer a napkin (or clothing protector at some facilities) if
they wish to use. Do not insist on this.
How to assist
• Some will not need any assistance
• Some will only need help setting up the meal
• Some will need checked on from time to time
to see if they need help
• Some will need some physical and verbal cues
to help direct them.
– Hand over hand approach (physical cues)
– Short and clear verbal cues, one at a time
•
•
•
•
•
•
Pick up your spoon
Put some carrots on your spoon
Raise the spoon to your lips
Open your mouth
Place the spoon in your mouth
Etc.
• Some will need total assistance, being unable
to feed themselves at all
– Never treat the resident like a child
– Be supportive and encouraging
– If the patient requests it, allow time for prayer
– Verify ID, and correct diet
– Encourage them to do what they can, like finger
foods
– Sit at resident’s eye level facing them
– Cut foods and pour liquids as needed
– Identify the foods, even pureed foods, “would
you like green beans?”
– Ask the resident which food they prefer first (even
if it is dessert)
– Do not mix foods together
– Offer hot foods/liquids carefully
– Do not rush, be relaxed and give the resident time
to chew and swallow.
– If the resident wants something else, honor this
request, ask for an alternative
– If the resident can not do it for themselves, wipe
food from the resident’s mouth or hands as
necessary during the meal.
– Make simple appropriate conversation without
asking many questions, talk positively about the
food.
– Give the resident your full attention, do not talk
over the resident’s head or with other staff.
– Alternate offering food and drink.
– Alternate cold and hot foods or bland foods and
sweet to help stimulate appetite.
If assisting a resident in their room
– knock first and wait for permission to enter.
– make sure they are sitting upright and you are at eye
level.
– Identify yourself
– Follow all of the guidelines as assisting in the dining
room.
– Before leaving, place the signaling device within the
resident’s reach.
– Before removing the food tray, check to make sure no
eyeglasses, dentures or other personal items are on it.
Adaptive equipment or assistive
devices
• Special cups with nose area missing to enable
to tip cup without tipping head back.
• Curved handle utensils
• Weighted utensils
• Built up utensils
• Plates with built up edges or scoop edges
• For visually impaired residents use the face of
an imaginary clock as a guide to explain the
position of their food and drink.
• For residents with “blind spots” place the food
where they can see it.
• For residents with hemiplegia or hemiparesis,
place the food in the unaffected side of their
mouth
Dysphagia- difficulty swallowing
• You will not be assigned to feed residents who
have dysphagia.
• If you suspect a resident has dysphagia or has
shown signs of swallowing problems, notify the
charge nurse.
• Alert the charge nurse immediately if any
problems occur while feeding the resident.
NEVER continue to feed someone who appears to
be having swallowing problems
• Dining assistants may NOT by law assist residents
with swallowing disorders.
Signs of swallowing problems
•
•
•
•
•
•
•
•
Coughing during or after meals
Choking during meals
Dribbling saliva, food or fluid from the mouth
Food residue inside the mouth after meals
Gurgling sound in voice during or after meals
Slow eating
Avoiding eating
Spitting out pieces of food
•
•
•
•
•
•
•
•
Several swallows are needed per mouthful
Frequent throat clearing during and after meals
Watering eyes when eating or drinking
Food or fluid comes up into the nose
Visible effort to swallow
Shorter or more rapid breathing while eating
Difficulty chewing
Difficulty swallowing medications