Occupational Therapy News OTnews July 2019 | Page 33

SERVICE DEVELOPMENT FEATURE support patients in selecting meal choices. To improve upon the space available, the layout of tables has been rearranged to accommodate wheelchair users, excess furniture has been removed, and height adjustable tables that are suitable for wheelchairs of varying sizes have replaced fixed tables. Results also highlighted that the majority of staff who completed the questionnaire did not feel confident in supporting patients with complex physical, cognitive, communication and eating and drinking needs at mealtimes. It is anticipated that multidisciplinary eating and drinking guidelines will improve staff confidence levels and guide staff on how to support every patient’s individual needs. Additionally, multidisciplinary developed guidelines aim to provide a more consistent approach from staff and ensure that patients receive the correct amount of support while maximising their independence at mealtimes. Training on supporting patients with complex physical, cognitive, communication and eating and drinking needs is also being developed to support staff. Newly-purchased adapted cutlery is recommended by the occupational therapists in multidisciplinary eating and drinking guidelines, as staff and patients felt that the availability of adapted cutlery was limited. Adapted cutlery has given patients with reduced upper limb control more independence while feeding, therefore having to rely less on assistance from others. The ‘Dining room project’ was created to be an evolving project by a team that shares a collective vision to improve the experience that patients have at mealtimes. The project is currently at the stage of implementing the actions based on the results collected, but questionnaires will be repeated this year to evidence the impact of the changes already implemented and to consider future improvements. The project provided occupational therapists with the opportunity to share specialist skills, expertise and experience in Prescott et al (2019) examined the effect of self- awareness on goal engagement and outcomes in a prospective cohort study involving adults with acquired brain injury attending outpatient rehabilitation in Queensland, Australia. Thirty five participants completed goal setting with occupational therapists. Measures of self-awareness and client-centredness were completed immediately afterwards, and goal- outcome data were collected 12 weeks later or at discharge. Participants were classified into three self-awareness groups: hyper-aware, accurate self-awareness and impaired self-awareness (ISA). Findings included that goal setting was highly client- centred regardless of level of self-awareness and all groups achieved clinically meaningful changes in Canadian Occupational Performance Measure (COPM) performance scores, although there were no statistically significant differences between groups. Further research is suggested, including investigation of the strategies occupational therapists use to engage clients with hyper-awareness and ISA. The feedback from questionnaires showed that 65 per cent of patients on ward one and 74 per cent on ward two use the dining room for every mealtime, which indicates the importance of making positive changes. Horwitz-Bennet (2015) identified ‘that hospital dining areas should be designed as comfortable, hospitality-inspired spaces customised for the user experience’; and this is exactly what the ‘Dining room project’ set out to achieve. The questionnaires asked for feedback from patients and staff on the dining room atmosphere. Research highlights that a home like environment with tables laid with table cloths, cutlery and condiments set out can promote a feeling of belonging (Hartwell et al 2015). Thus, to improve on the atmosphere rating, it has been agreed by catering staff that the tables will be laid for patients before each meal. Patients and staff have also participated in a vote to choose new photographs to be framed for the walls of the dining rooms, and a large café style picture menu has been hung on the wall to Reference Prescott S, Fleming J, Doig E (2019) Effect of self- awareness on goal engagement and outcomes after acquired brain injury. British Journal of Occupational Therapy, Jun 12. [Epub ahead of print]. supporting patients at mealtimes, and absorb new skills from the wider multidisciplinary team. Occupational therapists’ ability to understand the effects of a brain injury on occupational performance and provide remedial and compensatory advice to patients and the staff who support them, leads us to holding a valuable role in improving the experience that patients with neurological impairments have at mealtimes in ward based dining rooms. References Hartwell H, Shepherd P and Edwards J (2013) Effects of a hospital ward eating environment on patients’ mealtime experience: A pilot study. Journal of the Dietitians Association Australia 70(4): 332-338 Horwitz-Bennet B (2015) Good taste: Designing healthcare dining spaces. Available online at: www.healthcaredesignmagazine.com/trends/ operations-facility-management/good-taste-designing-healthcare-dining- spaces/ [accessed 8 March 2019] The Kings Fund (2012) Leadership and engagement for improvement in the NHS: Together we can. Available online at: www.kingsfund.org.uk/sites/ default/files/field/field_publication_file/leadership-for-engagement- improvement-nhs-final-review2012.pdf [accessed 8 March 2019] Kelly Hiscox, occupational therapist, South Warwickshire NHS Foundation Trust, email: [email protected] OTnews July 2019 33