Aims and objectives:
Having enrolled on the Dimensions of Care course, we were required to review our practice and bring about a change that would make a difference for the people we cared for. Working on a Learning Disability Assessment and Treatment Unit, we care for numerous patients who have communication difficulties. The unit team had commenced work on the Essence of Care Nutritional Benchmark, and we were working in the Multi-disciplinary Comparison Group. We noted that the photographs of food, used to depict the written menus were causing confusion for our patients when we did the menu choice each evening. We decided that we would try to simplify this process to cross this particular communication barrier. The people we cared for were unable to make a choice about their meals from a standard printed menu. We were choosing for them, but acknowledge our likes and dislikes would be different. The toolkit was developed to help the individual to recognise food by pictorial means and indicate their likes. It encouraged one to one interaction with a simple approach. It linked into the Person Centred Approach of Valuing People 2001 and the work we were doing on our unit on the Essence of Care Nutritional Benchmark.
Support for the change:
The work was developed through the Multidisciplinary Team who were working in the Nutritional Benchmark Comparison Group. The Speech & Language Therapy Support Assistant worked with us to develop our idea. We built up the toolkit and introduced it to the Nursing Team, who primarily support menu choice. Initially, we used pictures of the whole plated meal, but this caused confusion. We gradually built up the individual pictorial food items to match the set menus, each evening we would match the pictures to the following day's menus. We then had opportunity for one to one contact giving the individual time to select their food choice and place in on their 'plate'. As likes and dislikes emerged, we were able to respond and work with the catering staff to make menu changes.
Patient and public influence:
We were conscious we were choosing food for the people we cared for, as they were unable to read printed menus or choose when we read same out. As we introduced photographs, they began to take much more interest. When we broke the pictures down further to individual foods, they became much more involved. We had one to one time for them to select pictorial food and put it onto their plate. It built up their confidence and our understanding of their likes and dislikes. We asked simple questions from our pictorial questionnaires to ensure we were getting it right and made changes. At team meetings, the staff team would do a group evaluation as the project developed. We acknowledged not only their food choice, but who they had their meals with and at what times. We also used the format to promote healthy options.
Impact on the workforce:
All the team now use the toolkit when selecting menu choices with the patients as part of the Essence of Care Nutritional Benchmark action plan. We looked much more closely how we could use the toolkit method to assist us with communication in other areas , i.e. pictorial signs, choices of what people wanted to do, to explain issues about their health, treatment plans on the unit. It helped us consider and be person centred, not fit the people we care for into our plans.
Measuring the results:
We have fed into the Nutritional Benchmark Comparison Groups with other areas of our Primary Care Trust. We have done staff and patient questionnaires to continually evaluate our work and develop it further. We have fed into the Learning Disability Nutritional Benchmark Action Plan and exhibited the toolkit at the PCT Essence of Care Away Day to share our ideas. Currently, we are taking part in the planned Road Shows around our PCT areas.
Improved performance:
It has bridged the communication gap to enable people to have a choice and to take some control of a small aspect of their care when admitted to an in-patient unit. It is an excellent example of a Person Centred approach.
Reflecting diversity:
It acknowledges the high number of people with a learning disability who have communication deficits and are unable to comprehend and make the everyday choices you and I would make. It assists the individual to be independent, acknowledges they have a choice and respects their right to be part of their care. It also reduces frustrations and aggression in the individual who cannot verbally express their needs.
Sharing the learning:
We produced more pictorial items if menu changes were requested. We are duplicating the whole toolkit so it is available in other in-patient areas of our organisation. We are sharing our ideas with other teams in the Primary Care Trust who care for patients who have communication difficulties. We are using the process to communicate other information to our client group.
Outstanding features:
Its simplicity. A colourful interactive tool to assist everyday choice of food. It could also be adapted to assist choice in so many other areas of our work. It enable us to bridge the communication gap and respect people's right to their own choices.
