Patient Meal Choice Implementation

Introduction

The change that will be implemented is to give the patients on inpatient mental health ward the opportunity to choose their meals from the food chart developed by the dietician by analysing their health condition on a weekly basis. As there are four weekly menu cycles for three months on the ward, each patient will be asked to select what meal that he/she would like to eat on each day of the week from the lists of meals on the specific menu developed for them. This approach aligns with best practices discussed in healthcare dissertation help, emphasising patient autonomy and personalised care. Patients are allowed to make any additional request if needed and determined to be appropriate for the patients by the dieticians.

The goal of the change

The service users in mental health wards require proper nutrition through foods so that the nutrients such as vitamins, minerals, antioxidants and others are able to enter the body which is found to play an effective role in nourishing the brain and avoiding it to get harmed by oxidative stress (Teasdale et al. 2016). Thus, provision of providing food choices ability to the inpatients is important so that the ward managers and the matrons in the settings are able to ensure easy delivery of proper nutrition to the service users without facing barriers of rejecting to eat food by the inpatients. This is because providing choices of food would make the service users have opportunity to select what they like in taste making them prefer to eat the food, in turn, helping the service providers achieve better healthcare management in the settings. According to the NMC Code of Conduct, under “Prioritise People” it is guided that service user’s needs are to have minutely listened and proper response to their concerns and preferences are to be provided to ensure their health and well-being (NMC, 2015). Thus, in this respect offering food choices ability to the mental patient as a goal would results the service providers abide by the rule of NMC mentioned in “Prioritise People”. The goal of acting in the best interest of the patients in the change of providing food choices to the inpatients is important as it would lead to include them in their care decision. This is evident as providing food according to the mentioned choice and taste would lead the service users in mental health setting decide which nature of the food they are likely to eat (Aultman, 2019). The NMC Code informs that patients are to be included and empowered to make decision regarding their care (NMC, 2015). Thus, following the goal of change would also help nurses to abide by the principles and codes of care services set by NMC making them deliver legally ensured care. The change will be implemented in an inpatient acute ward that provides high quality, multi-disciplinary treatment and intensive support to patients dealing with acute psychiatric conditions. Patients admitted to this ward are more likely to stay for a short duration, usually less than six months in most cases. Patients on the ward will be asked every week to pick their meals in advance from the food chart allocated for them by the dieticians and newly admitted patients will also have the chance to join in during admission so that no patient will miss out on their preference. As the holistic approach is required in patients' treatments and recovery, I can argue that the food they consume while on the ward for treatment can have an effect on both their physical and mental health and consuming a well-balanced diet could be associated with the feeling of well-being (McLaughlin, 2018). The change will be beneficial for the wards managers and nurses of the settings as it would lead them to face fewer barriers and conflicts from the mental inpatients for not consuming food given to them. Moreover, the change would help nurses to ensure easy fulfilling of nutrient requirements by the patients, in turn, allowing them to show that care duties are performed in a quality manner. Further, this change would lead the nurses to ensure greater well-being of the patients while accessing care in the settings. (Refer to Appendix 1)

Background

In a recent survey organised by the British Association for Parenteral and Enteral Nutrition (BAPEN), it is reported that one in every four adults who are admitted at the mental care units or hospitals or care homes are at increased risk of malnutrition (telegraph.co.uk, 2008). This is because in most cases the patients are avoided to choose their meals according to their taste or effective diet is not managed by the nurses. It leads the nurses fail to provide quality care and ensure well-being of the patients by offering good nutrition making them face risk of having malnourished patients in the hospital. As commented by Bail and Grealish (2016), failure to ensure quality care and nutrition delivered by nurses to the patients creates negative image of the organisation in the medical field. This leads such organisations face legal issues due to failure of ensuring proper nutrition delivery to the patients. Thus, in this aspect, providing the patients in mental health units to have the opportunity of mentioning their choices of meal would help in reducing the malnutrition risk and avoid creating failed image of the nurses and the organisation in term of medical care. This is because the patients can avail food according to their choice and taste which ensures the nurse's success to deliver proper nutrition and well-being of the patients (Jones, 2017). In the study of Laur et al. (2015), it is reported that 23.3% cases it is seen that inpatients are unable to get proper nutrition in the hospital because they are not allowed to choose their preferred foods in the settings that have selective meal setting. This leads the patients avoid consuming proper amount of food as the provided meals do not attract them in having the food. Thus, the change where choice of food is provided to the inpatients is needed so that the patients can be motivated to eat proper amount of foods which would also help the nurses and ward manager delivery satisfaction care to the individuals (Feo and Kitson, 2016). The intake of proper amount of fruits and vegetables is essential for boosting the mental well-being of the individual. This is because the fruits and vegetables have required amount of micronutrients which are needed to incorporate essential fatty acids into the brain and helps in converting amino acids in the form of neurotransmitter which is required to transfer signals from the brain to other parts of the body (Pryor et al. 2016). Thus, promoting the choice of food among inpatients as the change would help the nurses allow patients to intake effective micronutrients making them successful to manage proper mental well-being in the settings.

The Implementation of the change

Change management procedures are stages that change management leaders go through in order to execute the intended change proposal for the best outcome and to motivate individual transitions (prosci.com, 2018). The good change management plan would help the team to work together as one to achieve the common change goal. It would also help each member to express what they think about the change (Richard et al, 2013). As change could be difficult and stressful for people involved, using a good change management plan could make change process easy and less stressful for the team. This could also equip the staff with the necessary information needed for the change and makes them feel empowered, ready and more comfortable for the change.

Change management model

The proposed change will be made by using Lewin's Change Management model. The Lewin's Change management model includes three step processes to create changes which are unfreezing, change and refreeze (Laker et al. 2019). In the unfreeze stage, the goal is to develop awareness regarding the present situation and the way current way of actions is hindering the organisation to implement the change. The key idea in this stage is that more the employees in organisation understand what is unnecessary and urgent they would be motivated at an improved concern to show acceptance to the change (Johnson et al. 2016). In this stage, to implement the mentioned change in the mental inpatient units the managers are required to inform the service providers as well as catering department regarding the way their nature of providing whatever food is available for the inpatient is hindering the delivery of required nutrition to the patients. As mentioned by Bovendeerd et al. (2019), informing health professional and service providers regarding the way their present services are hindering care for the patients would lead them understand need of changing their services. This is because the information makes health professional and service providers aware that their motive to fulfil the needs of the patients is not at all met making them fail to execute their tasks. Thus, information will be delivered to the catering department and nurses by showing the feedback from the patients and hospital survey reports where inpatients in mental wards have informed how the lack of choice for their foods is hindering their eating habits and disrupting their health. It would make the catering department and nurses become concerned and understand proper reason as well as requirement of change. In the changing stage, the people are informed regarding the new behaviours to be adapted, process to be implemented and way of thinking to be changed to implement the change (Cummings et al. 2016). In order to implement the proposed change, at this stage, the manager of the mental inpatient unit will inform nurses and catering department regarding the way they have to change their activities to implement the change. In this relation, the managers are to involve the dieticians to work collaboratively with the nurses and catering department at the hospital. The dieticians are professionals who have the knowledge about the nutrient content of each food and the nature of food items to be provided for each patient according to their health condition (Duijzer et al. 2017). Thus, the dieticians will provide list of different food items according to the mental and physical health condition of each patient to be allowed by nurses. This list is to be discussed by the nurses on each day to note the preferences and choices of food the service users wish to have for the day. The nurses will then inform the catering department the nature of meals to be prepared for each patient, in turn, helping all the patients in the setting to have their foods as per their choice.

The refreeze stage acts to reinforce, stabilise and solidify the new stage that is established after the change (Kim, 2015). In this stage, the managers at the mental inpatient settings will be required to regularly monitor the patients as well as nurses and catering department of the hospital to ensure all the individuals play their changed roles properly. In case the roles are not played in the changed manner, concerned people are to be informed and made to abide by the change so that the proposed change of allowing food choices to inpatients in mental units is able to be stabilised in the setting. In making the proposed change, Lewin's model is chosen as it is one of the simplest change models (Frampton, 2016). Thus, using the model would not require the manager of the mental inpatient settings to have intricate skills or training and would be able to implement the proposed change in an easier manner. Lewin's model is also chosen because it helps the organisation to make drastic changes in a successful manner (Kumar et al. 2015). This is evident as the use of the model would help the organisation to aware the nurses, ward manager and catering department the need for change, in turn, making them support the change. The Lewin's model helps the organisations to identify neglect issues by thoroughly analysing previous business process (Lv and Zhang, 2017). This is evident as the use of the model led the ward managers at first evaluate all the previous practices being undertaken making them identify in which aspect changes are to be made to accomplish the goal of providing food choices to service users.

The leadership style

Democratic leadership is referred to the nature of leadership where the members within a group develop participative role in the process of decision-making within the organisation. The democratic leadership style is beneficial as it makes the leaders increase staff productivity by encouraging involvement of the employees in sharing their ideas to develop proper change within the organisation (McKeown and Carey, 2015). Thus, democratic leadership style will be used for making the proposed change because it will lead the management of the mental inpatient unit include dieticians, nurses and catering department to share different innovative ideas regarding the way the proposed changed can be done in an effective way within limited amount of time. It would also be used as the leadership style will make the nurses, catering department and others feel productive and valued to be able to take part in decision making regarding the change in the organisation. However, the disadvantage of using democratic leadership style is that it slows down the process of decision makes and thus is not effective in intense situation (Donnelly, 2017). This is because collaboration of teams is required and decision-making processes are long in this style of leadership. Thus, to use this style of leadership in making the proposed change of providing food choices to the inpatients in mental units the manager will require ensuring limited amount of time is used in making decision for the way to make the change. (Refer to Appendix 2) The Autocratic leadership is referred to leaders who make choices based on their own ideas and judgements and rarely accepts ideas and advice from their followers (De Hoogh et al. 2015). The autocratic leadership style has the limitation of not including the subordinates or employees in the change making them feel lack of commitment and unaware regarding the reason for change (Fiaz et al. 2017). Thus, this leadership style is not used as it would result to make the nurses and catering department uncommitted and feel resentment to make the changes that result the change to occur in a hindered way.

The PDSA model for improvement

The improvement model offers a basis for initiating and executing the change that will result to make improvements. It is rooted in scientific approaches with directs desire to act instantly in regards to knowledge of learning (improvement.nhs.uk, 2018). The best model to use for the change proposal is the improvement model as it is simple and easy to apply to a healthcare setting. It also enhances individual knowledge thereby empowering them. It will be used in conjunction with the PDSA cycle which consists of Plan, Do, Study and Act. The change plan is for the patients on the ward to have choice on what meal they would like to eat on each day of the week. Patients will be supported by staff to pick their meals from the lists of meals on the menu determined for them by the dieticians on a weekly basis. The patients are the main target for this change and they as well as the organisation are the beneficiary.

Do

The play will be implemented in action by initially carrying out trial session to understand at what efficiency they are working. The trial session before finalising a plan for change is important to understand extent of responses and efficiency the plan is getting from those for whom the change is being made. It is also important as trial session provides scope to make alteration in the plan for its successful final implementation (Freeman et al. 2017). Thus, the plan of involving dietician to inform different food items for each patient and then the nurses to ask patient to mention according to the chart which food they prefer to have for the day is to be implemented in a trail way for a week. During the week, feedback is to be accessed from the patients. This is because feedback from patients helps to analyse strength and weakness of the change plan in turn mentioning further alterations to be made to ensure the change management plan delivers successful results (Chauhan et al. 2017).

Study

The multi-disciplinary team should come together to review patients feedback and the ward manager would be informed of the outcome. This is because ward managers are the leaders who control the nurses and catering department regarding the way to provide care to service users. The multidisciplinary team is to be involved in study because proper analysis of the change from perspectives of different professionals would help in creating improved change for the patients (Hjelle et al. 2016).In the process, the manager will then compare the old and new outcomes and the results will be marked. It would make the ward manager identify way to further develop the change management plan to ensure its success.

Act

Once the trial week is now complete, the staff would ask patients how they feel about the change, if they think that the change is necessary or not, if they think that selecting their meals has any impact in the treatment and recovery? If there is a positive result, then the new change will commence immediately after the trial week. Staff will then carefully direct patients during meal selection, making sure that patient is picking the meal they like and making healthy choices. The regular monitoring is to be done so that continuous changes in the plan can be accordingly made to make it able to remain stabilised in controlling the situation for which it has been developed (Patel and Saunders, 2018). Thus, after two months, the staff and patients should come together again to review how the new change has been going, if anyone thinks that something should be done differently. If everyone is happy with the new change, then it will become solidified. The MDT has to come together to discuss the change proposal and set out ways to implement it. They would study the change, implementation procedures and the best way to get the patients involve. There should be adequate communication of the change proposal and its implementation process to the staff team so that they should be able to explain the process to the patients. Patients should be involved in the whole process and should be encouraged to asked questions if necessary.

Barriers

The new change will mostly benefit the hospital to improve care quality as one of the common worries and complaints in care faced is that patients are not allowed to eat properly and assured nutrition. This change would enable patients to select what meal they would like to eat and will not miss out on their favourite foods while on the ward. It would also help patients to make additional requests if needed. However, the barrier for this change includes limited understanding of change. Some staff and patient might be reluctant to change and would like to stick to the old ways of doing things. This would result to create hindrance in establishing the change. Secondly, ineffective communication, for this change to successful there should be effective communication within the team and patients. So that all individuals involved would be aware and understand the change plans and benefit of this change. Thirdly, inadequate resources and budget to facilitate the change, as every change needs manpower and resources to implement it. The ward manager would set aside some resources for the change and extra staff might be needed on the meal selection day to engage and support patients to choose their meals.

Conclusion

The importance of adequate dietary intake for patients cannot be overemphasised. Better level of wellbeing was confirmed by individual that ate balanced diet. Also as reported in this study that unhealthy diet is associated with poorer mental well-being (O'Neil et al, 2014). Patients not having sufficient dietary intake or if they are not enjoying their meals while on the ward could cause distress, which will possibly lead to additional ill-health. This change proposal will be of huge benefit to patients on the ward as it would not only give them the chance to eat and enjoy their meals while on the ward but also make them feel valued, involved in their care, more satisfied and more independent (Barrratt, 2011). However, for this change proposal to be sustained, strong leadership is needed to hold it together. Effective communication, evaluation of feedbacks and constant reassurance to all involved in this change are very necessary for the change proposal to work well and to be successful. This new change should be monitored and reviewed from time to time to ensure that everyone is happy and on track with the change. Patients’ feedback should be reviewed by the MDT at regular intervals to ensure that patients are benefiting from the change. Successful Implementation of this change will definitely improve patients experience in the ward.

References

Aultman, J.M., (2019). How Should Health Care Professionals Address Social Determinants of Refugee Health?. AMA journal of ethics, 21(3), pp.223-231.

Bail, K. and Grealish, L., (2016). ‘Failure to Maintain’: A theoretical proposition for a new quality indicator of nurse care rationing for complex older people in hospital. International journal of nursing studies, 63, pp.146-161.

Barker, L. A., Gout, B. S., and Crowe, T. C., (2011). Hospital Malnutrition: Prevalance, identification and impact on Patients and the Health care System. Int J Environ Res Public Health, 8(2),pp, 514-527.

Bovendeerd, B., de Jong, K., Colijn, S., de Groot, E., Hafkenscheid, A., Moerbeek, M. and de Keijser, J., (2019). Systematic client feedback to brief therapy in basic mental healthcare: study protocol for a four-centre clinical trial. BMJ open, 9(5), p.e025701.

Chauhan, B.F., Jeyaraman, M., Mann, A.S., Lys, J., Skidmore, B., Sibley, K.M., Abou-Setta, A. and Zarychanksi, R., (2017). Behavior change interventions and policies influencing primary healthcare professionals’ practice—an overview of reviews. Implementation Science, 12(1), p.3.

De Hoogh, A.H., Greer, L.L. and Den Hartog, D.N., (2015). Diabolical dictators or capable commanders? An investigation of the differential effects of autocratic leadership on team performance. The Leadership Quarterly, 26(5), pp.687-701.

Duijzer, G., Haveman-Nies, A., Jansen, S.C., Ter Beek, J., van Bruggen, R., Willink, M.G.J., Hiddink, G.J. and Feskens, E.J.M., (2017). Effect and maintenance of the SLIMMER diabetes prevention lifestyle intervention in Dutch primary healthcare: a randomised controlled trial. Nutrition & diabetes, 7(5), p.e268.

Fiaz, M., Su, Q. and Saqib, A., (2017). Leadership styles and employees' motivation: Perspective from an emerging economy. The Journal of Developing Areas, 51(4), pp.143-156.

Frampton, M., (2016). Implementation of a Blended learning Educational Module on the Mental Health Act 2001 for Trainee Psychiatrists. Leading Change as a Professional, p.109.

Freeman, D., Sheaves, B., Goodwin, G.M., Yu, L.M., Nickless, A., Harrison, P.J., Emsley, R., Luik, A.I., Foster, R.G., Wadekar, V. and Hinds, C., (2017). The effects of improving sleep on mental health (OASIS): a randomised controlled trial with mediation analysis. The Lancet Psychiatry, 4(10), pp.749-758.

Hjelle, K.M., Skutle, O., Førland, O. and Alvsvåg, H., (2016). The reablement team’s voice: a qualitative study of how an integrated multidisciplinary team experiences participation in reablement. Journal of multidisciplinary healthcare, 9, p.575.

Johnson, A., Nguyen, H., Groth, M., Wang, K. and Ng, J.L., (2016). Time to change: a review of organisational culture change in health care organisations. Journal of Organizational Effectiveness: People and Performance, 3(3), pp.265-288.

Kim, T., (2015). Diffusion of changes in organizations. Journal of Organizational Change Management, 28(1), pp.134-152.

Kumar, S., Kumar, N., Deshmukh, V. and Adhish, V.S., (2015). Change management skills. Indian journal of community medicine: official publication of Indian Association of Preventive & Social Medicine, 40(2), p.85.

Laker, C., Cella, M., Callard, F. and Wykes, T., (2019). Why is change a challenge in acute mental health wards? A cross‐sectional investigation of the relationships between burnout, occupational status and nurses’ perceptions of barriers to change. International journal of mental health nursing, 28(1), pp.190-198.

Laur, C., McCullough, J., Davidson, B. and Keller, H., (2015). Becoming food aware in hospital: a narrative review to advance the culture of nutrition care in hospitals. In Healthcare(Vol. 3, No. 2, pp. 393-407). Multidisciplinary Digital Publishing Institute.

Lv, C.M. and Zhang, L., (2017). How can collective leadership influence the implementation of change in health care?. Chinese Nursing Research, 4(4), pp.182-185.

McKeown, M. and Carey, L., (2015). Democratic leadership: a charming solution for nursing’s legitimacy crisis. Journal of clinical nursing, 24(3-4), pp.315-317.

McKeown, M. and White, J., (2015). The future of mental health nursing: are we barking up the wrong tree?. Journal of Psychiatric and Mental Health Nursing, 22(9), pp.724-730.

Nagalla A., H Ibrahim E. and Hewedi M. (2017) ‘’patient’s satisfaction with Delivered food services in fayoum Hospital’’,EcNutrition. 9.2(2017)94-104.

Naithani, S. (2008) Hospital Inpatient Experiences of access to food: A quality interview and observational study.

O’Neil, A., Qurirk S. EJ. A., Housden, S., Brennan, S. L., Williams, l. J., Pasco, J. A., and Jacka, F.N., (2014). Relationship between diet and mental health in children and adolescents: A systematic review. American Journal of Public Health.

Patel, S. and Saunders, K.E., (2018). Apps and wearables in the monitoring of mental health disorders. British Journal of Hospital Medicine, 79(12), pp.672-675.

Pryor, L., Lioret, S., Van Der Waerden, J., Fombonne, É., Falissard, B. and Melchior, M., (2016). Food insecurity and mental health problems among a community sample of young adults. Social psychiatry and psychiatric epidemiology, 51(8), pp.1073-1081.

Sivakumar, P.T., Mukku, S.S.R., Antony, S., Harbishettar, V., Kumar, C.N. and Math, S.B., (2019). Implications of Mental Healthcare Act 2017 for geriatric mental health care delivery: A critical appraisal. Indian Journal of Psychiatry, 61(Suppl 4), p.S763.

Stranges, S., Samaraweera, P.S., Taggart, F., Kandala, N.B., and stewart-Brown, S. (2014). Major health well-being in general population: BMJ Open.

Teasdale, S.B., Ward, P.B., Rosenbaum, S., Watkins, A., Curtis, J., Kalucy, M. and Samaras, K., (2016). A nutrition intervention is effective in improving dietary components linked to cardiometabolic risk in youth with first-episode psychosis. British Journal of Nutrition, 115(11), pp.1987-1993.

Appendix

Appendix 1:

The benefit of meeting the fundamental rights of the patients by the nurses in mental health settings is that it helps them to provide respect and ensure dignity to the individuals (nice.org.uk, 2019). This is beneficial for the nurses to show value to the patients which drive them to access trust from the patients allowing them to deliver high-quality and satisfactory services. Thus, meeting the identified goal through the change is important to help the nurses in mental health settings provide inpatients proper care without hindrance. The violation of the NMC Codes results the nurses face legal actions against them and in some cases loses their registration to perform their profession (nmc.org.uk, 2019, NMC, 2015). Thus, the goal of making change to fulfil the NMC code guidance is important so that the nurses in mental health are able to provide proper care by following the NMC Codes.

Appendix 2:

The democratic leadership style is beneficial as it helps in building stronger team and creates facilitative workplace (Frankel and PGCMS, 2019). Thus, this leadership style is to be used in making proposed change as it would help in forming a stabilised change with the strong collaboration of the team of health professional, nurses, dieticians and catering department. Further, democratic leaders often face rejection of ideas to be implemented as many workers have put their time to provide ideas and when the ideas are not accepted they reject the selected ideas (McKeown and White, 2015). In order to resolve this limitation, the manager at the mental settings requires providing proper explanation regarding the specific ideas of specific employees chosen for making the proposed change.