6.3 Assisting with Eating

Tracy M. Christianson, RN, MN, DHEd, CCNE; Kimberley Morris, RN, BN, MN

6.3 Assisting with Eating

An important part of the HCA’s job is to assist clients with eating. This may include planning and preparing meals, shopping for ingredients, serving food, and assisting with eating. But eating habits and nutrition can be affected by a number of factors, such as culture, personal choices, religions, allergies, finances, aging, and illness.

Food practices are influenced by culture and/or religion. How and what food is prepared depends on cultural and/or religious practices. For example, in some cultures, beef is not commonly eaten. As an HCA, it is important to understand the food preferences and cultural influences of your clients to ensure you are offering person-centered care.

Supporting older adults to meet their nutritional needs requires you to understand the effects that aging has on clients’ appetites. Physical changes, vision, hearing, and poor-fitting dentures can all affect their ability to eat. Other factors from chronic illnesses, such as arthritis or cognitive impairments, can impact their control of eating and mealtime.

Considerations

Health Care Assistants can provide a pleasant atmosphere during mealtime by ensuring there are no unpleasant odors. Empty trash cans and remove urinals or bedpans from sight. Offer to assist the client to the bathroom and perform oral care prior to eating to make mealtime more comfortable. Ensure clients who wear dentures have them placed them in their mouths prior to eating. This allows the client to better chew and digest their food.

Clients should always be in an upright position during mealtimes. This helps to prevent choking. For clients with swallowing or choking difficulties, they should be kept in an upright position for 30–60 minutes after their meal is complete.

Some clients may only need assistance with preparing food, and they are able to eat independently. Many types of adaptive equipment, such as special plates, cups, and eating utensils, are available to help people be as independent as possible while eating. Other clients require complete support during eating, and the HCA will need to assist the client to eat. The HCA should sit next to clients while assisting with eating, and offer to keep those who are independent company. Mealtime is a good time to get to know clients. Clients who prefer to pray or have religious or spiritual practices prior to meals should be allowed to practice these rituals. Give privacy as appropriate and requested (McLain, et al., 2018; Sorrentino, et al., 2019).

Health Care Assistants should offer foods that are appealing to their clients, and allow them to choose the foods they would like to eat, as appropriate. Follow Care Plan guidelines when preparing special diets.

Assisting with Eating

Table 6.3.1 Procedure: Assisting with Eating


STEP	ACTION	REASON
1.	Inform the client that it is mealtime. Provide choices about foods.
2.	Perform hand hygiene.	Prevents the spread of infection
3.	Assemble equipment needed, such as: bowl plates cup eating utensils napkins
4.	Prepare the client’s environment by ensuring there are no unpleasant odors or sights.	Makes meal time more enjoyable
5.	Offer oral care prior to eating. Assist with applying dentures. Assist or encourage the client to put on glasses so they can see their food.	Enhances the taste of foods, helps clients chew more effectively, and lets them see what they are eating
6.	Position the client in a high upright sitting position.	Prevents the client from choking or aspirating food or fluids
7.	Allow the client time to pray before eating if they wish.	Respects cultural preferences
8.	Arrange food attractively on the plate.	Enhances mealtime
9.	Encourage the client to do as much as they are capable. Assist only as needed.	Maintains independence
10.	Cut food into small, bite-sized pieces if the client is unable to do so.
11.	Place a napkin under the chin or a cover-up over the chest. Replace soiled napkins as needed.
12.	Inform the client of food temperatures, especially for hot food.	Prevents injury
13.	Use a fork and spoon gently when feeding the client. Never force feed a client.
14.	Allow adequate time between bites before offering the next bite.	Prevents choking or aspiration of food or fluids
15.	Encourage the client to chew food well before proceeding to taking the next bite.	Prevents choking or aspiration of food or fluids
16.	Sit next to or facing the client if assisting with eating or while providing company during mealtimes. Allow the client to eat alone if they prefer. Check on them every 5–10 minutes.	Mealtime is a good time for HCAs to get to know their clients. Make eating time a pleasurable experience.
17.	For clients who have difficulty swallowing, HCAs should limit their conversation while the clients are chewing.	Prevents choking or aspiration of food or fluids
18.	Encourage, or assist, if needed, wiping off the mouth or face. Use straws or training cups as appropriate to allow ease of drinking and promotion of independence.	Special plates with guards, and padded eating utensils, helps to promote independence
19.	Remove uneaten food, liquid, and soiled dishes once the client is done eating. Clean the client’s area and all used dishes.
20.	If the client has swallowing problems, keep them in an upright position for 30–60 minutes after eating.
21.	Offer hand and mouth hygiene when the client has finished their meal.
22.	Wash and dry your hands.
23.	Document and report any chewing or swallowing problems, changes in appetite, and amount of food eaten and fluids taken in as intake.

Assisting a Client with Dysphagia

Table 6.3.2 Procedure: Assisting a Client with Dysphagia


STEP	ACTION	REASON
1.	Review client’s chart to assess for: Therapeutic diet Medical considerations (i.e., cardiovascular accident, Parkinson’s, neurological disease) Aspiration precautions Need for assistance Other client specific considerations (i.e., glasses, dentures, hearing aid, table allocation, feeding assistive devices, etc.)	Ensures you are following the correct dietary plan
2.	Perform hand hygiene and Gather required equipment if necessary.	Prevents the spread of infection
3.	Prepare Tray and Meal Area Correct diet Add thickener as ordered Utensils Napkin
4.	Assess Client. Watch For: Signs and symptoms for dysphagia: Gurgling or wet or change in voice Coughing while eating Drooling during a meal Food pocketing in the cheek Comprehension Ability to assist: Monitor throughout the meal Need for feeding assistive devices Position: Sitting upright Head slightly tilted forward Chin tucked down while swallowing food Supportive devices as required	Ensures there are no additional or underlying issues that would put the client at further risk of choking
5.	Offer oral care prior to eating. Assist with applying dentures. Assist or encourage the client to put on glasses so they can see their food.	Enhances the taste of foods, helps clients chew more effectively, and lets them see what they are eating
6.	Position the client in a high upright sitting position.	Prevents the client from choking or aspirating food or fluids
7.	Allow the client time to pray before eating if they wish.	Respects cultural preferences
8.	Arrange food attractively on the plate.	Enhances mealtime
9.	Encourage the client to do as much as they are capable. Assist only as needed.	Maintains independence
10.	Cut food into small, bite-sized pieces if the client is unable to do so.
11.	Place a napkin under the chin or a cover-up over the chest. Replace soiled napkins as needed.
12.	Allow adequate time between bites before offering the next bite.	Prevents choking or aspiration of food or fluids
13.	Encourage the client to chew food well before they take the next bite.	Prevents choking or aspiration of food or fluids
14.	Assess Client Eating Use small ½ teaspoonful bite size amounts Encourage a minimum of 2 complete swallows to clear food before the next spoonful Assess for pocketing. (with tongue depressor, pen light, and gloves) Provide prompting, encouragement and direction as needed	Prevents choking or aspiration of food or fluids
15.	During the Meal Promote independence and autonomy. Create a social environment: Acknowledge client’s preferences. Minimal communication while the client is eating.	Special plates with guards, and padded eating utensils, helps to promote independence
16.	Remove uneaten food, liquid, and soiled dishes once the client is done eating. Clean the client’s area and all used dishes.
17.	Keep the client in an upright position for 30 minutes after eating.	Prevents regurgitation and risk of aspiration
18.	Offer hand and mouth hygiene when the client has finished their meal.
19.	Wash and dry your hands
20.	Document and report any chewing or swallowing problems, changes in appetite, and amount of food eaten and fluids taken in as intake.

Review Questions

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Personal Care Skills for Health Care Assistants Copyright © 2023 by Tracy Christianson and Kimberly Morris, Thompson Rivers University. is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License, except where otherwise noted.