Current feeding policies for patients with stroke.

It is well known that policies for feeding patients who have suffered a recent stroke vary enormously. The choice of method used may depend on the severity of the stroke, i.e. swallowing ability, conscious level, ability to communicate and the level of sensory and motor dysfunction. Other considerations may include age and previous nutritional status. However, in the absence of evidence from controlled clinical trials, the preferences of individual physicians and nurses may have a significant influence. As part of the preparatory work before the start of a clinical trial of different feeding policies, the author wished to assess both the degree of variability of feeding practice on wards in the same hospital and also whether there were reasons other than lack of evidence which influenced feeding policies. One nurse from each of 19 wards (one neurology, nine medical and nine care of the elderly) in two hospitals of the same trust was interviewed to ascertain their current feeding practice for patients with stroke. The results showed the expected variability in feeding practice, possibly reflecting the uncertainties felt by physicians and nurses in this area. However, many comments revealed the concerns that nurses have in trying to meet the nutritional needs of their stroke patients in busy acute general hospitals.