Dietary policy- vent

Nurses Relations

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Specializes in Trauma, Emergency.

Quick little vent. When I was sitting most recently, dietary came in to see what pt wanted for lunch. Pt is 350lb female. Dietary suggested several different possible meals, some of which were balanced (others of which I could buy at McDonald's). Pt wants something from several meal choices. Hamburger steak, grilled cheese, Mac and cheese, loaded baked potato, broccoli with cheese sauce (yay?) and apple cobbler with diet Pepsi and whole milk. Dietary didn't say a word, just entered it in computer. Really? Really?! No contempt for the pt because MAYBE pt doesn't know any better... But shouldn't there be something in place that pts can order one entree item, 2 veggie-ish sides and maybe a dessert and that's it? Come on. Ugh. Cheers, pt. Cheers to your next hospital-sanctioned obesity-related health crisis.

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Specializes in Trauma, Emergency.

Also, what is up with hotdogs, cheeseburgers, grilled cheeses, frenchfries etc being on the everyday menu for pts? I thought hospitals were here to fix health problems and promote future health. Or at the very least not contribute to health problems...

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Specializes in Critical Care.

Welcome the world of HCAHPS. Even though there no actual questions on food, food quality/quantity/and options are the biggest "variable" that decide HCAHPS scores from patients (single vs double rooms is #2). Hospitals are well aware of this and are more than happy to give patients whatever food they want at any time of day and in any amount if it means good HCAHPS scores.

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Specializes in Med/Surg, Academics.

What diet did the doctor order? That would have restricted the choices that dietary cited to the patient.

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Specializes in Trauma, Emergency.

She's on regular diet. Is HCAHPS r/t press gainey? I'm still a NS so I haven't learned all that yet...

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Specializes in Critical Care.
What diet did the doctor order? That would have restricted the choices that dietary cited to the patient.

An ordered diet is a treatment and therefore the patient is free to refuse, making it little more than a suggestion.

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Specializes in Critical Care.
She's on regular diet. Is HCAHPS r/t press gainey? I'm still a NS so I haven't learned all that yet...

Press-Gainey is one of a few certified vendors approved to collect HCAHPS data and they also have their own patient surveys that are not HCAHPS. HCAHPS is a specific set of questions CMS uses to gauge performance, Press-Gainey and other consulting companies also send out other surveys to patients to help hospitals improve both their HCAHPS scores as well as their general patient satisfaction.

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Specializes in Trauma, Emergency.

Thanks!

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Specializes in Trauma, Emergency.

Side note: l am not a skinny person by any means- this is not a fat- hate thread :-)

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how mad would you be if your mother/father/child/brother who hadn't eaten in DAYS or maybe a week finally got to order what they wanted to eat. they wanted mac and cheese (a side item) mashed potatoes (side item) and mixed veggies.....NOPE! sorry! you only get two side items!

why? because someone who has lost control of their weight has to have restrictions put on how many entrees they can order?

it's frustrating to watch someone kill themself with nicotine, alcohol, or food....but there's not much anyone can do about it. thank goodness we still have the freedom to choose.

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Specializes in PDN; Burn; Phone triage.

Not much that could be done without a doctor's order. Heck, I'm assuming that this was a dietary aid that came by -- and not a dietitian/nutritionist - which would make recommending or restricting food choices out of their scope of practice, esp. since there wasn't a doctor's order. (Or dietary will tell patients when they're over their salt, fluid, or diabetic diet allowance.)

Some units do stress overall fat, protein, and caloric intake in many patients. Oncology. Burn. Some people need hamburgers, not salads.

As an employee, it irritates me that a decent salad from our cafeteria will cost over $8.00 without a drink or side but you can get a hamburger, large fries, and large soda as a "meal deal" for $4.50.

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Specializes in Critical Care, Education.

Hmm - I realize that we (nurses) have a tendency to want to fix everything but we need to be realistic. How much can be accomplished in 3 days (average LOS)? Just like your instructors probably reminded you back in the day when you were creating Care Plans.... you can't cure world hunger, just focus on the priorities. In an acute care setting, the care is focused on whatever brought them into our world plus any co-existing problems that have an impact on treatment. You're better off keeping them happy with cheeseburgers so they don't take out their frustrations on the nursing staff.

If the patient's current treatment does not require any sort of therapeutic diet, then it is pretty much a waste of time trying to correct a lifetime of poor food choices & eating habits in the 3 days they are in our hospital. Sad, but true. We can offer them some follow-up info, but they're probably not going to make any changes unless they get scared into it... "lose weight or die/suffer severe and immediate consequences"

I agree - hospitals are providing over-the-top hotel services to raise their HCAHPS scores because reimbursement is tied to these scores. It's nuts. I know of a facility where patients can have their car detailed during their stay. Crazy. Research has revealed very little correlation between pt sat scores & clinical quality. In fact, high pt sat scores have been associated with over-treatment. Oh well. At least we don't have to wash the cars ourselves or wear Hooters outfits . . . .yet.

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