FEATURE STROKE SERVICES
Reflections on ‘ the art of the possible ’
Can you successfully run mealtime groups in COVID-19 pandemic conditions ? One trust recently endeavoured to find out
Many people living after stroke experience problems with eating and drinking . This can lead to malnutrition , dehydration , reduced muscle strength and depression ( Poels et al 2006 ). It can also lead to longer stays in hospital , reduced ability to participate in rehabilitation and impact on quality of life ( Westergren et al 2002 ).
Rehabilitation interventions for eating and drinking have the potential to improve long-term outcomes by providing strategies , assistive devices and addressing psychosocial issues early in stroke recovery ( Jones and Nasr 2018 ). In 2014 , as part of a National Institute for Health Research ( NIHR ) Clinical Research Fellowship , Natalie Jones started to explore this topic with stroke survivors . Then in 2018 , Natalie received an NIHR Bridging Award , which enabled her to visit stroke units and talk to healthcare professionals , including occupational therapists , where it was found that occupational therapists were using mealtime groups to provide opportunities to prepare food and practise eating and drinking skills .
Consultations with patients and other healthcare professionals found that , although mealtime groups were being trialled , they lacked structure , a multidisciplinary team approach , and outcome measures were not routinely used .
In 2020 , Natalie commenced an NIHR Clinical Doctoral Research Fellowship , which aims to find out if it is possible to improve patient outcomes by providing more intensive interventions for eating and drinking in mealtime groups . However , before proceeding with her research plans , Natalie needed to establish if mealtime groups could be run successfully during COVID-19 pandemic conditions .
The first task was to complete a risk assessment for running a mealtime group , which was signed off by the trust ’ s ‘ COVID re-instatement group ’. The risk assessment
© sasirin pamai via Getty Images was co-produced with staff involved in service delivery and the unit manager .
The risk assessment included points for consideration , such as personal protective equipment ( PPE ), how patients would be seated and activities that would occur in the group .
During the COVID-19 pandemic , patients have not received visitors or been able to mix with other patients , so before mealtime groups could be re-installed new measures were required to meet the trust ’ s COVID-19 guidance .
Due to the COVID-19 precautions , it was decided to staff the group with three healthcare professionals , comprised of two activity co-ordinators and one occupational therapist . A speech and language therapist would also join the group to assess patients while the group was in progress .
Patients were arranged into ‘ activity cohorts ’ of six , to reduce the risk of cross infection by keeping patients in the same cohort for group activities during their stay .
Two of the six patients were triaged as clinically ‘ not ready ’ for mealtime interventions . Four patients were approached to see if they wanted to attend a breakfast group and all four said they would like to attend . The main motivations for this were a desire to work on eating and drinking skills and the possibility of social connection .
The four patients wanting to participate were brought into the ward dining room and they were sat at individual tables two meters apart . They wore masks and aprons in accordance with the risk assessment . For some this was the first time being out of their room since admission .
Patients were positioned at their tables so they could see and talk to each other . This layout took a little bit of manoeuvring ; wheelchairs were positioned at angles to support eye contact and conversation .
52 OTnews May 2021