"Force Feed" - page 2

72 yo patient, 12 days post hemicolectomy, ileus 5 days post-op. Finally up and around, but p.o. intake poor. Patient weights 125#, so no reserve there. Also PSA 500+, so he definately has other... Read More

  1. by   MandyInMS
    Originally posted by Nurse Ratched
    I think the doc may want to reconsider his choice of words:

    "Encourage po intake."

    I, too, remember doing the syringe thing with pureed foods "back in the day", nightmoon. If I had to do it over again, I wouldn't.
    DITTO....MD's wording is wayyy off...all you can do is encourage foods/snacks/supplements...you cannot "force" an alert /oriented person to do anything against his/her will for goodness sakes.Immagine this pt is YOU...how would you react? Can't post how I'd react..would be too many profanities...lol
  2. by   renerian
    Desert rat............served him right to be spit at!

    renerian
  3. by   ceecel.dee
    Originally posted by ktwlpn
    ...."force feeding" this fella would be assault and battery,wouldn't it?"

    Absolutely!

    "I am sure that you are doing all that you can with supplements and goodies"
    Absolutely! This is a gentleman, who says "I'm sorry you girls will have to write down that I ate so little, but I am really trying."

    This man is sick, not obstinate!
  4. by   ceecel.dee
    Originally posted by susanmary
    To start, your patient needs a nutrition consult. He may also have some depression (small wonder -- doesn't mean he's got major psych issues -- but depression might be caused by his surgery, and prostate cancer. He needs support -- not ultimatums.

    I would refer this case to your manager, and the ethics committee. Encourage a patient to eat, wonderful. Assist a patient with meals & snacks, wonderful. Force feed a patient -- never. Unethical, humiliating. Does he have any family? I would also start documenting verbatim when the patient states he is not hungry, etc, & his refusal to be "force fed."

    Our patients deserve to be treated with respect and dignity. This kind of case makes me very sad -- but I would follow up the chain of command if he were my patient. Good luck. He's lucky to have such a caring, compassionate patient advocate for a nurse!!!!
    Sue
    Sue, you are aligned exactly with my line of thinking. I agree with everything you said!
    Unfortunately, no ethics committee, but we derailed this order before any "forcing" would even be contemplated!
    Patient refused feeding tube after surgeon's sales pitch.

    Do you know what I suspect? The surgeon is considering his "stats". A couple of routine hip pinnings died before the magic "surgical recovery period". They were OLD, and the death were not his fault, but still recorded on the "stats sheet". Some admits directly to ICU from PAR that were not anticipated....noone could blame him for any of these, (he really is an excellent surgeon), but could this have anything to do with this order?
    Would love your opinions!
  5. by   ceecel.dee
    Originally posted by Flynurse
    I thought the term force feed had become extinct. Literally.
    Not since I very first became an aide in 1998 have I actually seen that written on a piece of paper.
    How very true! It really is out of character for him to have written that. It's the talk of the hospital (the report room anyway:chuckle ). Quite unusual language for him actually.
  6. by   ceecel.dee
    Originally posted by gwenith
    I would bet a small pile of Mars Bars that this Doctor will back down and in a hurry. He will bluster and he may threaten but whatever he does STAY COOL.

    You, of course, are exactly right! :chuckle :kiss
  7. by   ktwlpn
    Originally posted by NightMoonRN
    Back in the 70's when I was an aide, we "forced" our elderly patients to eat. I remember mixing pureed meat, potatoes and pureed veggies altogether with milk and butter. We would draw this concoction up into a bulb syringe and squirt it into their mouths. Thought it was barbaric then and certainly think it would be barbaric now. Absolutely hated the indignity of it all...besides I would wind up wearing half of it on my clothes and face as the patients gave me the razzberry.
    Glad to see patients' rights have changed all this and this should be respected at all costs.
    Oh yes-I remember "the blend" Years ago it was acceptable for the meal slop to come from the kitchen mixed like that...Yech-thankfully it has been decided that the residents have the right to eat identifiable food,each pureed course in it's own little compartment...Imagine eating a bowl full of pureed fish every Friday...barf...I also remember a new yound cna coming to tell me that a resident she had been feeding with a syringe sat up and ate her whole meal but "Now she is having some trouble breathing" Well-the chest x-rays showed both lung fields opaque with dinner.....poor thing died....
  8. by   debRNo1
    Originally posted by Nurse Ratched

    I, too, remember doing the syringe thing with pureed foods "back in the day
    I was mortified as a new nurse to see this abusive way of feeding the residents :imbar BARBARIC describes it very well.

    Of course it was the MEANEST cna in town who opted to "feed" this resident. Towels wrapped around her neck and liquid mush running down her face as she barely got a chance to swallow. What a horror to hear and see this happening.

    Wht loss in LTC is a biggie but thank the lord this isn't common practice anymore. It was the most degrading, humiliating, abusive thing I think Ive ever seen done to a PERSON. :stone

    An appetite simulant could be helpful and the MD should also consider depression as a reason for poor intake or refusal to eat. Sometimes it may take trying different meds until you find the one that works. Ive seen miracles with the right meds and they will begin to eat and put on wht !!! What a difference a tiny pill could make.

    Sometimes I think putting this HUGE meal down in front of these poor eaters turns them off. Maybe put the tray off to the side and try one item at a time ? Sandwiches, supplements, health shake type drinks work well too- offer a sandwich and a glass of milk or a shake when they wont eat the meal served. A little nutrition is better than no intake at all.

    Over the years Ive seen way too many residents "removed" from the DR without eating the meal and without the staff offering an alternative.

    When I was a charge nurse I used to have my little group of poor eaters sitting outside the nurses station, in the afternoon and I would get out the "goodies" I would cut sandwiches up and pass them out with a drink they preferred. Icecream and pudding went over well too.

    This would piss off the other nurses and the cna's for some reason but if they didnt eat they came to my snacktime. It was my fault they didnt eat because "I" spoiled them and was always giving them snacks !! When I gave them ensure or another supplement the staff would remind me that I needed a doctors order for it !!!

    I would say,
    "call the DOH theres a 1-800 number in the lobby!!"

    deb
  9. by   Rapheal
    We have a patient who has been in and out of the hospital for months and her condition is deteriorating. She has many psych issues. She had surgery for a partial small bowel obstruction and received TPN for awhile.

    She is off TPN and refuses to eat, even nutritional shakes. She becomes very angry with any encouragement to drink the shakes and starts to yell, and act out. Her latest thing is to start gagging as soon as the shake passes her lips.

    The doctor wrote an order yesterday "Have the patient drink Ensure shakes TID". Well sorry, I will encourage her as always. I have made sure she is getting the flavor she requested. She has had nutritional consults. She does not WANT to drink, does not want to eat. Doc refused my request to consider her to recieve antianxiety medication or to consider a psych consult. The doc told me "She already talked her way into surgery. She does not need to be in the hospital and as soon as she is eating she's out of here".

    She is angry that she is sick, angry that she is not receiving one on one nursing, angry that she is weak. I think it is her one way to control SOMETHING in her life at this time. I feel sorry for her because she takes no responsibility for her health and expects the doctors to "fix her". Yesterday she absolutely refused to get out of bed to use the BSC and was screaming when she had a bowel movement in bed. Of course she did not request a bedpan before she had to go.

    But anyways...She has many issues, and I cannot, I will not force anyone to take anything or do anything they refuse to do. The doctor will have to address the underlying issues of why his patient will not eat. Until then I cannot fix the problem by forcing something down someone's throat.

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