[GooeyRN]

When I see a diabetic eating something they shouldn't be eating, I strike up a conversation on how it is sometimes difficult to be compliant with the diabetic diet. I then let them talk. If they are adults who know what they are doing and know the consequences, I will not take food away from them. Its their decision. But I do document about the conversation and if they continued to eat the food.

I try my best to not make them feel guilty for their choices, while trying to encourage healthier choices. (like sugar free chocolate pudding with sugar free whipped cream on top, instead of chocolate cream pie for example, or blueberries with whipped cream instead of blueberry pie)

I am not a diabetic. I think it must be difficult to follow the diet day after day, for the rest of my life. I don't think I could handle it, either. We all have our unhealthy things in life. Mine is diet soda. I know the aspartame or splenda in it is really bad for me. But I choose to drink it anyway. I would be furious if a nurse took it out of my hand and did this. I am an adult of sound mind. I know the consequences of diet soda. But I choose to drink it anyway.

[Myxel67]

I expected a flurry of indignant replies in response to my long post (#27) Appaarently, it was so long nobody read it!

At least check out article in link from the clinical journal of the ADA.

http://clinical.diabetesjournals.org...t/full/20/2/51

[morte]

You could count out 900 calories worth of the candy and tell her that's her carb allowance for the day. Remove carbs from tray. If she wants any of the carbs on the meal tray, she'll have to trade some candy for it.)

this is something she had refused to do.....

I expected a flurry of indignant replies in response to my long post (#27) Appaarently, it was so long nobody read it!

yup, i tried, couldnt get throught it, will try again.....and i have more than a passng interest in nutrition.....appeared somewhat disjointed, as i said will try again

[Myxel67]

No, she had the full tray and refused to give up any of the carbs on it in exchange for candy. Here she has the candy, but can't get any of her other meal time carbs unless she exchages some of the candy. Not the most nutritious, but she wouldn't exceed carb allowance for the day

[nurse4theplanet]

Originally Posted by SassyRedhead

Nursing staff on my unit have been having a debate lately about where the line is with diabetic patients on MD-ordered ADA or carb control diets and patient rights. In particular, a diabetic pt on our unit had a big bag of candy in her belongings and went postal about being allowed to have it, even though she was ordered QID accuchecks with PO antidiabetic meds and sliding scale insulin.

My comment was that I am the licensed personnel in the situation responsible for carrying out MD orders (carb control diet in this case), and the pt was insisting on NOT exchanging anything off the tray for some of the candy but, rather, that she have it ad lib at the bedside. I feel that in allowing her to have the candy, I would be going against MD orders and could be held liable for any adverse consequences if she ate herself into a huge BS.

Now, I am not going to ever rip something out of someone's hands, but this was tucked into belongings and I would not get it for her after reminding her of the order and how this would impact her BS. If a pts family brought in a milkshake, for example, and the pt was consuming it and refused to give it up, I would just document the heck out of it after also informing the visitors that the MD has not given orders for such food and that this goes against the pts plan of care. For what it's worth, this pt also has known psych issues.

Am I right? Wrong? Completely off base?

I feel your frustration. This happens alot on our unit (well...for those who CAN actually eat and are not on TPN lol). Whether it is a diabetic diet, renal diet, or AHA...psych issues or no psych issues...some pt's just will not comply. If they aren't going to do it in the hospital during a health crisis, then you can bet your last dollar that they will not comply once they are at home. You can't force them to follow any MD order, including a diet. You document everything just as you said you did in your post and make sure the MD is aware so he doesn't make unnecessary adjustments to the sliding scale insulin or oral meds that could result in severe hypoglycemia. You can not be held liable for pt non-compliance.

[llg]

Originally Posted by Myxel67

BTW, even though doctors continue to order it, the ADA diet no longer exists. In its place are recommendations to determine energy requirement of pt (based on height, weight, age, level of physical activity, and disease process). The energy requirement is expressed in calories. Dietitians in our diabetes care center recommend that the calorie count be split as follows: 50% carbohydrate, 20% protein, & 30%, but even that is not endorsed by the ADA.

Below is an excerpt from an article that appeared in 2002 in "Clinical Diabetes", the Journal of the American Diabetes Association.
.

Hi, Myxel67. Thanks for putting this information here. It's exactly what is needed.

[GardenDove]

Lets face it, most people who get diabetes already have problems with their weight. That's what got them in trouble in the first place, their food addictions. It's unrealistic to expect that to suddenly change. Food addiction is a real thing, just like drug addiction.

[oriezo]

i am a new nurse and still learning to adapt to the nursing profession. i have been reading the various posts and this is the one that made me re-evaluate my perspective on patient care.

your views are truly wonderful. they help shape my point of view and how i can deal with my patients with compassion and still be within the legal bounds of the nursing responsibility.

to all, pls accept my heartfelt thanks...

[ckben]

[quote=GingerSue;2062815][quote=ckben;2061074]

but by agreeing to be in the hospital, they agree to the care which nurses will give them, which includes giving them an appropriate diet.

not sure about this agreement

eg. a diabetic lady was prescribed insulin and she refused the insulin, preferred to manage her diabetes other ways - according to her religion and alternative activities

I think that as nurses we have to respect the client's choice, try to inform and provide educational material, respectfully, and support their wishes

that's a different scenario. the pt. can refuse what they like, nobody's arguing that. but i, as a nurse, am not required to provide bad care to a pt. simply because they prefer it that way. they have a right to good care, and continually giving candy to someone whose blood sugars consistently remain in the 300s despite the insulin treatment we give them is NOT good care. as i said, i'm not going to take their candy away from them, but i won't be the one giving it to them and thus be directly responsible for enabling these habits and further contributing to the adverse effects of their disease process.

disagree if you like, but i personally would rather have a healthy patient who is upset at not having a privelege (yes, candy is a privilege, not a right) than an unhealthy one who likes me simply because i will let them do whatever they want. and in my experience, if you simply explain the reasons behind your actions, most people will not get upset anyway. but if you give in and allow the candy, the patient often perceives the issue as not that important, because "if it was really important, then all the nurses would care, and not just some of them, right?"

[joyflnoyz]

[quote=ckben;2063804][quote=GingerSue;2062815][quote=ckben;2061074]
disagree if you like, but i personally would rather have a healthy patient who is upset at not having a privelege (yes, candy is a privilege, not a right)

Sorry, if a person wants to eat candy, knowingh the consequences, that IS their right : the right to self determination. we <as clients> pay a physician for his ADVICE, the same as we pay a lawyer for her advice.
Then, as adults who are responsible for our own actions, each person makes a DECISION/CHOICE as to whether or not to follow that advice.

Let's also bring in the right to dignity and not being treated as if you are a child just because you area patient in a hospital.