When feeding a resident at the table, where should the CNA sit?

According to healthcare guidelines, a CNA should never stand over a resident while assisting with a meal. This is because sitting at eye level, ideally to the side of the resident, is the industry-recognized best practice when feeding a resident at the table. The correct positioning is crucial for fostering a sense of dignity, promoting communication, and ensuring safety during mealtimes.

Quick Summary

A CNA should sit at eye level beside the resident during meals to promote dignity, enhance communication, and ensure proper monitoring for swallowing difficulties. This practice fosters a respectful and comfortable dining experience for the resident.

Key Points

• Sit at Eye Level: Position yourself in a chair beside the resident at eye level, not standing over them.

• Promote Dignity: Sitting down shows respect and creates a more comfortable, equal interaction, rather than an intimidating one.

• Prioritize Safety: Sitting at eye level allows for a clear view of the resident's mouth to monitor for swallowing difficulties and prevent aspiration.

• Enhance Communication: Maintaining eye contact facilitates better social interaction and conversation, improving the dining experience.

• Adjust for Resident Needs: For residents with one-sided weakness, sit on their stronger side to provide optimal support.

• Create a Calm Environment: Minimize distractions like a television and engage in pleasant conversation to keep mealtime relaxed and focused.

Why Proper Positioning is Essential for Resident Dignity

Proper positioning is more than just a matter of convenience; it is a cornerstone of person-centered care that prioritizes a resident's dignity and well-being. When a Certified Nursing Assistant (CNA) stands over a resident during mealtime, it can create a power imbalance, making the resident feel intimidated, rushed, or infantilized. Conversely, sitting down to be at eye level conveys respect and establishes a more equal, comfortable interaction. This simple act can significantly influence the resident’s emotional state during a vulnerable time, making the meal a more pleasant and relaxed social experience rather than a task. For residents with dementia, a calm, eye-level approach can also reduce anxiety and confusion.

Seating and Positioning for Optimal Safety and Comfort

To ensure both safety and comfort, a CNA should sit in a chair beside the resident's table, maintaining an eye-level position. If the resident has one-sided weakness, the CNA should sit on their stronger, unaffected side. This placement offers several advantages:

• Clear Visibility: The CNA has a direct, unobstructed view of the resident's face and mouth, allowing for close monitoring of chewing and swallowing.
• Effective Communication: Eye contact is easily maintained, facilitating a pleasant conversation and encouraging the resident to participate in the meal.
• Timely Intervention: In case of choking or difficulty swallowing, the CNA is in an immediate position to provide assistance.
• Physical Connection: A CNA can gently place a hand on the resident’s shoulder to provide a reassuring and comforting physical cue, which can be especially helpful for those with dementia.

The Ideal Mealtime Environment

Creating the right environment is as important as proper positioning. Mealtimes should be treated as a dignified and respectful event, not a rushed task. CNAs can help create this atmosphere by doing the following:

• Minimize Distractions: Turn off televisions or radios and engage in pleasant, respectful conversation with the resident.
• Promote Autonomy: Encourage the resident to do as much as they can for themselves, even if it is just holding a piece of bread.
• Describe the Meal: Announce what foods are on the plate and ask what the resident would like to eat first.
• Maintain a Calm Pace: Allow the resident plenty of time to chew and swallow, offering small bites and alternating solids with liquids.

Comparison of Positioning Techniques

Feature	Best Practice: Sitting Beside the Resident	Poor Practice: Standing Over the Resident
Dignity	Promotes a feeling of equality and respect.	Creates a power imbalance; can feel intimidating or demeaning.
Communication	Facilitates direct eye contact and pleasant conversation.	Impedes eye contact and can make communication difficult.
Safety Monitoring	Provides a clear, close-up view of the resident’s swallowing process.	Obscures the view of the resident's mouth and can hinder observation.
Resident Comfort	Fosters a calm and relaxed atmosphere.	May cause the resident to feel rushed or anxious.
Caregiver Fatigue	Reduces physical strain from standing or bending over.	Can cause back strain or other physical stress over time.

Practical Steps for Feeding a Resident

1. Prepare the Resident: Ensure they are in an upright, 90-degree seated position, with feet flat on the floor or a footrest. Place a clothing protector—never a “bib”—on them.
2. Ensure Proper Hygiene: Have the resident wash their hands or assist them in doing so. Wash your own hands thoroughly before serving.
3. Position Yourself: Sit at eye level, next to the resident at the table. If they have a dominant side, sit on that side.
4. Present the Meal: Describe the food items on the plate and ask what they would like to eat first. Use positive language to encourage their appetite.
5. Encourage Independence: Allow the resident to participate as much as they can. Prepare food by cutting, buttering, or opening containers as needed.
6. Offer Food Respectfully: Serve small bites at a reasonable pace, ensuring they have swallowed before the next bite. Alternate bites with sips of fluid.
7. Maintain Communication: Talk with the resident throughout the meal, keeping the conversation light and friendly.
8. Clean Up After: After the meal, help the resident clean their face and hands. Clear the tray and ensure the resident is comfortable before you leave.

Conclusion

When feeding a resident at the table, the CNA should sit down at eye level, positioned alongside the resident to ensure their comfort, safety, and dignity. This approach prevents a perceived power dynamic, fosters positive social interaction, and allows for vigilant monitoring of the swallowing process. By following these best practices, CNAs not only fulfill their responsibilities but also enhance the quality of life for the residents under their care, turning mealtime into a respectful and enjoyable experience. Respectful positioning and attentiveness are fundamental to providing excellent, person-centered care.

Dementia Nutrition: Dining with Dignity

Frequently Asked Questions

Why shouldn't a CNA stand while feeding a resident?

A CNA should not stand while feeding a resident because it can feel intimidating and demeaning to the resident, creating a power imbalance. Sitting at eye level fosters dignity and respect, making the resident feel more comfortable and at ease.

What is the best position for a CNA to sit when assisting with feeding?

The best position is to sit in a chair next to the resident at eye level. If the resident has one-sided weakness, sit on their stronger, unaffected side to provide better support and encouragement.

How does sitting at eye level help with resident safety?

Sitting at eye level provides the CNA with a clear, direct view of the resident's mouth, allowing for close monitoring of chewing and swallowing. This is critical for preventing aspiration and ensuring the resident eats safely.

How does proper positioning affect communication during mealtime?

Proper positioning at eye level facilitates effective communication. It allows the CNA to maintain eye contact, which fosters a sense of connection and makes conversation more natural and pleasant for the resident.

Is it okay to rush a resident during mealtime?

No, you should never rush a resident during mealtime. The pace should be comfortable for them, allowing ample time for chewing and swallowing. Rushing can cause stress and increase the risk of choking.

Should a CNA use a 'bib' for a resident during meals?

No, it is best practice to refer to and use a 'clothing protector' or 'napkin' instead of a 'bib'. Using the term 'bib' can be infantilizing and disrespectful to a resident's dignity.

How should a CNA encourage a resident to eat more?

A CNA can encourage a resident to eat by describing the food in a positive way, offering food they enjoy, providing small, manageable bites, and engaging in pleasant conversation to make the experience more enjoyable.