Meal Supervision Role Play Handout

After watching the video 

Discuss as a group the two questions:  

What did the clinician did well?  

What might she do differently next time she provides meal supervision?  

See below for a summary of potential answers to these questions.  

What she did well: 

• She was patient and calm with his initial refusal to eat the meal, and provided encouragement and prompt to start the meal.  

• She was clear and confident that she was not going to change the meal that had been provided by food service, and that changes to meal plan can’t be made at the time of the meal.  She explained that the next opportunity to discuss the meal plan would be in the case review.

• She explained the time available to complete the meal (e.g. “you have 15 minutes to complete the meal”).  

• She explained the protocol if the meal was not able to be consumed.  

• She knew the meal plan well enough to notice that something was missing and communicated this calmly and non-judgmentally to the patient. She encouraged the client to avoid reading the nutritional labels on the food as this can often increase distress.  

• She provided feedback on behaviours she wanted the client to reduce (i.e. crumbling of the crackers).  

• She provided validation for the patient's distress (e.g. “I know that it’s difficult”).

• She provided encouragement (e.g. “You’re doing a really good job”).

• Role modelled normal eating.

What she might do differently next time:

• She wouldn’t leave the patient alone with the meal to answer the phone. It helps to inform colleagues that you are unavailable during meal periods.  

• If the role play continued, she would have sought to engage the patient in a distracting activity (e.g. discussing a preferred topic, or completing a crossword/puzzle game, according to the client’s preference).  

• In some circumstances, it can be helpful to decant drinks (e.g. juice) or remove items from packaging (i.e. onto a plate or bowl) if a patient is finding it difficult to not read the nutritional information on the packaging. This of course needs to be done in line with local food safety policies.    

General tips for providing meal supervision 

• Be prepared - preparation and predictability can lessen patient anxiety. 

• Explain to the patient (and family if appropriate) what to expect.

• Set the patient up ready for the meal, where possible reducing opportunities for eating disorder behaviours, for example, out of bed in a chair, remove tissues, roll up long sleeves.

• Have correct meal tray, everything you’ll need, prepare distraction techniques/conversations/games and outline exchange process for incomplete meals.

• Advise patient to use bathroom before the meal.

• Food as per meal plan – not negotiable, if patient wants changes to meal plan this must be deferred to review with the dietitian at MDT.

• 15min snack / 30min meal.

• Do not leave patient alone with meal.

• Encourage appropriate eating practices. 

• Discourage discussions about food.  

• Watch for hiding food, dropping, spilling or smearing food.

• Role model - eating (appropriate meal) with patient.

• Remove meal tray immediately following meal.

• Deliver supplementation if required.

• Nil access to bathroom 60min post meal – bed rest.

• Document intake and behaviours.