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Patient Feedback Volunteer

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Purpose 

We are looking for volunteers to improve the patient and carer experience through gathering and encouraging feedback from our patients and/or people who look after them at home (carers).

This could involve using the Friends and Family Test (FFT), short local surveys, or other feedback tools such as hearing patient stories or asking patients pre-set questions. You may have to pass on concerns, complaints, or issues raised by the people you speak with to staff, so that they can be dealt with. 

We are looking for volunteers who enjoy meeting new people, have excellent listening skills, and a friendly and open manner. In return you will meet new people and contribute to improving the wellbeing of our patients. You will also gain practical volunteer experience and learn about the healthcare environment gaining experience that may be transferable to paid employment.

Commitment level

2-4 hours, weekly or fortnightly for a minimum of 6 months

Shifts available 7 days a week, timings can be discussed upon application 

Summary of duties

  • The nursing staff will sign post you to patients/carers to conduct the survey and who will be being discharged soon. Alternatively, you may be asked to approach patients/carers in waiting areas or from a list with contact details.
  • The patients/carers who will be selected to be surveyed will be assessed to ensure that they are appropriate for volunteers to contact. Exceptions to this may be where you are undertaking surveys in a waiting area and patients/carers can not be pre-selected. You will receive safeguarding training as part of your induction to assist with this and have an identified supervisor should you have concerns about the person you are speaking with.
  • Introduce yourself as a volunteer and confirm the patient/carer is happy to take part in the survey.
  • Follow the role procedure to let the patient/carer know further information about the survey, such as what it is being used for, confidentiality, and where the results will go.
  • You will talk through the survey questions and record the answers. This is likely to be on an iPad provided by the ward/area. Or if you are undertaking patient conversations, see handbook.
  • If the patient/carer has any clinical questions, always escalate these to an appropriate staff member.
  • Any concerns must be reported to a staff member immediately.
  • The patient/carer is able to stop the survey at any time and withdraw.
  • Inform the nurse in charge/manger that you have completed the survey when you have surveyed all available patients/carers.
  • It is important to follow compliance with all infection control procedures and guidelines shared with you.

Skills, experience, attitudes, and qualities needed

Essential

  • Comfortable communicating confidently
  • Excellent listening skills and a non-judgmental attitude
  • A friendly and open manner
  • To feel comfortable in an acute hospital environment
  • To adhere to the Trust values of treating others with respect at all times
  • Understand the importance to stay within the boundaries of the role description

Desirable

•    Experience working with people with cognitive impairments or dementia
•    Experience working with people with autism or a learning disability 

Training and information provided

•    Volunteer mandatory training programme (please find further information on our FAQs page)
•    Department orientation and induction
•    Specialist training if required, such as Dementia Level 2
•    Shadowing induction sessions with an existing volunteer or staff member demonstrating the role.
•    Ongoing supervision and support 
•    Ongoing updates and information

Challenges of the position

•    Coming into hospital can be an anxious time for patients and their relatives. Sometimes this may make people less tolerant than they might usually be and they may come across as impolite. It is important that the volunteer remains calm and listens politely and seeks staff support immediately if required.
•    Potentially supporting patients with cognitive impairments or dementia (around 25% of inpatients at NBT have dementia), additional training and support will be provided. 

Boundaries of the position

Volunteering within the NHS has clear boundaries to ensure that we are keeping our patients and volunteers safe. Please download the detailed role description below for further details. 

Reimbursement of expenses

•    Travel expenses to and from the hospital can be reimbursed
•    Meal vouchers for use in the staff Vu restaurant are offered if volunteering for over 4 consecutive hours in one day

Benefits of volunteering

•    Gain practical volunteer experience and learn about the healthcare environment 
•    Develop skills and experience that may be transferable to paid employment, such as working as a part of a team
•    Opportunity to help/support patients during a difficult time provide facilitating meaningful feedback
•    References can be provided on completion of three months volunteering, if required
•    Ongoing support and supervision sessions
•    Making friends with other volunteers and meeting new people
•    Awards in recognition of volunteering contribution
•    Free parking

Recruitment information

You will be asked to provide two independent references from people who have known you for more than three years (this cannot be a family member).

You will also need to have a standard Disclosure and Barring Service (DBS) check for this role, which will be paid for by the Trust.

How to apply

If you would like to apply for this volunteer opportunity, please click the link below to be taken to the application portal, where you will be able to apply online: 

Current Vacancies

If you would like an alternative method to apply, such as a paper application form, please get in touch with us directly on: 

Telephone Number: 0117 414 0110

Email: Volunteer.services@nbt.nhs.uk

Postal Address: Volunteer Services, North Bristol NHS Trust, Brunel building, Level 1, Gate 18, Southmead Hospital, Bristol, BS10 5NB

Patient Feedback Volunteer Role Description.docx
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Eating well on haemodialysis - information for kidney patients

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Introduction

This information will help you choose foods to keep you well on dialysis. You may also be given some extra information if needed. Your dietitian may change the advice in the future if your health, blood tests or appetite changes.

Contents

  • Protein foods
  • Fluid
  • Salt
  • Potassium
  • Phosphate
  • Small appetite
  • Vitamins

You will be able to talk to your dietitian regularly about your eating. You can contact your dietitian at any time. See the bottom of the page for contact details.

What can I eat? 

Beans, lentils, fish, eggs, meat and other protein foods

These are high protein foods. They are essential:

  • For strong muscles
  • To fight off infections
  • For healthy skin and blood

Before starting dialysis, you may have been advised to eat smaller portions of protein foods. Now your body is losing some protein during dialysis. You need to eat extra protein foods to replace what you are losing.

High protein foods and their recommended portions

  • Meat, chicken and turkey - palm size portion
  • Fish - hand size portion
  • Eggs - 2 eggs
  • Beans, lentils - half a tin or 6 tablespoons
  • Quorn, tofu, tempeh, soya, protein - palm size portion

Try to eat protein foods at two meals every day. Speak to your dietitian if you are struggling to manage these.

Dairy or dairy alternatives (such as soya drinks and yoghurts)

Milk, cheese, yoghurt and fortified soya milk are great sources of protein and calcium. They also contain a lot of phosphate.

Phosphate levels in the blood may be high when the kidneys are not working properly; this can increase your risk of heart disease, cause weak bones and itching. Your dietitian will advise if you need to limit these foods to lower phosphate levels in the blood. See phosphate section below for more information.

Potatoes, yams, cassava, plantain, bread, rice, pasta, cereals and other starchy carbohydrates

These foods give us energy.

Try to include one serving at every meal.

Wholegrain varieties are high in fibre. Fibre helps to keep your bowels healthy and prevent constipation. Constipation can prevent your dialysis from working well.

Try to choose these wholegrain foods:

  • Wholemeal or granary bread
  • Wholegrain cereals such as shredded wheat or Weetabix
  • Wholewheat pasta
  • Brown rice

You may have been advised to always boil potatoes, yam, cassava and plantain; this reduces the potassium. Your dietitian will advise you if you still need to do this.

Fruit and vegetables

Eat at least five portions of a variety of fruit and vegetables per day.

You may have been advised not to eat some fruit and vegetables because your potassium levels in the blood have been high. Your dietitian will advise you if you still need to do this.

Fatty and sugary foods

Foods high in fat and/or sugar include pastry, fried foods, cakes, biscuits and chocolate.

If your appetite is good and you want to manage your weight and eat to keep your heart healthy, you could:

  • Eat smaller portions of high fat/high sugar foods.
  • Choose low fat options where possible such as lean meats.
  • Choose lower fat dairy foods such as milks, yoghurts and cheeses.
  • Use smaller amounts of unsaturated fats and oils such as vegetable oil and olive oil spread.

Fluid

Fluid mainly comes from liquids you drink.

When most people start dialysis, they are still passing urine. Fluid is removed from the body by dialysis and by passing urine.

Many people find that after a while on dialysis they pass less urine; they begin to rely on dialysis to remove most of the fluid.

If you are drinking more fluid than can be removed, you will become fluid overloaded (oedema). The extra fluid puts a strain on your heart and lungs. It is often difficult to remove extra fluid by dialysis.

Signs you are overloaded are:

  • Rapid weight gain
  • Swollen ankles
  • Feeling breathless
  • Higher blood pressure

You will weigh yourself before and after dialysis sessions. The change in weight from the end of one session to the beginning of the next is mainly fluid. Your doctor, dialysis nurse or dietitian can advise you on your ideal maximum weight gain between dialysis sessions.

If you are gaining too much fluid your doctor, dialysis nurse or dietitian may advise you to limit the fluid you drink.

Tips if you need to have less fluid:

  • Try to have fewer drinks and spread your fluid throughout the day.
  • Use a small cup or glass for drinks.
  • If eating sloppy or liquid foods such as such as soup, custard, yoghurt, ice-cream, reduce how much you drink.
  • Spicy and salty foods can make you thirsty so try to reduce these foods.
  • Try using plastic ice-cubes in drinks to save extra fluid.
  • Rinsing your mouth, gargling with mouthwash and brushing your teeth can help freshen your mouth.
  • You can quench your thirst with slices of lemon, orange, frozen grapes, pineapple cubes, boiled sweets, sugar free mints and chewing gum.
  • If you have a dry mouth, artificial saliva sprays may help such as Glandosane (available on prescription).
  • Keep a record of all liquids you are having including all drinks, soups, gravies, jelly, yoghurts, and ice-cream.

Your dietitian can give you more ideas to help.

Salt

Eating less salt can help you to feel better. Reducing salt helps your dialysis remove fluid, can improve your blood pressure and make you feel less thirsty.

Most of the salt we eat comes from processed and ready prepared foods.

Tips to reduce salt:

  • Have more home cooked foods. Cook from scratch where you can.
  • Try to reduce processed foods. Sausages, bacon, ham, ready meals, jars of mustard, sauces, pickles, and table sauces are salty.
  • When shopping, check food labels. Aim to eat mainly foods which have less than 0.3g salt per 100g or with a green traffic light symbol for salt. If you are choosing ready meals, aim for less than 1.8g per portion.
  • Consider having higher salt foods (more than 0.3g salt per serving, or amber or red traffic light) less often and in smaller amounts.
  • Free apps such as FoodSwitch or NHS Food Scanner can help.
  • Flavour your food with herbs, spices, lemon, garlic, vinegar, dry mustard powder.
  • Try to avoid using salt in cooking. Taste food first as you may not need it.
  • Try not to add any salt at the table.
  • Avoid salt that has ‘low in sodium’ written on the label as these contain potassium. This includes LoSalt, Solo, Saxa So-low.

Your dietitian can give you more help to reduce the salt you eat.

Potassium

Potassium is a mineral found in many foods. It helps our nerves, muscles and heart to work properly. Our kidneys usually control the level of potassium in the blood. Extra potassium is passed out in the urine.

Dialysis removes potassium but levels can build up between sessions, especially if you start to pass less urine. Your levels of potassium in your blood will be checked regularly.

The target range for potassium in your blood is 3.5 – 5.9mmol/l. A high level of potassium can be dangerous, as it can affect your muscles and heart.

Your dietitian will advise if you need to eat less potassium to keep your blood levels safe.

These are foods and drinks higher in potassium:

  • Some fruits such as apricots, avocado, bananas and dried fruit.
  • Some vegetables such as mushrooms, parsnips, spinach and tomatoes.
  • Potatoes which have not been boiled such as chips and jacket potatoes.
  • Snacks such as potato crisps, nuts, chocolate and liquorice.
  • Drinks such as coffee, malted milk drinks and fruit juices.
  • Alcoholic drinks such as cider and strong ales.
  • Soups containing tomatoes and vegetables.
  • Salt substitutes such as Losalt, Saxa So low and Solo.

Only limit high potassium foods if you have been advised to.

If you have diabetes, you may have been recommended to eat more fruit, vegetables and nuts. Your dietitian can advise you on appropriate quantities and help you choose lower potassium options.

Phosphate

Phosphate levels in the blood can be high when the kidneys are not working properly; this can increase your risk of heart disease, weaken your bones and cause itching.

Dialysis is poor at removing phosphate from the blood. Your levels of phosphate in your blood will be checked regularly.

The target range for phosphate in your blood is 0.8 – 1.5mmol/l. If your levels are high, eating less phosphate can protect your bones and heart, and help you feel less itchy.

High phosphate food and drinks include:

  • Cola drinks and other dark coloured fizzy drinks which contain phosphoric acid.
  • Processed foods containing phosphate additives such as ready meals, processed meats and cake mixes. Check the ingredients label for additives with ‘phosphate’ in the name such as diphosphates, triphosphates, sodium phosphate.
  • Nuts and chocolate.
  • Products with raising agents such as muffins and scones.
  • Malted milk drinks, drinking chocolate and cocoa.
  • Evaporated and condensed milk.
  • Fish with edible bones such as sardines, pilchards and whitebait.
  • Shellfish such as fresh crab and scampi.
  • Offal products such as liver, liver sausage and pate.

Other high phosphate foods such as dairy products, milk, fish and meat are good sources of protein and other nutrients. Some recommended portion sizes are below.

Your dietitian can guide you on how many portions to have per day or per week. For most people 2 servings per day of dairy foods and up to 6 eggs per week will limit the amount of phosphate you’re eating.

High phosphate foods recommended portions

  • Milk - 200ml
  • Yoghurt - 1 small pot
  • Cheese - 1 small matchbox size portion
  • Eggs - 6 per week

If you are already following a low phosphate diet your dietitian will advise if you need to continue. Only limit high phosphate foods if you have been advised to.

To help control phosphate levels, some people may be prescribed tablets called phosphate binders. Your dietitian will advise on the best way to take these to make sure they work well.

Small appetite?

If yes, the following information may help.

  • Eat little and often throughout the day. Try three meals and 2 - 3 snacks every day.
  • Eat small nourishing snacks between meals such as cereal and milk, cheese and biscuits, cakes, biscuits, desserts, pastries.
  • Have a snack, sandwich or a milky drink if you cannot manage your normal meal.
  • Try easy to prepare high protein meals such as cheese, scrambled egg, poached egg on toast or omelette.
  • Use full fat and full sugar versions of foods and drinks such as full fat milk, full fat yoghurt instead of diet or low fat ones.
  • Try to eat more on days or at times you feel better.
  • Spread butter, margarine, honey, jam and marmalade thickly on bread, croissants, and crumpets.
  • Add honey or sugar to cereals and puddings.

Eating well is important to help you feel better and cope with dialysis.

Some of these foods are high in salt, sugar, phosphate and potassium which may not be in line with the diet you have previously been advised to follow. If you have diabetes or you are limiting potassium or phosphate, speak to your dietitian for more information.

Vitamins

Water soluble vitamins are lost during the dialysis process.

Your GP can prescribe a multivitamin tablet (Renavit) suitable for people with kidney disease; this helps to replace the vitamins lost during dialysis.

Renavit contains a beef product so if you are unable to take this, we can recommend an alternative.

You will need to take Renavit after your dialysis session (three times a week for most people).

You are recommended to discuss any other vitamin, mineral, herbal or fish oil supplements with your dietitian or doctor before taking; some can be harmful for kidney patients.

Can I eat during dialysis?

Some people find it more difficult to eat well on dialysis days. This can be due to lack of time and being away from home.

Many people take a packed lunch or snack with them to dialysis. This can be particularly helpful if you have diabetes, or if your appetite is poor.

Eating during your dialysis session can help you get nourishing food even on busier dialysis days.

  • Try to include high protein foods such as a sandwich with a meat or fish filling.
  • If you normally choose low potassium or low phosphate foods, you should continue to choose these for meals and snacks during dialysis.
  • If you experience nausea or low blood pressure whilst on dialysis, consider eating smaller amounts more often during your session.

How can I eat more sustainably?

Many people want to eat food that is more environmentally friendly. Below are some ideas you could consider.

  • Try some plant food sources of protein such as beans, lentils, soya mince, Quorn, tofu.
  • When buying fish look for the Marine Stewardship Council or Aquaculture Stewardship Council symbols.
  • Try calcium fortified plant milk such as soya or oat instead of cow’s milk.
  • Opt for wholemeal breads and wholegrain versions of pasta and cereals.
  • Choose local and seasonal produce.
  • Avoid chopped, ready prepared and packaged fresh fruit, veg and salads if you can.
  • Reduce food waste, especially of fresh fruit and veg, by choosing tinned and frozen alongside seasonal fresh produce.

Further information

Patients Know Best

An easy-to-use online service that allows you to monitor your own blood test results. You can find out more and register to use it at https://patientsknowbest.com/register/

Websites

Information on kidney disease and food written by the kidney dietitians at North Bristol NHS Trust

Education videos on how to eat less salt presented by the kidney dietitians at North Bristol NHS Trust

Kidney Care UK diet and lifestyle information including recipe books to download

Kidney Patient Guide diet information including menus and recipe books to download

Website of the Edinburgh Renal Unit and contains useful dietary information

Webinar on importance of protein for people on haemodialysis

Kidney Care UK practical advice to help you reduce your weekly food shopping bill while maintaining a nutritious and kidney friendly diet

Contact your dietitian if you need further help. 

© North Bristol NHS Trust. This edition published March 2023. Review due March 2026. NBT003498.

Contact Nutrition & Dietetics

Kendon House
Kendon Way
Southmead Hospital
Bristol

Telephone:  0117 414 5428 or 0117 414 5429

Rapid Eye Movement (REM) Sleep Behaviour Disorder

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What is REM sleep?

Sleep is split up into different “stages” through the night. Rapid Eye Movement (REM) sleep is a stage which first occurs around 90 minutes after you fall asleep. The first period of REM normally lasts around 10 minutes, and as sleep continues there tends to be more REM in the second half of the night.

It is called ‘rapid eye movement’ sleep because your eyes will move more rapidly behind closed eyelids.

During REM, dreams may be much more vivid. This is due to the fact that the brain is more active during this stage.

REM sleep is important and is associated with many aspects of health and brain function. Therefore it is important to get enough REM sleep to be better able to function during the day.

The image below shows the stages of sleep we move through in a typical night. Non REM stage 1 is light sleep and Non REM stage 3 is deep sleep.

What are parasomnias?

Parasomnia is a word used to describe unusual behaviours that occur during sleep. There are many different forms, with sleepwalking being the classic example. Sleepwalking and sleep terrors are Non REM parasomnias (occurring from Non REM Stage 3 - “deep sleep”). They are common during childhood but occur more rarely in adults.

When abnormal events occur during REM sleep, then they are known as REM parasomnias.

REM-related parasomnias include:

REM sleep behaviour disorder

People begin “acting out their dreams” by vocalizing or moving their arms and legs during REM sleep. They may recall dream content associated with the behaviour if they wake up - such as calling for help, trying to hit something or trying to defend themselves.

It is caused by a failure of the normal mechanism which keeps people still during dreams. It can cause poor sleep quality and unintended injuries to yourself or your partner.

Recurrent isolated sleep paralysis

People with this condition wake up but are unable to speak or move their body at all for several seconds. Around half of people will experience this once, but frequent episodes can cause anxious feelings about going to sleep.

Nightmare disorder

This condition describes those who have recurrent, vivid dreams, usually about threats to survival or safety. It may lead to poor sleep quality, fatigue, distress even during the day, and other psychological symptoms.

Non-REM and REM parasomnias
Non-REM parasomnias REM parasomnias
Sleeping walking REM sleep behaviour disorder
Sleep terrors Recurrent isolated sleep paralysis
Confusional arousals Nightmare disorder
Sleep-related eating disorder  
Abnormal sexual behaviours during sleep  

Why is this happening to me?

REM sleep disorders are usually caused by a problem with the part of the brain that sends information down the spine to the muscles. During normal REM sleep, these cells keep your muscles still so you don’t act on your dreams. However, with this problem, it means the body is able to act out behaviours associated with dreams during the night.

There are some risk factors which may make someone more likely to develop a REM parasomnia, and these include:

  • Being male
  • Being aged over 50
  • Having other neurological disorders such as Parkinson’s Disease
  • Having other sleep disorders such as narcolepsy
  • Taking certain medications such as antidepressants, or the use or withdrawal of alcohol and/or other illicit drugs
  • Having post traumatic stress disorder

There may be no particular reason in which people develop these sleep disorders. However, in a lot of cases, people subsequently go on to develop certain types of neurodegenerative disorders such as Parkinson’s and Lewy body dementia. This may be several decades later. REM sleep disorders can sometimes be the first symptoms that present in these conditions. This is why it is important that you discuss any symptoms or concerns that you may have with your doctor.

How are REM parasomnias diagnosed?

Person lying in a bed with sleep testing equipment attached to his head and face.

A detailed sleep history is sometimes enough on its own to make a diagnosis of an REM sleep behaviour disorder, especially if there is already a diagnosis of an associated condition such as Parkinson’s Disease.

A one or two night inpatient sleep study may be needed. This is known as “Polysomnography” (which means taking multiple measurements during sleep).

Polysomnography involves the use of a number of wires which are stuck to the patient, which are used to take various measurements of the body during sleep. The important thing we look for in REM behaviour disorder is muscle tension during REM sleep. 

Image credit: File:Polysomnography model.jpg - Wikimedia Commons

How are REM parasomnias treated?

Management of REM sleep behaviour disorder includes providing physical safeguards in your sleep environments, and some medications which may be offered to help with the condition.

Physical safeguards

Some examples of adjustments that may be suggested to keep you and your bed partner safe include:

  • Padding near the bed
  • Soft barriers at the side of the bed
  • Moving clutter and sharp-edged furniture away from the bed
  • Some partners put a large pillow between them during the night

Other factors

Stress and poor quality sleep can make REM sleep behaviour
disorder worse.

Sleep hygiene is a term used to describe a healthy approach to the management of sleep and wakefulness. This can often improve not just the quality of sleep but also help with sleep disorder symptoms. Examples of sleep hygiene measures are listed below.

Sleep hygiene measures

  • Regular waking times and bedtimes
  • Avoid caffeine in the afternoon and keeping the amount low in the morning
  • Avoiding stimulating activity in the hours before bed
  • Psychological relaxation techniques prior to sleep
  • A comfortable, quiet sleeping environment at the right temperature
  • Trying to sleep enough so as not to need an alarm clock to wake in the morning
  • Avoiding alcohol or other sedatives before sleep

Medications

Medication is not always needed, but may be used if the condition is severe, distressing or causing injuries. The most common medications that may be offered are:

Clonazepam

This acts as a sedative in order to help reduce arousal during the night. However there may be side effects such as daytime tiredness, impaired balance and slower breathing during the night.

Melatonin

This is a hormone that exists naturally in the brain, which can be supplemented. It can help reduce the severity and frequency of REM parasomnia. It has fewer side effects than clonazepam.

Stopping other medications

Some medications can cause or worsen REM sleep behaviours, and should be discussed at your initial appointment. Some examples of medications that might be having an effect include:

  • Antidepressants
  • Beta blockers
  • Alzheimer’s medications

Where to find more information

If you are seeking any further information that was not covered on this page, here are some free resources.

American Academy of Sleep Medicine

www.sleepeducation.org/sleep-disorders/rem-sleep-behavior-disorder

The Sleep Foundation

https://bit.ly/3QHV0OD

How to contact us

Rosa Burden Centre

Southmead Hospital

Westbury-on-Trym

Bristol

BS10 5NB

Telephone: 0117 414 0450

If you or the individual you are caring for need support reading this information please ask a member of staff for advice.

If you’re an overseas visitor, you may need to pay for your treatment or you could face fraud or bribery charges, so please contact the overseas office: Tel: 0117 414 3764 Email: overseas.patients@nbt.nhs.uk

Major Trauma Practitioners

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beezy

Physiotherapy - Major Trauma and Hyper-Acute Rehabilitation Team (HART) Practitioner & HART Therapy Lead

Beezy Wakefield

BSc (Hons), MCSP, HCPC

Beezy graduated from Southampton University in 2004. After 7 years of completing her core training at North Bristol NHS Trust, she specialised in Trauma and Orthopaedics. She spent 9 years leading and developing the trauma physiotherapy service and 2021 she secured a post in the Major Trauma Team as a practitioner with a special interest in pelvic and lower limb trauma. In November 2022 she became lead AHP for the HART team.

SMTN

Physiotherapy - Major Trauma and Hyper-Acute Rehabilitation Team (HART) Practitioner

Denise Axelsen

Denise Axelsen is qualified as a physiotherapist in 2010 (from University of the West of England), having worked within the fields of intensive care, neurosurgery and Major Trauma, where she has been working as a Major Trauma Practitioner since 2018. She supports the Network as Allied Health Professional Lead with the goal of uniting the delivery of rehabilitation across our region and throughout our Trauma Units.

SMTN

Physiotherapy - Major Trauma and Hyper-Acute Rehabilitation Team (HART) Practitioner

Nicholas Crease

Nick trained as a physiotherapist at the University of the West of England, Bristol qualifying in 2009. Following posts treating patients at several acute Hospital Trusts across England and Wales, and a period of travel, he returned to work in Bristol at Southmead Major trauma centre as a Senior physiotherapist in 2015. In 2018 after three years of treating complex orthopaedic, respiratory and spinal injured patients he stepped into the role of Major Trauma Practitioner, assisting in the management of those most injured patients attending the Trauma Centre. Nick has interest in complex pelvic and spinal trauma, older persons trauma and injury prevention – supporting national projects, alongside community and local government initiatives in this area.

Physiotherapy - Major Trauma and Hyper-Acute Rehabilitation Team (HART) Practitioner

Cora Deegan

SMTN

Speech and Language Therapist - Major Trauma and Hyper-Acute Rehabilitation Team (HART) Practitioner

Emma Bailey

Emma qualified from City University as a Speech and Language Therapist in 2016. The beginning of Emma’s career was spent in acute London hospitals working across areas including stroke, neurosurgery, upper airway and critical care. Moving back to the South West, she then specialised in neuro-rehabilitation at Frenchay Brain Injury Rehabilitation Unit before finally joining the Major Trauma team in August 2022. In her current position, Emma is excited and privileged to deliver therapy and support the development of the Hyper Acute Rehabilitation team alongside her major trauma practitioner role. Emma’s areas of interest include supporting teaching opportunities, tracheostomy and complex neuro-rehabilitation. Outside of work she enjoys gardening, swimming, running and attempting to surf!

SMTN

Speech and Language Therapist - Major Trauma and Hyper-Acute Rehabilitation Team (HART) Practitioner

Hannah Austin

Hannah qualified from Plymouth Marion University as a Speech and Language Therapist in 2019. Hannah began working in community rehabilitation in South Gloucestershire working with patients with progressive neurological diseases, long term conditions, stroke and frailty. With NBT, Hannah has worked across areas including hyper-acute stroke, facilitating aphasia conversation groups, neurosurgery and complex care pathways. In 2022 Hannah joined the Major Trauma Service, contributing to the development of the Hyper-Acute Rehabilitation Team, combined with her Major Trauma keyworker role. She has particular interest in Traumatic Brain Injury, complex dysphagia management and neuro-rehabilitation.

SMTN

Speech and Language Therapist - Hyper-Acute Rehabilitation Team (HART) Practitioner

Rory

Rory qualified from Manchester Metropolitan University as a Speech and Language Therapist in 2021. He has worked in the Neurology directorate at Southmead Hospital since 2016; first as a Band 2 HCA, then as Band 3 Behavioural HCA, until deciding to follow SALT as a career. After finishing his Masters, he was employed by the Core Clinical team as a Band 4 SALT assistant before finally joining the Hyper Acute Rehabilitation Team (HART) in September 2022 as a newly qualified SALT. In his role he delivers therapy and assessment of acute swallowing and communication disorders for patients in the very early stages of their rehabilitation, as well as support and education for friends and family. Rory has an interest in acute neuro-surgery and neuro-rehabilitation

SMTN

Occupational Therapist - Major Trauma and Hyper-Acute Rehabilitation Team (HART) Practitioner

Hannah Stroud

Hannah studied Occupational Therapy at Plymouth University and graduated in 2015. Hannah spent the first 2 years of her career as a rotational member of staff before becoming a static within stroke. Following this Hannah was successful in gaining a post on the Neurosciences rotation at North Bristol Trust, whilst working on the Neurosurgery ward her special interest in Major Trauma and complex rehabilitation developed. In June 2022 she joined the Major Trauma Team as an Occupational Therapist supporting the development of the Hyper Acute Rehabilitation Team.

SMTN

Occupational Therapist - Major Trauma and Hyper-Acute Rehabilitation Team (HART) Practitioner

Lucy Thomas

Lucy graduated from Cardiff University as an Occupational Therapist in 2009. She began her career in brain injury at the Bath Neuro Rehab Service before joining the general rotation at the Bristol Royal Infirmary where she worked for 8 years. Here she gained experience across multiple clinical specialities including Stroke, Oncology and Haematology, Trauma and Orthopaedics and Surgery.

In 2019 Lucy joined the Neurosciences rotation at Southmead Hospital, working in Stroke and Neurosurgery. Lucy’s specialist interest in brain and spinal injury led to her joining the Major Trauma Team in 2022 as Highly Specialist Occupational Therapist and Major Trauma Practitioner.

Occupational Therapist - Major Trauma and Hyper-Acute Rehabilitation Team (HART) Practitioner

Claire Campbell

SMTN

Major Trauma Nurse Practitioner

Anna Greene

Qualified as a nurse from Leeds University in 2010. She has always had a keen interest in Major Trauma, starting her career in Oxford John Radcliffe hospital Trauma ward, subsequently she moved to work in several London hospitals in the Emergency Departments. Since 2017 she has been working as a Major Trauma practitioner initially at St Georges Hospital in London and then relocating to the Southwest and Southmead hospital in 2021. Anna has a keen interest in Education and now has an extended role as the Severn Major Trauma Network Nursing Education Lead.

 

SMTN

Major Trauma Nurse Practitioner

Laura Crowle

Laura qualified from The University of Leeds as a Nurse in 2002. Laura has worked in a variety of surgical wards, including General Surgery, Urology and Plastic Surgery. Her interest in trauma started whilst looking after complex trauma patients undergoing plastic surgery. Laura has been working for the Major Trauma Service since 2013. She is a member of the National Major Trauma Nursing Group, which was started to develop Nurse Education and competencies for nurses caring for major trauma patients. Laura is the lead nurse for governance at the Major Trauma Centre. She has a keen interest in patient and staff wellbeing. Laura has undertaken Advanced Practice modules, including Patient Assessment and Clinical Reasoning, Pathophysiology and Diagnostic Reasoning for Advancing Practice, and Non-medical prescribing.

SMTN

Major Trauma Nurse Practitioner

Kaitlin Lynch

Kaitlin qualified with her nursing degree from University of Detroit Mercy in 2012 and with her Masters of Science in Nursing from the University of Michigan in 2018. After qualifying as a nurse practitioner, she began working for a neurosurgery team in Detroit, Michigan. She moved to England and started at Southmead Hospital in December of 2021, working on an elective surgical ward. Kaitlin began working as a Major Trauma Practitioner in July of 2022.

Major Trauma Practitioners

SMTN Rehabilitation Prescription

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Rehabilitation Prescription

Patients with rehabilitation needs at Southmead MTC can expect the creation and delivery of a bespoke patient Rehabilitation Prescription (RP). This document supports transitions of care and documentation of rehabilitation needs / expectations advocated by a number of national clinical reference groups and best practice guidance (NICE, BOAST and BSPRM guidelines). The RP can sometimes be referred to as a Rehabilitation Plan. The Southmead MTC RP provides a platform for explaining the injuries, management and rehabilitation trajectory for patients after Major Trauma. It also aids continuity of care when patients are transferred home or to their local hospitals or rehabilitation facilities, sharing clinical and rehabilitation information and supporting provision of a handover of care.

 

Rehabilitation Consultants

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Shigong

Consultant in Rehabilitation Medicine and Clinical Specialty Lead for the Bristol Centre for Enablement

Dr Shigong Guo

LLM MSc(Orth Eng) MRCS 

 

Shigong Guo is a Consultant in Rehabilitation Medicine specialising in trauma, vascular and amputee rehabilitation. He is also Clinical Specialty Lead for the Bristol Centre for Enablement. With an academic background in bioengineering and medical law, as well as previous higher surgical training in trauma & orthopaedics, Dr Guo has a keen interest in the biomechanical and medico-legal aspects of musculoskeletal trauma and amputations, and their effects on clinical practice and rehabilitation.

Leadership Team

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Dr Julian Thompson Clinical Director, Severn Major Trauma Network

Clinical Director, Severn Major Trauma Network

Dr Julian Thompson

MA(Oxon) BMBCh MD(Res) MRCP FRCA FFICM EDIC DMCC DipIMC RCSEd

Dr Julian Thompson is a Consultant in Intensive Care at Southmead Hospital Bristol, Clinical Director of the Severn Major Trauma Network, Associate Professor at the University of Stavanger, Norway, and a Critical Care Doctor for the Great Western Air Ambulance.

Julian was trained in Oxford and London, completed a doctorate in hypoxia and genetics at University College London and has worked in a range of international healthcare systems. Previous leadership experience includes being Executive Director of London’s Air Ambulance from 2011-15, working as a medical officer in the British Army and leading expeditions that include reaching the summit of Mount Everest. He is Deputy Editor of the Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine and his research interests include critical care, major trauma and extreme environment medicine. 

Clinical Lead, Severn Major Trauma Centre

Dr Nirosha De Zoysa

Severn Major Trauma Operational Delivery Network, Major Trauma Centre, and HART Manager

Shabba Vaithianathan

Nick Blundell

Severn Major Trauma Network Quality Governance Lead

Dr Nick Blundell

 

Dr Nick Blundell is a Consultant in Emergency Medicine at Southmead Hospital in Bristol and Quality Governance Lead for the Severn Major Trauma Network. He completed his medical degree in Cardiff, and his Emergency Medicine training in South Wales, Sydney and Severn. He has a MSc in Trauma Sciences and a PGC in medical education / simulation.

Severn Major Trauma Network Training Lead

Dr Fran Verey

Dr Fran Verey is the training lead for the Severn Major Trauma Network. She is a Consultant in Emergency Medicine and Trauma Team Leader at North Bristol NHS Trust. She oversees, develops, and delivers training in all aspects of trauma care along the patient's journey from arrival to discharge, across all healthcare groups. She has developed a specialist interest in older trauma and the difficulties it poses compared to more traditional trauma; and through this she has developed an older trauma specific study day. Her aim is to ensure trauma training is accessible to all health care professional groups, as well as develop training specifically to get junior doctors interested in trauma training. Fran is keen on working on inter specialty training in trauma with the aim of setting up more training in which ED and surgical specialities train together.

Specialist Clinical Psychologist (Lead Psychologist for Major Trauma & Plastics Services)

Dr Joanna Latham

DClinPsy, PGCert, BSc

Dr Joanna Latham is a Specialist Clinical Psychologist chartered with the Health and Care Professionals Council (HCPC) and registered with the British Psychological Society. Jo has been working in the NHS with people experiencing mental health difficulties since 2010. After qualifying with a Doctorate in Clinical Psychology with Lancaster University in 2017, Jo has pursued additional post qualification training in post-traumatic stress disorders and has expertise in treating psychological difficulties arising after a traumatic injury. Since 2019 she has supported hundreds of people who have sustained life-altering or life-changing damage as a result of accident or deliberate attempt to harm. Jo has extensive experience of working with people after such traumatic events which can have significant effects on their body, mind, relationships and how the individual lives the rest of their lives.

Severn major Trauma Network Director of Rehabilitiation/ Consultant in Rehabilitation Medicine and Clinical Specialty Lead for the Bristol Centre for Enablement

Dr Shigong Guo

LLM MSc(Orth Eng) MRCS

Shigong Guo is a Consultant in Rehabilitation Medicine specialising in trauma, vascular and amputee rehabilitation. He is also Clinical Specialty Lead for the Bristol Centre for Enablement. With an academic background in bioengineering and medical law, as well as previous higher surgical training in trauma & orthopaedics, Dr Guo has a keen interest in the biomechanical and medico-legal aspects of musculoskeletal trauma and amputations, and their effects on clinical practice and rehabilitation.

Denise

Severn Major Trauma Network AHP Lead

Denise Axelsen

Denise Axelsen is qualified as a physiotherapist in 2010 (from University of the West of England), having worked within the fields of intensive care, neurosurgery and Major Trauma, where she has been working as a Major Trauma Practitioner since 2018. She supports the Network as Allied Health Professional Lead with the goal of uniting the delivery of rehabilitation across our region and throughout our Trauma Units.

Severn Major Trauma Network Support Coordinator

Daniel Fletcher-Walliss

Dan has been working in the NHS for more than 6 years starting in an administrative apprenticeship role progressing into an Assistant Patient Pathway Co-ordinator, which lead him to becoming a TARN Data Administrator which he had been doing for a year developing his skills in data management, entry and analysis, learning about the Major Trauma Network, the Major Trauma centre at Southmead and developing relationships with a variety of colleagues at Southmead. Which has helped within the role of the Network Support Coordinator, developing relationships in the wider network and helping contribute to work projects in the Severn Major Trauma Network.

South West Complex Termination of Pregnancy Network Post-Op Care

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After your Abortion

In advance of you coming to Southmead Hospital for your abortion, we would like to provide you with some detailed information about what to expect after your procedure 

Side effects are common after an abortion, but usually short-lived. Any side effects you experience will depend on your procedure and the anaesthetic used.  

Side Effects From the Surgical Procedure

Bleeding – it is normal to have some bleeding after your surgical abortion. This may be heavier than a normal period, with small clots. It can last for up to two weeks.  

Pain – cramping pain is normal, as your womb returns to its normal size. Cramps can be constant or can come and go. It’s not unusual to continue to get cramping on and off for up to two weeks.  

Side Effects From the Anaesthetic

Drowsiness – it’s important you don’t drive, sign important documents (such as contracts) or operate heavy machinery for 24 hours after having an anaesthetic. Some car insurance specifies you shouldn’t drive for 48 hours after an anaesthetic, so please check with your insurance provider.  

Nausea and vomiting should settle within 24 hours following sedation or a general anaesthetic.  

Bruising – you may develop some bruising and pain where the cannula was inserted in your hand. Bruising usually settles within a week or two.  

Pain – you may feel some soreness in the vein where the anaesthetic was injected. This usually settles within a few hours. If you are in discomfort, you may want to take some pain relief tablets, such as paracetamol or codeine. Avoid taking ibuprofen until 12 hours after your procedure, if you had the painkiller suppository. Avoid pain relief that contains aspirin as well, as it can increase bleeding. Heat can help with cramps and make you feel more comfortable. Try applying a heat pad or (warm) hot water bottle wrapped in a towel or blanket to your lower abdomen. Wearing comfy, loose clothing and relaxing at home can also reduce pain. 

Abortion Aftercare

It is important you take all the time you need to look after yourself after your abortion. We recommend you use the sanitary wear you are most comfortable with.  

Your vagina will clean itself with natural discharge. It’s best not to use a vaginal douche as this can disrupt the normal bacteria in the vagina and increase risk of infection.  

If you have been given antibiotics, make sure you take all the tablets you are given as directed.  

Drink plenty of water and don’t drink alcohol for 48 hours after treatment.  

You may resume sexual or other physical activity when you feel ready to do so. 

Serious Complications 

Serious complications have warning signs. If you experience any of these symptoms below, you need to call us right away:  

  • Very heavy bleeding that soaks through more than 2 sanitary pads an hour. These pads should be suitable for a heavy flow.  

  • Abdominal pain or discomfort that is not helped by pain relief medication, or by a heat pad.  

  • Vaginal discharge that smells unpleasant.  

  • Feeling hot and shivery with a high temperature that is 38°C or above.  

Generally feeling unwell. Sepsis can be caused by an infection in any part of the body. Sepsis after an abortion is rare, but very serious. Symptoms of sepsis can be like having the flu at first. If you develop any of the signs below it is important to seek urgent medical advice:  

Feeling dizzy or faint, confusion, slurred speech, extreme shivering, severe muscle pain, being unable to urinate, severe breathlessness, cold, clammy and pale or blotchy skin, loss of consciousness  

Pregnancy Symptoms and Testing

Nausea and vomiting (morning sickness) should stop after a couple of days. This is one of the first pregnancy symptoms to stop after an abortion. If you still have symptoms of pregnancy three weeks after your treatment, please contact your original abortion service who you initially contacted before you were referred to Southmead Hospital. 

If you have any questions, or are having symptoms that concern you, please contact either your original abortion care provider, your local NHS hospital, or the gynaecology ward in Southmead Hospital on 0117 4146915 

Eating nourishing food and drink: Information for kidney patients

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You have been directed to this information if you have a poor appetite or have lost weight.

It is important to make the most of what you are eating.

Choosing foods and drinks that are nourishing will help make sure that your body gets the energy and nutrients it needs.

This page has advice on:

Malnutrition

Malnutrition can happen when your body does not get enough nutrients from your diet. It can also happen when you have a low body weight or have recently lost a lot of weight.

It is quite common in people with a kidney condition. 

When your kidneys are not working well, this can mean that you lose your appetite and feel nauseated. It can also affect the way food tastes.

Malnutrition increases your risk of:

  • Illness, infection, and slow recovery. 
  • Slow wound healing. Muscle loss (including muscles like the heart and lungs). 
  • Fatigue. 
  • Falls. 
  • Low mood. 
  • Being unable to do your usual activities.

How can I prevent malnutrition?

  • Aim to eat ‘little and often’. This means trying to eat smaller meals, snacks, and drinks every 2-3 hours. This can be helpful if you are not able to eat large portions. 
  • Try not to skip a meal. If you cannot manage a main meal, have a nourishing snack or drink instead. 
  • If your appetite is better at a certain time of the day, aim to eat more at that time. 
  • Eat what you fancy when you feel you can. See the ideas later in this information.
  • When you feel well, cook extra portions of meals and freeze them for use on another day. If it is a family member who usually cooks your meals, ask them to cook extra of the meals you like and freeze them. 
  • Fortify your meals and snacks. Food fortification increases the number of calories and nutrients without increasing how much you are eating. How to do this is explained later. 
  • You may find it easier to have some ready meals in the freezer. Companies such as Wiltshire Farm Foods and Oakhouse Foods deliver ready meals. There is also a choice of smaller portions. 
  • Do not drink a lot of fluid just before your meal. This can fill you up and reduce your appetite. Try to choose nutritious drinks if you are going to have them. 
  • A few minutes of fresh air can increase your appetite. A short walk outside can be helpful too.

All the tips above are explained in more detail below.

Nutrition goals

Remember to set yourself 1-2 realistic nutrition goals when thinking about what changes you could make to your current eating habits. You can write your nutrition goals down. Writing your goals down will help you to remember what you want to do. You can also share this with your family and health care team.

What if I usually limit phosphate, potassium, and salt?

It can be challenging to eat well if your appetite is poor, and you are also trying to avoid certain foods for your kidneys. 

You may not need to limit foods that are high in phosphate, potassium, or salt for now. Your dietitian can give you more guidance. 

If you take phosphate binder tablets you should continue to take these as usual. 

If your eating pattern has changed then you can ask your dietitian for advice on fitting your binders to your food.

Food fortification

What is food fortification?

‘Fortifying’ is another word for enriching. It means adding extra energy and nutrients to food. This is particularly important if you can only manage to eat small amounts.

How can I fortify my meals and snacks? 

Here are some ways to increase the calories and nutrients in your food:

Fortify with butters and oils

  • Choose full fat butters and spreads. 
  • Add butter, spread or oil to rice, pasta, potatoes and vegetables. 
  • Add butter, spread or oil when cooking such as frying or oven roasting.
  • Add butter or spread to scrambled egg or omelette. 
  • Put butter or spread thickly on bread or toast before adding jam, marmalade, or savoury topping.

Fortify with mayonnaise and salad cream

  • se full fat mayonnaise and salad cream. 
  • Add generous amounts of mayonnaise or salad cream to sandwich fillings such as tuna, egg or chicken mayonnaise. 
  • Have mayonnaise and salad cream on salads, baked potatoes and with potato chips. 
  • Have coleslaw and other mayonnaise or salad cream- based salads as a vegetable with your meal.

Fortify with sugar, honey, and syrup 

If you have diabetes, you may be used to reducing sugar. While you are not eating well you can relax this a bit. Discuss this further with your dietitian.

  • Add sugar or honey to hot drinks.
  • Add sugar, honey, or syrup to porridge and breakfast cereals.
  • Sprinkle or drizzle over tinned or stewed fruit, rice pudding, custard, and puddings.

Fortify with milk, full fat plain yoghurt, cream, or cheese

  • Use full fat milk, yoghurts, and cheese. You could use single or double cream. 
  • Add milk, yoghurt or cream to soups, scrambled egg or omelette. 
  • Add milk, cream and/or cheese to mashed potato. 
  • Make cream-based sauces for pasta, fish, and vegetables, such as cauliflower cheese, baked fish and cheese sauce, pasta carbonara. You could add cheese to these sauces too. 
  • Add yoghurt or cream to creamy curry sauces. Sprinkle grated hard cheese on top of meals, such as beans, egg or houmous on toast, spaghetti bolognese, soup and casseroles. 
  • Include cream cheese or sliced hard cheese as an extra sandwich filling, for example having ham, beef or salmon with cheese.
  • Drizzle cream over tinned and stewed fruit, desserts, or puddings.

Nutritious drinks

It is important to choose drinks which contain calories and nutrients.

  • Try not fill up on water, tea, or coffee, particularly before meals. 
  • Make hot drinks, such as tea, chai, coffee, and hot chocolate with half or full fat milk. 
  • Use sugar or honey instead of sweeteners in your hot drinks. 
  • Choose full sugar squash instead of ‘no added sugar’ versions. 
  • If you have been given nutritional supplement drinks, have these between meals.

What about my cholesterol?

You may be worried that eating more fat and sugar will affect your health. As malnutrition can cause other problems, it is important to tackle this first. Once you are eating well again you can go back to your normal healthy way of eating.

To include healthy fats in your diet, choose:

  • live oil or rapeseed oil (monounsaturated fats). 
  • Olive oil based full fat spreads. 
  • Oily fish, such as mackerel, salmon, sardines, trout, fresh tuna. 
  • Oily fruit and vegetables, such as *avocado or olives in oil. 
  • *Nuts and seeds: pistachio, walnuts, chestnuts, almonds, hazelnuts, peanut, pecans and sunflower seeds

*check with your dietitian before eating lots of nuts or avocados as these are high in potassium.

Getting enough protein. Why is this important?

Protein is important for keeping your muscles strong and healing wounds. 

Protein cannot be stored by the body. When you are unwell, the amount of protein your body needs can increase. 

It is important to have enough high protein foods every day. Try to have a high protein food at each of your meals every day.

Foods that are high in protein:

  • All types of meat, chicken, turkey including cold meat and processed meats such as sausages, bacon and crumbed chicken. 
  • All types of fish including processed fish such as those in breadcrumbs or batter and tinned fish. 
  • Eggs.
  •  Beans, lentils (including dhal) and chickpeas (including hummus). 
  • Quorn, soya, tofu, and tempeh. 
  • Any type of milk and cheese. 
  • Yoghurts, fromage frais and kefir. Choose the higher protein ones.

Choose, where possible, fresh and unprocessed meat, fish, chicken, and turkey. These are lower in salt. Choose full fat and full sugar dairy and non-dairy foods.

Meal and snack ideas

There are no set rules, you don’t have to eat breakfast at breakfast or dinner at dinner time. You may find some of these ideas appeal at different times of the day.

Meal pattern

It can be helpful to stick a regular mealtime routine and not skip meals. However, this is not always necessary if you are still eating every few hours over the day and eating as much as you can and when you feel hungry.

Check with your healthcare team if you are on certain medication, such as insulin or glucose lowering medications. These may need to be taken at specific times of the day with food.

Make the most of ‘good days’.

If you cannot manage a meal, have a nutritious snack or drink instead. See some of the ideas given on this page.

Remember, not eating can make you feel like not eating.

Breakfast

  • Thickly spread butter and jam on bread rolls, crumpets, muffins or croissants.
  • Toast with nut butter.
  • Danish pastries.
  • French toast / eggy bread.
  • Eggs – omelettes (fortified), scrambled (fortified), boiled or fried egg on buttered toast.
  • Bacon or sausage sandwich.
  • Baked beans topped with grated cheese on buttered toast.
  • Small cooked breakfast with your choice of fried or scrambled (fortified) egg.
  • Porridge made with full fat milk, cream and sugar, honey, or syrup.
  • Cereal with full cream milk, cream, sugar or honey or syrup.
  • Cheese and cold meat roll.

Light meals and lunches

  • Cheese and biscuits generously spread with butter or full fat spread.
  • Sandwich or bagel or bread roll or pitta spread generously with butter or full fat spread and filled with a high protein filling such as:
    • Beef and horseradish, ham and cheese, chicken and pesto, turkey, cheese and pickle, tuna mayonnaise, egg or chicken mayonnaise, hummus and falafel or nut butter.
  • Try different types of bread, such as ciabatta, baguettes, and paninis.
  • Baked beans topped with cheese on buttered toast.
  • Eggs – omelettes (fortified), scrambled (fortified), boiled or fried egg on buttered toast.
  • Bacon or sausage and fried egg sandwich.
  • Soup, such as cream of chicken or lentil with buttered bread/toast.
  • Sausage roll, scotch egg, pasty or pork pie.
  • Pizza or quiche.
  • Tinned spaghetti topped with grated cheese.

Main meals

  • Plain fish topped with white or parsley or cheese sauce (made with full fat milk), mashed potato (fortified).
  • Fish pie or cottage pie topped with fortified mashed potato and grated cheese.
  • Macaroni cheese or lasagna or creamy pasta using fortified cheese sauce.
  • Meat or vegetable bolognese topped with grated cheese.
  • Lentil or vegetable pie topped with fortified mashed potato and grated cheese.
  • Cheesy potato, cauliflower, or broccoli bake with extra cheese topping.
  • Creamy (fortified) risottos with protein foods and extra cheese topping.
  • Ready-made meals from a supermarket or home delivery company such as Wiltshire Farm Foods or Oakhouse Foods.

Snacks and puddings

  • Rice pudding, custard, or yoghurt (not the low fat version).
  • Trifle.
  • Class of full cream milk and biscuits.
  • Danish pastry, doughnut, jam tart, Swiss roll, or cream cake.
  • Milk jelly.

Nutritional supplements

Your dietitian may recommend also nutritional supplements alongside this advice. There are milk style and fruit juice style drinks, desserts, and powders. Samples can be provided for you to try. They can be prescribed for a few months by your GP.

If you already have nutritional supplements, try the following:

  • Chill them before drinking.
  • Use them instead of your usual milk on cereal.
  • Add them to yoghurt or custard.

If you find them too thick or sweet you can dilute juice-based supplements with fizzy drinks and milky ones with milk. You could make them into a smoothie or milk shake, jellies, sorbets, slushies or ice cream. Ask your dietitian for some recipes.

Most supplements come in multiple flavours. Ask the pharmacist for a different flavour if you don’t like the one you are usually given.

How can I stimulate my appetite?

  • Eat food that appeals to the senses.
  • If the smell of some foods affects you then try to:
    • Avoid the kitchen during cooking.
    • Avoid cooking things with strong smells (e.g. Brussel sprouts, fish).
  • Choose cold foods.
  • Choose foods that are quick to prepare.
  • Make food more attractive by adding a garnish.
  • If you’ve lost interest in eating, try to imagine foods with appealing sights and smells, then try a small portion.

Fresh air and the environment

If you are able, fresh air and a small amount of exercise before a meal can help increase your appetite. Make meals sociable and in a relaxed, pleasant environment.

A small amount of alcohol before a meal can increase your appetite (check with your doctor first as alcohol can interact with some medications).

Nutrition goal

Setting yourself a nutrition goal and writing it down will help you succeed. See the example below to help you plan your goal. 

Example

What do you want to do and when?

I want to start using full fat milk on Friday after I’ve been shopping.

Why do you want to do it?

To give me extra nourishment and stop me losing weight.

How will you do it?

Every day I will add full cream milk to tea and use on cereal .

Try to answer these questions yourself and write down your goal. 

© North Bristol NHS Trust. This edition published November 2024. Review due November 2027. NBT003379


 

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Contact Nutrition & Dietetics

Kendon House
Kendon Way
Southmead Hospital
Bristol

Telephone:  0117 414 5428 or 0117 414 5429

Trail Point 6

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Supporting our LGBTQIA+ Staff

At NBT we have an LGBTQIA+ Staff Group which is open to colleagues who come from this equality community. The group provides a platform for LGBTQIA+ staff to exchange information, ideas and raise awareness about this area of equality at NBT, as well as creating a network for colleagues to support each other. It is free to join and the group's mailing list is completely confidential.

Our LGBTQIA+ WhatsApp group is also available for colleagues to join as a confidential space to get peer support, network and discuss internal and external LGBTQIA+ events. 

As an organisation, we seek to be progressive and inclusive, and aim towards eliminating discrimination, and victimisation against all equality communities, especially protected characteristic groups. As part of this, all our staff are encouraged to speak up and report any abuse, whether they experience it themselves, witness it or are a manger of someone who has experienced abuse. We have processes for staff to raise their concerns, such as through our Freedom to Speak Up Guardians and Harassment & Bullying Helpline, for additional support we also have Wellbeing Champions.

We’re working hard to develop and improve the support available to all our staff, whether someone has suffered abuse, or even an experience that made them feel uncomfortable, we want to be there for all our staff. We are also supporting our managers to improve their understanding and confidence, one of our latest initiatives is an EDI Guide for Managers and Staff.

Our wellbeing package includes support for psychological health and emotional wellbeing, such as our Staff Psychology team and our Employee Assistance Programme service, which offers confidential expert advice and compassionate guidance 24/7. If you’re a member of our staff and you need support, I encourage you make use of these resources, or to reach out to Inclusion@nbt.nhs.uk.

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