Dietary policy- vent

allnurses Guide · Jun 29, 2012

I will eat what I like. Nurses can promote health, offer advice and guidance, about different diets and why/when they should be used. After that, its up to the pt. We are are nurses, not nagging nannies, not their mommies.

Personally I avoid red meat 80% of the time, drink diet Coke, exercise. When I want an ice cream float or a mediumrare steak piled with mushrooms and gravy, I'm going to eat it. Since the only snapshot you might see of my life is the glass of wine and the steak; you may draw all the wrong conclusions. Same with a patient who is finally getting to eat something.

tothepointeLVN, LVN · Jun 29, 2012

You can lead a horse to water...... but you can't make them eat healthy and being inpatient isn't the time to force a new dietary lifestyle on them unless it affects their immediate well being which I assume it doesn't because she is on a regular diet.

Don't ever underestimate the power food has to heal. Perhaps by giving the patient control over what she could eat when the rest of her life in under someone else's (hospital staff)

Since your a nursing student I'll tell you something I learnt as a student about food. I had a patient with Raynauds who was s/p amputation of one of her fingers on her right hand. She was also a vegetarian. She was starving because not one had evaluated whether she was able to safely eat (she was) and removed the NPO sign and given her a tray. I had evening clinical so it was coming on to dinner time.

Dietary had sent her up a vegan plate. It was the most flavorless blandest saddest meal I have ever seen. (The hospital had options for vegetarian and vegan meals and the cafeteria had the most AMAZING vegetarian food downstairs.) The patient had been able to keep it together up until that point but she saw her food and tried to eat it will one bandaged hand and one IV.

To her that meal represented the injustice of everything that had happened to her.

The nurse assigned to her didn't really understand the problem and kept on restating that she had ordered a vegan plate and that should be fine. This was an oncology floor so a missing finger in comparison is no big deal.

Luckily I had the most amazing clinical instructor who helped me navigate the system so we could get her IV switched over so she could use her good hand and got her a gardenburger with fries sent up. Healthy? Not really. Was it in her words the BEST hamburger she ever tasted.

Through the meal I was able to listen to her life story and give want little advice I could (suggesting voice to text programs so she could continue school etc) I wouldn't have been able to build that rapport if I didn't understand that vegan wasn't the same as just vegetarian and vegetarian food could be tasty too.

The last time I was inpatient myself if I hadn't been able to order mashed potatoes and jello from the kitchen when I wanted it I wouldn't have eaten at all.

Sartorius1 · Jun 30, 2012

I am a diet aide in a large hospital. Patients that I work with are on an MD ordered diet order that they must follow. If the pt. makes a big enough fuss, the RN can override for some items. If the pt. continues to make a stink, the doctor will change the diet order.

We have a policy that allows for one hot entree item and up to six sides. Patients abuse this frequently. One way or the other, they will get their two hamburgers, meatloaf, vanilla milkshake and four brownies. It is a control thing. Often times deciding what they want to eat is the only thing in their power while they stay in the hospital.

I don't always agree with their choices and can politely make healthier suggestions, but that is not my job. If we notice a repeated problematic behavior (for example a patient once asked me for 40..yes FORTY packets of sugar for her oatmeal) then we page the dietician and a consult is arranged.

To echo what some others were saying, you're really not going to be able to change these behaviors in the three 12's you work during the week. Believe me. I hate seeing someone on their second heart surgery screaming at me because they can't have salt and coffee. These types of patients have their families smuggle in McD's. It's a public health issue and not something that's easily addressed when someone is sick, tired, and hungry. If someone is sick and wants unhealthy food, I'm not going to argue. They want comfort and that's fine by me.

Oh, and one final tidbit....the post-partum and antepartum patients are usually the ones abusing our system. I'm sure they are famished, but they always "discretely" order extra food for theur husbands! :uhoh3:

trauma_lama, BSN · Jun 30, 2012

Thanks for all the replies so far! I guess I'm just still naive...

imintrouble, BSN, RN · Jun 30, 2012

Patient satisfaction is paramount! Our lowest scores are meal tray/food related.

Pts get whatever they want, even if it directly opposes their diet order.

If my diabetic pt with a blood sugar of 350 wants ice cream, cookies, and whole milk as a night time snack, that's what he gets. I will suggest something more appropriate, but if he refuses, I trek on down to the kitchen and load up the tray.

Most pts where I work have a mini mart on their bedside table of snacks and candy anyway. If there is any exception to the above it's the geriatric pts who just don't want to eat anything anymore.

VICEDRN, BSN, RN · Jun 30, 2012

I don't think your naive, RN in training. I think that giving the patient whatever they want to eat when they are with us gives the patient the message that we don't care or that we don't think its an important part of the healing process.

I am not saying they can't eat what they want but I am also not here to sanction a diabetic eating whatever they want like it doesn't matter at all. That's not my role in this patient's life. I am supposed to be setting a good example and I am supposed to prevent post op patients from getting a freakin ileus from eating too soon. (when I worked on a ortho unit at least)

Don't believe me? Ask the patients. I have had patients flat out honestly tell me that we "medical people" don't *really* care because we don't force them to adhere to the diet as ordered.

I agree that its related to customer service and patient satisfaction. As far as that's concerned, I think its absurd.

OKNurse2be · Jun 30, 2012

I can totally understand both sides here. The pt wants what they want to eat; what is going to taste good to them and maybe to some extent a sense of something familiar to them away from the comforts of their home. On the other hand, we know that Hamburgers, French fries and other "junk food" is "bad" for them, but all we can do is try to educate them and ultimately let them choose for themselves. I do think that portion sizes can still be manipulated to the extent of that they can have what they want, but in smaller quantities. A hamburger in a hospital is still a hamburger even if it's 1/2 the size of a Big Mac, right? All I am saying is that I think there are ways to give the pt what they want, but in a healthier way to where it's less calories than the meals they would otherwise have consumed. I know it's idealistic, and I do wish that nursing care wasn't so "wrapped up" in patient satisfaction surveys. I don't like that pt satisfaction is more important than what is ultimately the best for the pt.

minnymi · Jun 30, 2012

Patient satisfaction is paramount! Our lowest scores are meal tray/food related.
Pts get whatever they want, even if it directly opposes their diet order.
If my diabetic pt with a blood sugar of 350 wants ice cream, cookies, and whole milk as a night time snack, that's what he gets. I will suggest something more appropriate, but if he refuses, I trek on down to the kitchen and load up the tray.
Most pts where I work have a mini mart on their bedside table of snacks and candy anyway. If there is any exception to the above it's the geriatric pts who just don't want to eat anything anymore.

umm...no. if they can go and get it then that's one thing, but i will NOT bring it to them nor will i go down to the cafeteria to get it.

anotherone, BSN, RN · Jun 30, 2012

I wouldn't say a word either. thatwas probably a dietary aide not a nutritionist either. but i would not say anything. Why do peopel think others don't know those choices are unhealthy. i would say most people KNOW AND DO NOT care. choose them anyway and become defensive. we have had drs order 1800 calories or 2000 calorie only diets and they too are ignored by the patient. i might tell the patient once, and after i get cursed at or fired forget. Diets can be ordered and patients can refuse. so one nutritionist talk to a patient about his 1800 calorie heart healthy diet etc and pt went ballistic and threw the trey at the nutritionist and then rang non stop for his diet to be changed to regular.before anyone utters one word the nutritionsit APPROACHED it in a nice super professional way the pt just went ballistic because god forbid he not eat 3000 calories a day of fried food.

orthonurse55 · Jun 30, 2012

I haven't read all of the comments yet but want to add my 2 cents. Sometimes the people that come in to ask those questions are dietary aides - they are not dieticians and are in no way trained or authorized to help the patient to make healthy choices.

aachavez · Jun 30, 2012

Dad was recently in the hospital, on admit he had high blood sugar. He had an MD ordered diet, so when he spoke to a dietary aide to order breakfast, and they quickly told him NO MORE CARBS FOR YOU!!!! Ok so they were nicer than that, but he was over his limit, and they gave him other options that fit into his plan. Maybe that patient just didnt have a specific diet plan yet? Altho seeing how many comments there are about nurses being able to over ride these orders for 'customer satisfaction' is worrysome. What's the point of even having ordered plans if they can be so easily ignored?

Im still in nursing school, so This is still all new to me. But it really bothers me to see all the posts all over this site where it seems the focus these days in hospitals is all about customer satisfaction scores, and not on healing.

rnlately · Jun 30, 2012

umm...no. if they can go and get it then that's one thing, but i will NOT bring it to them nor will i go down to the cafeteria to get it.

Agree with you. I'm not going to ALLOW a pt to gorge him/herself with high sugar foods just to I can trek up and down the hall every 2-4 hrs checking your BS and then having to load you with extra insulin.