Decline in competence associated with eating independently

• Anxiety
• Decreased activity tolerance
• Impaired physical comfort
• Impaired physical mobility
• Impaired postural balance
• Muscle hypotonia
• Pain
• Prolonged inactivity
• Unaddressed environmental constraints
• Weakness

• Mental disorders
• Musculoskeletal impairment
• Neuromuscular diseases
• Significant comorbidity
• Stroke
• Wounds and injuries

• Age
• History of neurologic, sensory, psychological or musculoskeletal impairment
• Self-care abilities, including knowledge and use of adaptive equipment, preparation of equipment and supplies, and technical and mechanical skills
• Musculoskeletal status, including coordination; functional ability; gait; mechanical restriction (such as cast, splint, and traction); muscle tone, size, and strength; range of motion; and tremors
• Psychosocial status, including coping mechanisms, family members, lifestyle, motivation, patient's perception of health problem and self, and personality

• Difficulty bringing food to mouth
• Difficulty eating in an acceptable manner
• Difficulty getting food onto utensil
• Difficulty handling utensils
• Difficulty opening containers
• Difficulty performing eating actions in the appropriate sequence
• Difficulty picking up cup
• Difficulty using assistive device

• Patient will have feeding self-care needs met.
• Patient will have few, if any, complications.
• Patient will express feelings about feeding limitations.
• Patient and family members will demonstrate correct use of assistive devices.
• Patient and family members will carry out feeding program daily.
• Patient and family members will identify resources to help cope with problems and discharge.

Suggested NOC Outcomes

• Assess patient's functional, cognitive, and perceptual level at periodic intervals. Document and report any changes. Ongoing assessment allows you to identify changing needs and adjust interventions accordingly.
• Observe patient's functional, perceptual, and cognitive level every shift; document and report changes. Careful observation helps you adjust nursing actions to meet patient's needs.
• Perform the prescribed treatment for the underlying condition. Monitor patient's progress and report responses. Applying therapy consistently aids patient's independence.
• Weigh patient weekly and record weight. Report a change of more than 1 lb/week to ensure adequate nutrition and fluid balance.
• Monitor and record breath sounds every 4 hours to check for aspiration of food. Report crackles, wheezes, or rhonchi.
• Encourage patient to express feelings and concerns about feeding deficits to help patient achieve the highest functional level. Provide emotional support to help patient come to terms with self-care deficit and achieve the highest functional level.
• Initiate an ordered feeding program:
  • Determine the types of food best handled by patient to encourage patient's feelings of independence.
  • Place patient in high Fowler position to feed to aid swallowing and digestion. Support weakened extremities and wash patient's face and hands before meals.
  • Provide assistive devices; instruct patient on their use to allow more independence.
  • Supervise or assist at each meal—for example, cut food into small pieces. This aids chewing, swallowing, and digestion and reduces the risk of choking or aspiration.
  • Feed patient slowly. Rushing causes stress, reducing digestive activity and causing intestinal spasms.
  • Keep suction equipment at the bedside to remove aspirated foods, if necessary.
  • Instruct patient and family members in feeding techniques and equipment. This aids understanding and encourages compliance.
  • Record the percentage of food consumed to ensure adequate nutrition.
• Encourage patient to carry out the aspects of feeding according to patient's abilities. This gives patient a sense of achievement and control.
• Refer patient to a psychiatric liaison nurse, support group, or such community agencies as Visiting Nurse Association and Meals on Wheels. Additional resources reinforce activities planned to meet patient's needs.

Suggested NIC Interventions

• Patient meets feeding self-care needs.
• Patient accepts help from staff if needed.
• Patient participates in activities designed to minimize risk of complications.
• Patient and family members demonstrate proper use of assistive devices.
• Patient follows daily self-care feeding program. Family members provide assistance, as needed.
• Patient and family members identify and contact available support resources, as needed.

• Patient's expression of feelings and concerns about inability to feed self
• Observations of patient's impaired ability to perform self-care
• Patient's response to treatment
• Patient's weight
• Patient's intake
• Interventions to provide supportive care
• Instructions given to patient and family members, their understanding of instructions, and their demonstrated skill in carrying out self-care functions
• Patient's response to interventions
• Evaluations for expected outcomes

• Batchelor, M. M. K., McConnell, E. S., Amella, E. J., Anderson, R. A., Bales, C. W., Silva, S., … Colon, E. C. S. (2017). Experimental comparison of efficacy for three handfeeding techniques in dementia. Journal of the American Geriatrics Society, 65(4), e89-e94. doi:10.1111/jgs.14728
• Roberts, H., Pilgrim, A., Jameson, K., Cooper, C., Sayer, A., & Robinson, S. (2017). The impact of trained volunteer mealtime assistants on the dietary intake of older female in-patients: The Southampton Mealtime Assistance Study. Journal of Nutrition, Health & Aging, 21(3), 320-328. doi:10.1007/s12603-016-0791-1
• Sakamoto, M., Watanabe, Y., Edahiro, A., Motokawa, K., Shirobe, M., Hirano, H., … Yoshihara, A. (2019). Self-feeding ability as a predictor of mortality Japanese nursing home residents: A two-year longitudinal study. Journal of Nutrition, Health & Aging, 23(2), 157-164. doi:10.1007/s12603-018-1125-2