This articles deals with the dietary advice that should be provided to people with type 2 diabetes by anyone working in the community (it does not cover advice on physical activity or prevention of type 2 diabetes). If a patient with type 2 diabetes is overweight or obese, the most important factor is to lose weight — even a 5–10% weight loss can improve insulin sensitivity and hence diabetic control. Other factors that are considered in this article are the type of carbohydrate that can be eaten, with wholegrain/high-fibre, lower glycaemic index starches being the best option (the glycaemic index measures the effect of carbohydrates on blood glucose level). Although sugar provides 'empty calories' (food that supplies energy but negligible nutrition) and can result in weight gain, it does not contribute to diabetes directly. Cholesterol levels should be reduced by eating the correct fats, and salt levels should be kept to below 6g a day.
This articles looks at the dietary advice that should be provided for people with type 1 diabetes. As well as focusing on healthy eating generally, blood sugar control can be optimised if both the type and amount of carbohydrate is considered. Low glycaemic index (GI) carbohydrates, where glucose is released slowly into the blood stream, may help to lower the individual’s glycated haemoglobin (HbA1c) levels (HbA1c is a form of haemoglobin that is measured to identify the average plasma glucose concentration over a prolonged time period). Carbohydrate (‘carb’) counting should be considered as it can improve glycaemic control and promote independence in regard to food choice and management of the condition. Gestational diabetes (that which develops during pregnancy) is also considered, as this can affect birth outcome, the baby’s future health and the health of the mother after the birth.
Dysphagia is a swallowing condition that mainly affects older adults and which can be a short- or long-term issue. Dysphagia can have an enormous impact on patients and their carers and for community nurses, early identification is key to managing the condition successfully. Similarly, by familiarising themselves with the signs and symptoms of the condition, nurses can ensure prompt referral to a speech and language therapist who can formulate an individualised plan of care. Managing dysphagia requires a multidisciplinary approach, with the aim of helping patients to maintain an adequate and safe oral intake.
While cancer treatment can be debilitating enough in itself, one of the lesser known side-effects is the impact it has on patients’ nutrition, including reduced appetite, nausea and changes in taste. This article takes an in-depth look at the elements that community nurses need to be aware of when managing patients undergoing treatment for cancer.
Nutritional intake can have an effect on many areas of a patient’s health, while malnutrition specifically has a recognised role in pressure ulcer development. In this article, the author looks at whether there is any high quality evidence to recommend specific nutritional measures when trying to prevent pressure ulcers, as well as looking at overall recommendations for malnourished patients. Nutritional screening remains essential to help identify those patients most at risk of malnutrition and allows community nurses to prepare nutritional care plans and begin to correct any nutritional deficiencies. The author recommends that community nurses perform nutritional screening at any patient contact, be that in hospital, nursing home or in the patient’s
own home. Recording the outcome of screening at regular intervals also helps to identify trends in a patient’s nutritional state and means that any reduction will be picked up quickly.
The quality of nutrition provision in nursing homes can often seem like an afterthought. Natalie Welsh, a nutrition specialist nurse at Tameside Hospital NHS Foundation Trust, explains how we can improve...
The management of nutrition in people with dementia is complex as it involves weight loss due to cognitive and physical problems caused by the condition. There is a range of practical approaches that the community nurse can implement, but these must be adjusted to suit each person. Often, a large proportion of the community nurse’s time is spent supporting carers, family and friends who are looking after a relative who has dementia at home. This can be a demanding role and carers often experience physical and emotional fatigue. For those working with patients with dementia in nursing, residential and care homes, it is particularly important that staff are supported with strong leadership to provide a flexible approach to meal times and that suitable menu options are available.
As with many conditions, diet has a crucial but often underrated relationship with serious mental health problems. In this article the author examines how diet, nutrients and different food types can have a deleterious or beneficial effect on mental health problems such as dementia, schizophrenia and bipolar disorder. Understanding the complex reactions between healthy eating and cognitive and emotional development can help community nurses provide holistic care for their patients.
Wound care and nutrition are two interlinked areas that will have a serious impact on the caseload of any community nurse. Healthy eating and regular physical activity help to prevent chronic illnesses, which in turn have an effect on the development of wounds and ulcers. In particular, malnutrition can impair wound healing and so it is essential that at-risk patients are identified in the early stages using an evidence-based nutritional screening tool. If a wound has developed, adequate nutritional management plays a key role in the healing process. If necessary, patients should be referred to a registered dietitian for a detailed nutritional assessment and treatment plan. This article looks at the link between nutrition and wound care, as well as highlighting preventative measures that can be encouraged in all patients at risk of developing a wound.
Statistics suggest that one-in-four adults are obese, and up to 33% of school-aged children are overweight or obese (National Obesity Forum, 2015). Thus, on a daily basis, it is likely that general practice nurses (GPNs) will engage in consultations with patients who are overweight or obese, quite often while presenting for advice for another condition. This article explores how to broach this sensitive issue and the nurse’s role to reduce weight stigma in line with the new Nursing and Midwifery Council Code (NMC, 2015). Practical advice to support patients in managing their weight, and identifying appropriate onward referrals, including for bariatric surgery and eating disorders, will also be discussed.
