An in-depth inquiry into how stroke patients are supported with eating and drinking in stroke units

Background An estimated eighty percent of stroke patients have difficulties with eating and drinking, with over fifty percent requiring some form of assistance. Evidence suggests those receiving nutrition and hydration via enteral or parenteral routes receive adequate nutrition. In contrast, stroke patients who require assistance to eat and drink via the oral route do not always meet their nutritional requirements, affecting their well-being and recovery from stroke. This study explores this phenomenon in contemporary stroke unit settings. Methods A qualitative collective case study using non-participant observation, documentary analysis and semi-structured interviews was undertaken. The study gathered data from two sites incorporating acute and rehabilitation stroke services (cases). Forty-six multidisciplinary team (MDT) members, 31 patients and 13 informal carers (ICs) were recruited to the study. Data was thematically analysed using a six components approach developed by Braun and Clarke (2006). Findings All MDT members considered adequate nutrition paramount to stroke patients’ recovery with nursing staff responsible for supporting eating and drinking. However, patients did not receive consistently adequate support to eat and drink. This was due to multiple, interwoven factors including lack of formalised assessment of eating and drinking abilities unless under SLT management; poor communication and monitoring of patients’ support requirements, nutritional intake and nutritional status; other work/ tasks given priority over supervision at mealtimes; inconsistent provision of accessible, nutritious, appealing food. Knowledge to support this activity varied hugely across the MDT, particularly with HCAs who reported variable levels of training but predominantly carried out this work unsupervised. Conclusion and implications for practice Stroke patients do not receive consistent support with eating and drinking. Further research and the inclusion of specific recommendations for support with this activity in national guidance may promote this activity.