There are issues of practical convenience that need to be considered in feeding Mary. I will make sure that she is comfortably seated and that she assumes a suitable posture for eating food. I would observe if Mary is able to masticate the spoon fed morsel of food. If she has difficulty in chewing the intake properly, then I might resort to a semi-solid meal – one which could be easily swallowed. There are other such contingencies that could arise in the process of feeding Mary. But all times, I would adhere to the recommendations of the nutritionist and all times avoid those food items that had invoked allergic reactions in Mary in the past.
It is also important to remember that Mary is showing signs of depression. Depressed patients will not generally have a healthy appetite. Their general lack of interest in life would mean that they are disinterested in food as well. There have been a few cases of injudicious action by nurses in the last few years. There are functional laws within the jurisdiction of theUnited Kingdomthat provide legal recourse to hospitalized patients who are provided negligent or inappropriate care by nurses. The following passage, taken from The Journal, dated November 25, 2005 illustrates this point: “A midwife from South Tyneside Hospital is facing a Nursing and Midwifery Council hearing, charged with not giving appropriate care to two patients between September and October 2003. Siew Seng Bradwell, 51, fromSouth Shieldswill appear before the council on Monday for the four-day hearing. A spokeswoman for the NMC said yesterday: ‘There are eight charges, all relating to failing to listen to the patient and giving unnecessary intervention’” (The Journal, 2005). This story is particularly relevant to the case of Mary, as she has difficulty in communicating due to her limited speech.
As a nurse attending the ailing Mary, I would be eager to find out why she is tearful most of the time and showing signs of depression. To some degree, the chronic and early decline of her health is a contributing factor behind this. But Mary is only 34 years of age and she might not be mentally prepared for her bearing this burden. What she needs at this stage is not just nutritional inputs but also spiritual ones. Using the services of a psychological counsellor is an option that I would definitely use, for when Mary comes out of her Depression, her appetite for food will also return to normal. In addition to availing the services of a professional psychologist, I would also apply basic psychotherapeutic principles that are inculcated in every nurse. Hence, the scope of services that a nurse can offer is very wide ranging. Helen Keleher makes some valid observations in the introduction to her book titled Community Nursing Practice: Theory, Skills and Issues, where she states
“Understanding the social basis of health is essential for effective nursing practice in the community because health is much more complex than merely the absence of disease or infirmity. The philosophy of community nursing embraces and promotes the social model of health, which provides a framework for community practice. The social foundations of health include the social context in which people live, work and play, as well as a wide range of social, economic, cultural, environmental and political factors that influence the health of every person and population group. Collectively these are known as the determinants of health” (Keleher, 2007)
The case of Mary should also be approached from the aforementioned perspective. As a nursing professional, I am expected to go beyond the text book rules and guidelines. I would try to understand the determinants of Mary’s health before arriving at concrete solutions for her. Many of the health determinants are not easy to quantify, for they are subjective assessments (Jones & Symon, 2000). As a result, the process I adopt to gather Mary’s health determinants should go beyond merely pedagogic ones to include subjective and intuitive assessments. The Environment of Care advice sheet is useful here, as it lays out precautions and actions to be taken in contingency situations. As Mary has shown signs of depression, it is not far fetched to think that she may think of suicide. It is a moot point that she has limited mobility, which would thwart any attempts at suicide. The likely issue is not so much the probability of suicide as the very thought of it. I will have to make sure that the environment in which Mary lives is free of dangerous objects. If Mary is be to cared at her home and not at the controlled environment of a hospital, then the task of making the surroundings safe becomes more challenging. As the detailed document pertaining to environment of care states,