I work on a med-surg unit with plenty of diabetic patients. Most are noncompliant with high A1Cs and are always demanding cookies.
I try to find a balance. Last week I had a 400 pound patient demanding multiple snacks outside of his diet. He had a wound that wasn't healing and I explained to him that high blood sugar levels could interfere with the healing process. He still demanded that I give him whatever he wanted. I managed to convince him to meet me in the middle and have one of what he wanted instead of two of everything and covered his carbs and blood sugar.
So question: when a diabetic patient demands sweets, has high blood sugars and isn't NPO or clear liquids for a procedure, do you just continue to give them all the snacks they want? Or do you insist that if they want to be noncompliant with the hospital diet that they must get their own treats?
It's ironic that the units carry primarily refined carbs.
It's ridiculous...personally, I don't think we should have any snacks. The patients get plenty of food on their meal trays, and most of them ask for popsicles and graham crackers just because they're there.
It's ridiculous...personally, I don't think we should have any snacks. The patients get plenty of food on their meal trays, and most of them ask for popsicles and graham crackers just because they're there.
They're useful, at times. Some patients' blood sugars do drop between meals and some medication is better taken with a small amount of food. We also have post-op patients and new admissions who may not have had an opportunity to eat all day.
It's ridiculous...personally, I don't think we should have any snacks. The patients get plenty of food on their meal trays, and most of them ask for popsicles and graham crackers just because they're there.
Our meal service ends at 6:30pm. We have patients all the time that are kept NPO all day, finally taken for their scope or whatnot at 3:30pm, and come back to the unit at 7pm. We'll also have patients fall asleep or feel nauseated and not order dinner and be starving come 11pm. We have patients who get an upset stomach if they take their pills without food, so those crackers are a lifesaver for a 2am antibiotic. And we'll have patients that need applesauce or pudding to get down some horse pills. Finally, having juice and crackers available on the unit is a literal lifesaver with a hypoglycemic patient.
I won't confiscate food; they're adults and have rights. I've had pts in w/ DKA when floating to the medical stepdown floor, whose family have brought in all kinds of carby deliciousness. I'll educate and cover for it.
However, I as the licensed professional also have the right to follow the medical plan of care, in this case the prescribed diet. So no, I won't fetch Mt Dew and cookies (of course it makes it easier being in an ICU where we only stock crackers and juice.)
And to be honest, I'm more concerned about meeting our accreditation marks--one of which is FSBG within a certain range by a set time postop following CVT surgery--than pt satisfaction scores.
I do vigilant assessments and try to treat each patient with a "do no harm" mentality. Sometimes a cookie isn't just a cookie, sometimes a cookie is a self care for a crushed spirit.
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Pay attention to the circumstances that are leading the person to not understand the consequences of their decisions.
As your cookie example illustrates, sometimes "a lack of knowledge or understanding" is not the problem and "education" is not the answer. As a former diabetic myself, that is what frustrates me about much of the diabetic literature and most of the conversations about the compliance with diabetic patients. Nurses focus on "education" as the proper intervention for these types of problem even though "a lack of knowledge or understanding" is not the problem.
If we are going to help such patients, we need to explore and treat the other causes of their non-compliance -- causes that are not so easily labeled and "fixed" with "education." Until we really research non-compliance and address the other causes, we are doomed to fail.
I write this post as someone who was diagnoses as "diabetic" 7.5 years ago ... but whose diagnosis was down-graded to "glucose intolerance" after 6 years of stable lab results, treated with diet and exercise alone -- no meds. I am what everyone would consider a "success story" -- but even I backslide at times and reach for the cookies, particularly when I am stressed. In addition, I have a PhD in nursing and have done research related to hyperglycemia. If I were stressed and wanted a cookie and some nurse wrongly assumed that I was ignorant of the consequences of eating too many carbs, I'd be pretty PO'd by her efforts to "educate" me.
We need to move beyond using "education" as a crutch to avoid dealing with the patients real issues related to life-long carbohydrate restrictions.
Specializes in Psych, Addictions, SOL (Student of Life).
I work on a med-surg unit with plenty of diabetic patients. Most are noncompliant with high A1Cs and are always demanding cookies.
I try to find a balance. Last week I had a 400 pound patient demanding multiple snacks outside of his diet. He had a wound that wasn't healing and I explained to him that high blood sugar levels could interfere with the healing process. He still demanded that I give him whatever he wanted. I managed to convince him to meet me in the middle and have one of what he wanted instead of two of everything and covered his carbs and blood sugar.
So question: when a diabetic patient demands sweets, has high blood sugars and isn't NPO or clear liquids for a procedure, do you just continue to give them all the snacks they want? Or do you insist that if they want to be noncompliant with the hospital diet that they must get their own treats?
Well you are not going to fix a non-compliant patient in one acute hospital stay. All you can do is stick to the ordered diet as much as possible and document the patients non-compliance. In our facilities we do non-compliant care plans to show that the patient is refusing to comply despite have the risks and benefits explained to them and they're verbalizing understanding of said risks and benefits. You are not responsible for another persons lifestyle choices but in my experience people with this level of non-compliance can become quite angry when denied and make a shift miserable if not dangerous for staff. As long as the issue is well documented in progress notes and the physician is aware - there is not much you can do.
As your cookie example illustrates, sometimes "a lack of knowledge or understanding" is not the problem and "education" is not the answer. As a former diabetic myself, that is what frustrates me about much of the diabetic literature and most of the conversations about the compliance with diabetic patients. Nurses focus on "education" as the proper intervention for these types of problem even though "a lack of knowledge or understanding" is not the problem.
If we are going to help such patients, we need to explore and treat the other causes of their non-compliance -- causes that are not so easily labeled and "fixed" with "education." Until we really research non-compliance and address the other causes, we are doomed to fail.
I write this post as someone who was diagnoses as "diabetic" 7.5 years ago ... but whose diagnosis was down-graded to "glucose intolerance" after 6 years of stable lab results, treated with diet and exercise alone -- no meds. I am what everyone would consider a "success story" -- but even I backslide at times and reach for the cookies, particularly when I am stressed. In addition, I have a PhD in nursing and have done research related to hyperglycemia. If I were stressed and wanted a cookie and some nurse wrongly assumed that I was ignorant of the consequences of eating too many carbs, I'd be pretty PO'd by her efforts to "educate" me.
We need to move beyond using "education" as a crutch to avoid dealing with the patients real issues related to life-long carbohydrate restrictions.
I educate to cover myself, not because I believe the patient is unaware. I know they've heard it millions of times before. I know they don't care or want my opinion. Life-long issues need to be dealt with as an outpatient and the patient has to want to deal with them. I don't have time for that in acute care.
No "snacks" and what do you do when a patient is off the floor during a meal...or is nauseated during a meal time...or sleeps through a meal...or is a late admit? However, we do have chicken salad sandwiches, yogurt, bagels, and sometimes fresh fruit in our small fridge to go with soup and crackers in the supply room.
I think the crackers and applesauce are more for giving meds...the ones that need to be taken "w/food" or for the patients who need help swallowing and aren't really "snacks" per se. And I love the popsicles for slightly nauseated post-op patient or GI patients....
Cheap refined carbs,that I would not feed to my dog.
That's a bit judgmental and taking it a bit far. Yes, it is simple but it's not meant to be a replacement or to be eaten all the time. It would be much more of a problem/more expense to keep fruit and veggies continually available. That's why those are on meal trays and snacks aren't offered regularly.
Cheap refined carbs,that I would not feed to my dog.
SubSippi
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It's ridiculous...personally, I don't think we should have any snacks. The patients get plenty of food on their meal trays, and most of them ask for popsicles and graham crackers just because they're there.