"Is substitution really the best and only solution to the shortage of nurses?"

August 10, 2018 by Tom de Castella

The object in question is similar to a toddler's water cup. It is plastic and has a lid with a wide circular spout on it. But you won't find the Thomas the Tank Engine logo on it, because this container—a beaker with a plastic spout—is used by many elderly patients in nursing homes and some NHS wards to drink.

No one seems to know exactly how long the plastic spout beaker has been in circulation. Nurses who worked in the 1990s said they remember they were introduced, but they may have been there longer.

"If you are still using a plastic spout beaker, please think about it."

Beakers may be used to minimize spillage, although they may also be seen as a way to help patients with certain diseases that affect their ability to hold the cup or swallow normally.

However, despite concerns about its negative effects over the years, beakers can still be found in wards and nursing homes. However, changes may be brewing.

In June, a group of nurses, speech therapists, and nursing home staff launched a movement to replace them. They used the social media hashtag #endplasticspoutedbeakers to call on healthcare organizations to consider alternatives.

The event on Twitter brought together different professionals and showed people's enthusiasm for this issue. The people behind it believe that the spout beaker is dangerous and harms the dignity of the patient.

Elizabeth Meatyard is one of those who publicly opposed the use of beakers on social media. She said she hopes people will start discussing what kind of wine is appropriate for older people.

"Although she can hold a glass or a teacup, in all likelihood, I got one of these terrible spout beakers"

She used to be a nurse and had an aunt in a nursing home in Birmingham. She said: "Although she can hold a glass or tea cup almost all of the time, and despite numerous conversations with the staff, I still got a terrible beaker with saliva."

Residents of nursing homes like her aunt "instinctively" know how to hold a cup or glass, and think that the beaker that gave her a spout also "deprived her of a little independence".

Ms. Meatyard emphasized that the staff in nursing homes are "very cute", but claimed that if it is considered acceptable to "baby" the elderly, then this culture is problematic.

She said that what is needed will not take too much time. She thinks that helping aunts drink water from a glass or tea cup will bring a completely different level of care. "I hope she and the others I saw in her case have dignity last year or so," she told The Nursing Times.

She pointed out that her aunt's nursing home is currently rated as "excellent" by the Care Quality Committee, and questioned why it seemed to turn a blind eye to the beaker.

She called on CQC inspectors to regularly ask staff why in the environment they visit, plastic spout beakers are the norm rather than the exception. "This is part of the care. I won't give an excellent review," Ms. Meatyard said.

"They should only be used when the patient is being formally evaluated and this is part of their care plan"

Dr. Joanne Fillingham, clinical director of the NHS Improvement United Health Specialty, said that in a few cases, such as Parkinson's disease or Huntington's disease, a spout beaker may be needed. However, for others, they can cause harm, and Dr. Fillingham warns that he is a trained speech and language therapist.

She told the Nursing Times that fluid enters the more posterior mouth—the end of the mouth is the middle of the tongue—rather than entering the front of the mouth like a regular cup. It allows less time to process liquids and swallowing, and there is a risk of aspiration pneumonia-when food/liquid enters the throat and may be traced to the lungs instead of down the esophagus into the stomach.

"For weak or elderly patients, this is not a good thing," she said. "So, clinically, it doesn't make sense for these people." In addition, she emphasized that the beaker may have a negative impact on dignity.

"In our lives, we drink in glasses or cups," she said. "The only time we used a pacifier was when we were babies, because you had a sucking reflex-drinking from a pacifier or bottle."

She emphasized that adults do not need to suck in this way-it is "naive" to assume that someone can only drink in this way. Dr. Fillingham added that the therapist has struggled with the inappropriate use of plastic spout beakers for "for many years" and she hopes to raise awareness so they are not just the default choice.

"Do we raise a person's dignity by giving a beaker of water to drink?"

Dawne Garret, head of senior care at the Royal College of Nursing, says they can also confuse patients.

"People with dementia may not be able to recognize their use, which prevents them from staying hydrated," she said. "The lid on the beaker also makes it difficult for patients to assess what they are drinking, especially if they need to ingest thick liquids."

Despite the new movement and previous concerns, the researchers acknowledged that there is a lack of evidence to show how widespread the actual use of nozzle beakers is.

Dr. Ian Long, a senior lecturer in public health at the University of Exeter, has been following the event on Twitter, saying that he suspects that no one really knows. "There may have been studies on hydration in nursing homes, but I don't know if there is any [spout beaker] in it," he said.

He said that the drinking glass problem seems to be a "trivial matter", but it involves a wider range of issues. Dr. Lang said that this may be due to a conflict between the convenience of the staff and the dignity of the patient.

Despite the lack of conclusive evidence, the rumored beaker with a plastic spout seems to be the most common in nursing homes.

George Coxon, head of the Pottles Court Nursing Home in Devon, which was rated "excellent" by CQC, said that in the 1990s, spout beakers were a "standard issue" in nursing homes, and it is still the case in some places.

"No residents in my nursing home use them," he said. Instead, they used "a whole bunch of hybrid cups", which he thought was more commonplace. He said that residents can say "that is my cup" instead of everyone owning the same product.

Mr. Coxon pointed out that a resident used a two-handed container because she was easier to pick up, but did not have a lid or spout. Although he does not rule out using them when deemed necessary under certain circumstances, he emphasized that this is to give residents personal choice.

"If they want a good plastic spout beaker, but don't think they have done so, always ask," he told the Nursing Times. If a beaker is needed, he recommends that people keep a record so that in the case of a CQC inspection, they can prove that it was a deliberate decision, rather than doing something lightly.

Tracey Chapman is an admiral nurse who works in the community and has worked closely with people with dementia. She said that spout beakers are routinely used for all elderly patients.

"You shouldn't think that because someone is old, weak or confused, or suffering from dementia, it is acceptable to give them a beaker with a plastic spout," she said. "Do we raise a person's dignity by giving a beaker of water to drink?"

She said she remembered an older woman who did not understand the nozzle. She said that she would turn the beaker, turn it upside down, and try to drink, but the liquid spilled from her front.

Ms. Chapman described the experience of drinking from a beaker with a spout as "terrible" and she said that all nursing students should try it. "Unless you have that kind of experience, it's hard to resonate," she told The Nursing Times.

Dr. Fillingham agreed that these beakers were uncomfortable to drink, and added that because they are often used to hold tea and coffee, they can quickly become soiled. "Plastic spout beakers are not suitable for anyone," she said. "I don't want to take a sip, nor do I want my mother to take a sip."

But she said that if patients are unable to make a choice, caregivers need to make decisions in their best interests. In this case, there are usually better alternatives than plastic spout beakers, such as the use of adult fitness bottles, she emphasized.

The Nursing Times asked the NHS in the UK to provide national opinions on the use of spouted beakers by health services, but a spokeswoman said that a personal trust decides what patients drink.

Evidence from several acute trusts contacted by The Nursing Times shows that these beakers are not used regularly, but they have not been banned.

The University of Manchester NHS Foundation Trust has nine main locations, including three acute hospitals, and it stated that spout beakers are only used in “exceptional” situations.

"For many years, all our hospitals have widely accepted that wide-mouth beakers should not be used," said a trust spokesperson. "In special circumstances, for a small number of patients who have undergone clinical evaluation, the use of a wide-mouth beaker may be considered beneficial to maintain individual independence and moisture."

In addition, a spokesperson for the Guy and St Thomas NHS Foundation in London stated that it will only use them "when a speech and language therapist assesses a clear clinical need."

The Royal College of Speech and Language Therapists recognizes that spout beakers may sometimes be required.

A spokeswoman said: “We think it should be used according to the individual needs and choices of the patient.” “For example, we know that Parkinson’s disease patients with tremor may prefer to use plastic spout beakers.”

But Ms. Garret of RCN bluntly expressed opposition, saying that if the use of plastic spout beakers is not closely monitored, it will "cause multiple problems." She said: "They can only be used when the patient is formally evaluated and it is part of their care plan."

Mr. Coxon said: "If you are still using plastic spout beakers, please think about it and make sure you do it for the right reasons."

Plastic beakers are at least 50 years old, although there are now a variety of professional beakers/cups/mugs available, some of which are suitable for people with Parkinson's disease or tremors. Many hospitals have heavy cups with small handles, which makes it difficult for disabled and elderly people with dexterity or poor grip to use them. Need to invest in a more user-friendly design. The patient needs to choose. Some problems can be solved by flexible plastic straws, and Mr. Gove hopes to prohibit the use of such straws. You can use a special straw with a one-way valve to make sucking easier. As your article suggests, people often make assumptions about patients and choose cups for hot drinks or plastic beakers. The juice in a separate container makes drinking impossible, or overflows in large amounts. Hydration is very important, as is dignity.

I am very grateful to you for bringing this question to the front desk. Like most things related to "hydration care", it raises many broader issues related to aged care, dignity, and nursing time...repeated concerns. I totally agree with the main points in the article. As the chairman of the National Hydration Network-this is something we can make sure to stay on the agenda and lobby for specific research in this area. I am not a very active Twitter-but I will emphasize go to your # and spread the word. Best wishes to all who participated in this article.

I don’t know how many words there are in this article, but it can be summarized in three words: assess your patient/client/resident. You should not automatically provide someone with a spout beaker, just as you should not use baby language to adults, and vice versa. However, it is absurd to immediately condemn these beakers as "damaging to dignity". Dehydration due to hand tremor or wearing a drink in front of you is "indignant." Has anyone been to the gym recently? How many able-bodied people are willing to use a beaker with a spout without affecting their dignity?

I think all of the above has put forward some valid opinions. We need to get rid of the ritual practices that plague us in many areas of practice once and for all, but not only nurses need to proactively provide patients/residents with choices and the choices that best meet their actual needs; managers, caregivers and family members also need to consider To this point. Managers, because they are in charge of money, nursing staff, especially those in NH, are usually the main staff who provide most of the front-line care, such as assisting with food and family, because they sometimes veto or think they know them best "Doting" is relative.

I often think that plastic beakers are detrimental to dignity. China will be fine, but do not tolerate commercial dishwashers. I work with clients with dementia. Drinking fountains are often confused, dropped, thrown, etc. The nozzle can be shortened to enhance proper swallowing, and perhaps the weight of the base can be increased to avoid tipping. But a "pretty" decorated case might be a cheaper alternative that looks like a regular cup with a lid?

Log in or register for a new account to join the discussion.

Nearly one-fifth of the learners say...

South Central Essex NHS Foundation Trust

Royal Wolverhampton NHS Trust

Royal Wolverhampton NHS Trust