This assignment discusses the importance of eating and drinking, which is an activity of daily living. The nursing process will be briefly described; the assessment stage will be discussed and linked to relevant literature.

Hinchliff et al (2003) argues that Roper et al's model of nursing is holistic because it illustrates activities of living can be influenced by different factors. Theses factors are biological, psychological, socio-cultural, environmental and politico economic. These factors inter-influence the activity of living as Roper et al (2000) states the more an activity of daily living is analysed, the more complex it becomes. However Dossey et al (2000) states that holistically assessing patient's needs involves evaluating the data given. In relation to practice Annie informed myself of her mobility difficulty and I thought how does she gain access to the shops?

Assessment is the first stage of the nursing process (Hinchliff et al 2003). This contrasts with Castledine (2004) believing that assessment is the first step in determining the health status of the patient. However Roper et al (2000) highlights the assessment stage should be called assessing to suggest assessment is an ongoing procedure. The patient needs to be continually assessed to implement changes as their condition improves or deteriorates.

Roper et al (2000) believes assessing is collecting information form the patient, reviewing the information, and identifying the patient's problems. Roper et al (2000) states the patient's problems should be prioritised. The patient is assessed for potential problems which nursing research states could occur. Dossey et al (2000) explains that assessment is an information gathering phase which provides the nurse and patient with the opportunity to prioritised and identify problems.

Information collected at assessment can be subjective or objective (Roper et al 2000). Objective information is measurable e.g. weight. Christensen et al (1995), believes objective data is more accurate than subjective data because objective data is measurable not a personal interpretation. Objective data can be verified by a colleague (Hinchliff et al 2003). Therefore objective data is more accurate because it can be rechecked. Roper et al (2000) states that objective data is used more frequently because nursing research suggests using assessment tools which provide a numerical score. This makes the data gained objective.

Roper et al (2000) states information given by the patient or interpreted by the nurse is subjective. Walsh (2002) believes that a good assessment includes subjective data because it allows the patient to describe their feelings and perception of symptoms.

Hinchliff et al (2003) illustrates that information gained at assessment assists the nurse in the formulation of a care plan. This coincides with Walsh (2002) who agrees that information provided at assessment provides a basis for good nursing care and suggests that nursing care is only as good as the assessment it has been based on. The multidisciplinary team should be informed of relevant information gained at assessment to ensure that the relevant care can be planned.

Annie's nutritional status was assessed on admission using the Roper et al (2000) activities of daily living model. Green et al (1998) recommends nutritional assessment should be undertaken on admission. A nutritional assessment being completed at admission would determine if the patient has or is at risk of developing malnutrition (Copeman 2000). The NICE guidelines show that malnutrition accounts for twenty nine per cent of all hospital admissions.

When assessing Annie I asked her if she had any problems eating and drinking because I noticed her clothes were too big. This is an example of subjective data Copeman (2000) discloses that malnutrition is a serious problem in the elderly. Nurses should be aware of malnutrition and aim to ensure all patients are well nourished and adequately hydrated. Chen et al (2001) states malnutrition in the oldre adult is frequent.

Annie was weighed on admission and her Body Mass Index calculated. Annie's BMI was estimated at being fifteen, this shows that Annie is underweight. Copeman (2000) criticises the BMI scale cut off points because she feels the cut off point indicating malnutrition should be greater than twenty two in the elderly. Copeman (2000) proves that other studies with a higher cut off point for malnutrition have been found to be more appropriate. If the BMI cut off point was higher, Annie would not be malnourished.

Annie informed myself that her dentures were too big. Steele et al (1998) discovered dental problems were a risk factor of malnutrition because they often cause the patient to become reluctant to eat. This could have contributed in Annie's malnutrition because she is limited to certain foods. Nursing research shows that ill fitting dentures can be an indicator of weight loss (Steele et al 1998.)

Annie notified myself of her difficulty in masticating food. Mclaren (1998) demonstrated that physical effects of ageing impair eating and drinking, theses include masticating and dysphagia. Annie complained of xerostomia. Xerostomia can cause a reluctance to masticate (Coutts 2001). Annie told myself that food tastes bland. Gariballa et al (1998) suggests taste declines as part of the ageing process. Copeman (2000) agrees with Gariballa et al (1998) that a change in the perception of food makes it appear unappetising.

Biernacki (2001) argues that patients like Annie have complex nutritional needs due to their dementia. Therefore I should assess Annie adequately to meet the needs of her dementia.

Whilst assessing Annie it became apparent that due to her dementia she was experiencing delusions. This could affect her ability to eat and drink because Annie could believe her food is being poisoned and refuse to eat it (Alzheimer's Society 2001). Annie is unable to plan and prepare a meal due to her dementia. This is reinforced by Malone (1997) showing that dementia affects nutritional statues because the patient loses their planning and co-ordination skills.

During her assessment Annie was unable to recall when she last ate or drank. Roper et al (1996) believe that patient's with Alzheimer's Disease have difficulty to go shopping therefore they are unaware of the need to buy food. Mclaren (1998) argues that people with dementia forget to eat and have a reduced food intake.

Annie broke down in tears and complained of feeling lonely when I asked her about her home environment. Roper et al (1996) suggests that a loss of appetite can be an indicator of an emotional disturbance. Annie could have this following the death of her husband. Grief negatively affects the appetite because feelings of hunger are stifled and eating is reduced to a sinful act (Wikby 2004). Chandra et al (1991) believes that bereavement and social isolation results in eating less frequently. Nursing research conducted by Wikby (1994) proved that appetite increased when people ate with others as oppose to eating alone. Tolson et al (2002) states that eating should be a social activity. However Annie is unable to perceive it socially since she became a widow. Therefore this suggests strong reasons for Annie being malnourished.

Annie has impaired mobility due to her arthritis. Annie has no means of travelling to the shops. Noble (1999) feels that elderly people are in a vulnerable position to buy their food due to a lack of public transport to enable them access to the shops. Noble (1999) states that elderly people either have to rely on corner shops which can be expensive or as in Annie's case rely on others to do their shopping. Annie's daughter Pat does her shopping for her which limits Annie's independence and choice of food.

From writing this assignment I have discovered that assessment is a complex recurrent procedure (Roper et al 1996). I have learnt that the approach to patient care is to evaluate the problems, prioritise the problems and try to solve the problems. I have also reflected on past experiences of assessments and I now realise that I was assessing a patient using a nursing model which was providing a guide for the assessment. I have learnt to value the patient's opinion even when the patient had dementia, because the patient can still inform others of their symptoms when prompted. I have learnt that malnutrition is a common problem in hospitals.

To conclude the assignment a number of points have been made relating to the assessment stage of the nursing process. Roper et al (2000), states that eating and drinking is essential to human existence because it provides the energy source required by the body to maintain cells and grow new cells. Aggleton et al (2000), agrees that eating and drinking is vital to maintain the homeostatic balance of the body.