How do you teach a life-saving diet?

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Let me preface, I work on a Cardiac Telemetry unit in Hawaii. Sadly, business is booming.

There's a mound of evidence: Whole food, plant-based diet -> Reversal of Heart Disease, Diabetes, Stroke, Cancer. My intention is not debate on this subject, although I realize that its quite complex and probably out of my realm of expertise. I believe it. I want my patients to believe it. But how do I get through to them.

My average discharge instructions look like such:

See your PCP.

See your Specialist.

Stay Active.

Don't smoke.

Take Drug A

Here is when you take Drug A

Here is why you take Drug A

Here is the side effects of Drug A

Here is when you take Drug B

Here is why you take Drug B

Here is the side effects of Drug B

Here is when you take Drug C

Here is why you take Drug C

Here is the side effects of Drug C

Here is when you take Drug D

Here is why you take Drug D

Here is the side effects of Drug D

Here is when you take Drug E

Here is why you take Drug E

Here is the side effects of Drug E

And oh yeah... Eat a low-fat, low-sugar, low-cholesterol, high-fiber diet.

GOOD LUCK!

Clearly discharge is not the time to stress such a dramatic diet change. I need a more captive audience, not one that is itching to get out of the hospital.

But when? Do you talk after their angioplasty/CABG? Before it? Do you set them straight... use the dreaded "Heart Attack" wording to scare them into attention? Do you point blank say "Look dude, these drugs/procedures are great and all, they probably saved your life this week... but you will be back... this will only delay your death. You want the cure?"

I just don't know. Most of my fellow RN/MDs spend less than 1% of their time talking about diet/activity... cause we just don't think its getting through... we don't believe they will change. Are we part of the failure rate? Because we don't believe? Or am I just setting myself up for heartache.

If I spend an hour one day talking about diet, explaining the physiology of it, showing them past medical studies with amazing results -> will I have a nervous breakdown when I see them munching on McDonalds?

Will my MDs get upset? After all, our Cardiologists specialize in two things: Surgical and Pharmacological intervention. My message would, depending on how blatant I am, stress that these two methods are palliative methods at best, while the true cure costs only a few dollars more a week in your vegetable aisle and a nightly neighborhood stroll.

Is it a conflict of interest to down play medical/surgical intervention compared to lifestyle changes... while at the same time, being employed by that same medical/surgical institution? Am I under cutting my MDs? Am I giving our patients an excuse to be "non-compliant" with their medications?

I feel horrible right now. I feel that every patient who heard my "Oh yeah, eat healthy, you know how, just do it", discharge instructions... that part of their eventual death to heart disease/stroke/cancer/diabetes is on my hands.

My conscience won't let me stay silent anymore. Where do I start?

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When I weighed 240 pounds and had health problems a few do-gooders tried to help me. It didn't work. I just resented it. It was only when I decided that I was worthwhile and worth saving that I was able to go on my life-saving food plan. A person has to make their own individual choices. As for me, I knew I had a choice. I could choose to live or I could choose to die. I chose Life and lost 120 pounds.

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Specializes in Infusion, Med/Surg/Tele, Outpatient.

I actually first went to school for nutrition. Clinical nutrition wasn't worth it for me - nobody cared. I now just send an order for the RD/LD or Diet Tech to come teach. What I tell my pts - especially the non-compliant ones? (be sure to keep the tone of your voice neutral or joking so they don't take offense)

1. We really appreciate the repeat business. See you next time.

2. Thank you for the job security.

After that is said, people will usually will blink, then smile. That's when I talk about what you can do to stay out of the hospital, like diet or exercise. There are some that don't care. And we see those pts 2-3 times a month. Job security.

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"Job security."

Hah! My wife says the same thing. "If you guys cure everyone, you'll have no patients."

I could live in that world.... I'd just get a job at an old folks home taking care of all the 100 yr olds... =)

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I used to work in a drug/alcohol treatment setting where we got lots of clients with HTN who were put on a low Na+ diet in the hospital. The (2 gm Na+ diet) trays the hospital kitchen sent were pretty unappetizing, and I certainly didn't blame the clients for not wanting to eat like that from now on. I used to spend time (I was in a setting where I had the luxury of spending time doing client teaching -- those were the days ... :)) pointing out that a 2 gm Na+ diet didn't have to be what the kitchen was sending them, they could eat tasy, appealing, interesting food on the diet, it would just take a little learning and effort on their part. Most of the clients would say something like, "I don't care, it's my life and if I drop dead, so be it!" My response used to be, "Well, if it was just about you dropping dead, I'd say sure, go for it. But the catch is that you're not going to drop dead -- you're going to have a stroke and live, and spend the next twenty years in a nursing home dragging one side of your body around after you and drooling into your oatmeal". The usual reaction I would get is, "Oooooohhhhhh, I didn't know that -- um, tell me more about the diet ..." and they would be much more open to listening and learning.

Maybe a little "reality therapy" will get your clients' attention?

The other option that springs to mind is to raise this as a unit-wide issue, and discuss the possibility of instituting a more aggressive unit-wide diet/teaching program that everyone would get. I'm sure the hospital's dieticians would be interested in participating in a program like that.

And, eventually, you have to just let go and make peace with the idea that other people's choices and decisions aren't your responsibility. Much of this information is widely available in the public arena -- it's not like it's a secret that better lifestyle choices would help these people.

Best wishes!

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You might enjoy a book on Motivational Interviewing in Health Care. It is a way of talking to people and helping them explore what kind of changes they think will help them...it seems to be very effective.

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Specializes in M/S, MICU, CVICU, SICU, ER, Trauma, NICU.

I have reconciled myself to the fact that all of our patients (except for the pediatric ones) all have the same history...obese, diabetic, hypertensive, CAD...

I'm even thinking of making a permanent stamper with those particulars so I don't have to rewrite so many histories...

What surprises me is that these types of patients actually think that their post-op management should be unremarkable and anything that goes wrong couldn't POSSIBLY BE THEIR FAULT.

Behaviors are cultivated and deep. I do not change behaviors. I just say,

"See you next time...."

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Most people who smoke know it is not good for them.

The same goes for the diet.

The problem is not a lack of education.

It is human nature.

Some people will eventually take the knowledge they have learned and put it to work. People can change their health habits, but only they can do it once discharged. We can't do it for them.

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And oh yeah... Eat a low-fat, low-sugar, low-cholesterol, high-fiber diet.

GOOD LUCK!

Clearly discharge is not the time to stress such a dramatic diet change. I need a more captive audience, not one that is itching to get out of the hospital.

But when? Do you talk after their angioplasty/CABG? Before it? Do you set them straight... use the dreaded "Heart Attack" wording to scare them into attention? Do you point blank say "Look dude, these drugs/procedures are great and all, they probably saved your life this week... but you will be back... this will only delay your death. You want the cure?"

I just don't know. Most of my fellow RN/MDs spend less than 1% of their time talking about diet/activity... cause we just don't think its getting through... we don't believe they will change. Are we part of the failure rate? Because we don't believe? Or am I just setting myself up for heartache.

If I spend an hour one day talking about diet, explaining the physiology of it, showing them past medical studies with amazing results -> will I have a nervous breakdown when I see them munching on McDonalds?

McDonalds has a couple of acceptable items on their menu for a cardiac diet.

Don't forget to teach them to read food labels for milligrams of sodium per serving and where to find the serving size in the nutrition facts.

Let them know that the AHA recommends 1500 to 2000 mg. of sodium per day total.

The average american easily consumes twice that much sodium.

Let them know what sodium will do to their cardiovascular disease if they consume too much of it.

Teach them the food sources of "good" cholesterol.

And remember that they will eat what they eat. Some people listen and learn. Some are not listening.

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Specializes in M/S, MICU, CVICU, SICU, ER, Trauma, NICU.
Most people who smoke know it is not good for them.

The same goes for the diet.

The problem is not a lack of education.

It is human nature.

Some people will eventually take the knowledge they have learned and put it to work. People can change their health habits, but only they can do it once discharged. We can't do it for them.

And neither do I lose sleep over them....

Everyone has a choice. That's the bottom line.

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