Dietary policy- vent

malamud69, BSN, RN · Jul 7, 2012

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.

Yes this is the world we live in...It is terrible that to this day so many doctors know nothing about nutrition.(Plant based diets are the best) I don't care what anybody says...eating the standard american diet of meat and potatoes and fats and cheese...bleepin cheese on everything...worse yet milk (Cows milk is for baby cows...not humans..plenty of Vit D and calcium from good ol' mother nature) etc....w/ salad and veggies as an afterthought is NOT healthy. So the bottom line it seems in most institutions is cost...and yes its easiest to cook for hundreds of people when its processed crap. We do not practice or teach prevention in this country ...if we did we would do actual "health" care instead of after the fact "sick" care. Shoot at the LTC I work at they wonder why on certain days all the residents have the runs...hmmm...could it bee the disgusting franks and beans they served the night before or the everyday greasy eggs and sausage for breakfast...give me a break!

rngolfer53 · Jul 7, 2012

Aren't hospital supposed to promote HEALTH? Mc Donalds is the BEST EXAMPLE of unhealthy eating!

I agree in general with you, but at the same time have a little different perspective. As a former pediatric oncology nurse we were THRILLED if the kids would eat, and a lot of the time nobody really cared if it was healthy or not. Nothing worse than watching them starve, and seeing them with a Big Mac and some fries often made my day. Healthy food would have been much better, but you take what you can get.

The old saying: Don't let the perfect get in the way of the good.

For someone who is not eating to the point of risk, any food is better than none.

The OP describes a very different situation.

Akeos · Jul 8, 2012

I have to disagree with most of you, I think food should be looked at as part of the treatment plan for patients, If it's a cancer patient who's wasting away or a 90 yr old on their death bed, then by all means eat as much and whatever you'd like. but if your a 350 lb middle aged person who's most likey in the hospital for health reasons related to their obesity in the first place then why on earth would we let them continue to gorge themself in massive amounts of unhealthy food? Put a calorie restriction on them, and give them a specific menu with acceptable choices, So they might be unhappy for a while, but they're not going to starve, and they'll still have options of food they want to eat. Saying they're in the hospital for a couple days and we're never going to change their habits so why bother trying is like saying well they're not compliant with their medications at home so why bother giving them to them while their here. They're in the hospital in improve their health status, that includes nutrition, and we're the one's that should be saying I'm not going to contribute to the problems and habits that put in the hospital in the first place.

rnlately · Jul 8, 2012

I have to disagree with most of you, I think food should be looked at as part of the treatment plan for patients, If it's a cancer patient who's wasting away or a 90 yr old on their death bed, then by all means eat as much and whatever you'd like. but if your a 350 lb middle aged person who's most likey in the hospital for health reasons related to their obesity in the first place then why on earth would we let them continue to gorge themself in massive amounts of unhealthy food? Put a calorie restriction on them, and give them a specific menu with acceptable choices, So they might be unhappy for a while, but they're not going to starve, and they'll still have options of food they want to eat. Saying they're in the hospital for a couple days and we're never going to change their habits so why bother trying is like saying well they're not compliant with their medications at home so why bother giving them to them while their here. They're in the hospital in improve their health status, that includes nutrition, and we're the one's that should be saying I'm not going to contribute to the problems and habits that put in the hospital in the first place.

Exactly!!! This is also the reason that careplans exist. To hopefully move toward a healthful goal.

tothepointeLVN, LVN · Jul 8, 2012

If the patient is not on a restrictive diet then we have no right to restrict their eating. Remember patient autonomy? We are NOT food gods. You did that to me when I was in the hospital and didn't have a restricted diet then you'd be hearing about and you wouldn't be the only one I'd be talking about it to. We can promote health but we need to avoid unrestrained self righteousness.

malamud69, BSN, RN · Jul 8, 2012

If the patient is not on a restrictive diet then we have no right to restrict their eating. Remember patient autonomy? We are NOT food gods. You did that to me when I was in the hospital and didn't have a restricted diet then you'd be hearing about and you wouldn't be the only one I'd be talking about it to. We can promote health but we need to avoid unrestrained self righteousness.

So in the days of acceptable boozing and smoking on the job would you have allowed that as "autonomy"...do really think we have learned nothing about the negative health effects of these types of foods???

tothepointeLVN, LVN · Jul 8, 2012

So in the days of acceptable boozing and smoking on the job would you have allowed that as "autonomy"...do really think we have learned nothing about the negative health effects of these types of foods???

Your statement implies I would be living in the past but have knowledge from the future so I'm not going to address that point.

The situation that the OP outlined was a patient who was on a regular diet with NO restriction order a combination of menu items that was allowed on a regular diet. It was within the patients right to do so regardless of their weight. We don't even know why the patient was there. Maybe she fell off her horse or something not related to her eating habits. Either way she was not on a doctored ordered special or restricted diet.

I know you have just started nursing school and this is not a slight but you may not have gotten to the part about patient autonomy and the right to choose or refuse care. We provide care we do not provide judgement.

malamud69, BSN, RN · Jul 8, 2012

Your statement implies I would be living in the past but have knowledge from the future so I'm not going to address that point.
The situation that the OP outlined was a patient who was on a regular diet with NO restriction order a combination of menu items that was allowed on a regular diet. It was within the patients right to do so regardless of their weight. We don't even know why the patient was there. Maybe she fell off her horse or something not related to her eating habits. Either way she was not on a doctored ordered special or restricted diet.
I know you have just started nursing school and this is not a slight but you may not have gotten to the part about patient autonomy and the right to choose or refuse care. We provide care we do not provide judgement.

Not knowing certain things, you make some interesting points...

trauma_lama, BSN · Aug 9, 2012

Your statement implies I would be living in the past but have knowledge from the future so I'm not going to address that point.
The situation that the OP outlined was a patient who was on a regular diet with NO restriction order a combination of menu items that was allowed on a regular diet. It was within the patients right to do so regardless of their weight. We don't even know why the patient was there. Maybe she fell off her horse or something not related to her eating habits. Either way she was not on a doctored ordered special or restricted diet.
I know you have just started nursing school and this is not a slight but you may not have gotten to the part about patient autonomy and the right to choose or refuse care. We provide care we do not provide judgement.

I'm perfectly familiar with patient autonomy, and I strongly advocate for it with my own patients. I'm not judging anyone. I'm simply stating that it doesn't make sense to me why someone admitted for obesity-related complications would be allowed to order the quality and quantity of food that she ordered without receiving some sort of education about her choices or restriction on which items she may pick from. If she's paying for the food like at a restaurant, a la carte, order away! But for insurance or medicaid, it doesn't seem fair to other policy holders or tax payers that someone can contribute to their own hospital-visit-warranting- health problem without being called out on it. You're right, I'm not there to judge- so I don't. I may be a student nurse but I'm not a moron.

tothepointeLVN, LVN · Aug 10, 2012

If the MD didn't prescribe a restricted diet then she gets to eat what she wants.

If we start pointing fingers at people stating it's not fair that they get to live xyz lifestyle because it costs more then it's a slippery slope. I cost my insurance a pretty penny when I fell off my horse. Thats a high risk lifestyle. The entire point of insurance policies is that the risk is spread around. One person on a diet or NOT on a diet isn't going to affect anything. If she was paying cash for her visit does that mean she can still eat what she likes or does she still get judgement.

Long term diet changes needs to be implement with supportive services such as a nutritionist and perhaps a lifestyle coach not simply denying you food while in the hospital and binging when you get home. Most people's eating habits are pretty fixed. They eat the kind of food they have grown up with. How do you know that patient hadn't received or would received nutritional counselling?

Some problems are inpatient problems some are outpatient problems.

And what your saying sounds a heck of a lot like judgement to me.

trauma_lama, BSN · Aug 14, 2012

If the MD didn't prescribe a restricted diet then she gets to eat what she wants.
If we start pointing fingers at people stating it's not fair that they get to live xyz lifestyle because it costs more then it's a slippery slope. I cost my insurance a pretty penny when I fell off my horse. Thats a high risk lifestyle. The entire point of insurance policies is that the risk is spread around. One person on a diet or NOT on a diet isn't going to affect anything. If she was paying cash for her visit does that mean she can still eat what she likes or does she still get judgement.
Long term diet changes needs to be implement with supportive services such as a nutritionist and perhaps a lifestyle coach not simply denying you food while in the hospital and binging when you get home. Most people's eating habits are pretty fixed. They eat the kind of food they have grown up with. How do you know that patient hadn't received or would received nutritional counselling?
Some problems are inpatient problems some are outpatient problems.
And what your saying sounds a heck of a lot like judgement to me.

Well then I'm very sorry that you're misunderstanding me. As I said, no judgement. This situation just makes as much sense to me as giving someone having DTs a fifth of vodka.

sharpeimom · Aug 14, 2012

When I was a patient in stroke rehab almost nine years ago, I was there for six weeks, after a week in the hospital.

Knowing my husband wasn't eating properly and on some days, not much at all and I worried. Neighbors sent in food

and invited him to dinner, but he just picked at it.

Finally, with my nurse's permission,I formulated a plan. In addition to my meal, for lunch and dinner, I ordered egg

salad, tuna salad, chicken salad, or maybe a hard boiled egg, plus bread. I'd also order jello and/or a raw veggie plate,

and a piece of fruit.

It would have looked like I was eating a ton, if I hadn't had a very helpful nurse. It simply meant that my type-1 diabetic

husband didn't get sick, which was my goal.