As a home healthcare nurse, you work with patients and their families in the home setting. Being in a patient's home allows you to assess and intervene in various healthcare problems that might not be identified in another health setting. In 2011, 4.7 million individuals received home healthcare.1 One of the important aspects of home care nursing is the assessment of the nutritional status of patients and their families. Healthy People 2020 points out that an individual's diet and body weight are related to that person's health status. Good nutrition is essential for all age groups. A healthy diet can reduce the risk for many health conditions.2 Because your first priority in the home is to provide care and treatment for the patient, his or her overall nutritional status must be ascertained. Is the patient following the diet prescribed? Has weight increased or decreased? What are the thoughts about maintaining the diet ordered? Are there questions about the diet? How does the patient look? If there is an infant or small child in the home, you should evaluate his or her progress in relation to nutrition and weight gain. For example, is a 3-year-old-girl eating foods provided her? Are new foods tried when presented to her? Does the family limit overly sugary, fatty and salty foods? Is fast-food relied on over simple, but more nutritious meal items?3 An adolescent family member's nutritional status often raises universal concerns. Many adolescents utilize fat and/or added sugar in larger proportions for energy. Lower ingestion of Vitamin A, folic acid, fiber, iron, calcium and zinc fall below recommended intake.4 You can attempt to steer the adolescent from sugar-sweetened beverages, pizza, whole milk, burgers and fries to poultry, fruit, fat-free milk and whole wheat bread, as examples. Most likely you will encounter an elderly family member in the patient's home. In 2010 alone, 7.1 million intergenerational households existed in the U.S.5 Nutrition is an essential element of health in this older population as well, and it clearly affects the aging process.6 In this group, malnutrition is increasing and can have a devastating effect on the older person's quality of life and of life itself.7 An initial assessment of the elder's eating habits, then, is essential. What does the individual eat? How often does he eat? Is the elder drinking an adequate amount of water? Is there an existing medical condition that might affect his appetite? Has he lost weight in recent months? Does he eat with the family during meal times? As a home healthcare nurse, your interactions with your patient and his family members can be rewarding because with a few simple, informal assessments and interventions, you can increase the overall well-being of the entire group. This is certainly true when it comes to the family's nutritional status. Remember to:
- Do an initial and ongoing assesment of each family member's nutritional status;
- Document those assessments, not only of the patient, but of all those you intervene with concerning nutrition;
- If you identify a nutritional problem (e.g., elderly family member losing weight and not eating), contact the elder's physician for dietary orders, an order to work with the older individual, and make arrangements to have the elder seen by the physician as soon as possible;
- Supply the family with sample diet menus with the approval of the respective physicians; and
- Make a referral through the agency for a dietitian to visit the home if need be to provide a more formal assessment and ongoing monitoring of the patient's and the family's nutrition.
FOOTNOTES
1. Center for Disease Control and Prevention. Fast Stats. www.cdc.gov/nchs/fastats/home-health-care.htm. 2. "Nutrition and Weight Status", Healthy People 2020. Available at: www.healthypeople.gov/2020/topics-objectives/topic/nutrition-and-weight-status. 3. "Feeding and Nutrition: Your Three-Year-Old". Available at: https://www.healthychildren.org/English/ages-stages/toddler/nutrition/Pages/Feeding-and-Nutrition-Your-Three-Year-Old.aspx. 4. Debby Demory-Luce and Kathleen Motil (2015), "Adolescent Eating Habits", UpToDate, Wolters Kluwer, 1. Available at: http://www.uptodate.com/contents/adolescents-eating-habits. 5. Rachel Beals (2012), U.S. News and World Report. Available at: money.usnews.com/money/retirement/articles/2012/03/20/should-seniors-live-alone-or-with-family. 6. Tanvir Ahmed and Nadim Haboubi (2010), "Assessment and Management of Nutrition in Older People and its Importance to Health", 5 Clinical Interventions in Aging , 207. 7. Id.
