Are patients allowed to order food from outside places and have it delivered to their rooms if they are on anything but a regular diet?
Right now we have a morbidly obese pt. who is a raging diabetic. He's on a diabetic diet. He can not even move himself around in the bed independently. All of us have been stressing our backs lifting his legs, pannus, arms, etc. so that he can turn and reposition. Getting him to sitting position on the edge of the bed is a real back buster. Don't even get me started on the two hour long dressing changes.
Just about every night he orders large amounts of food from the local fast food delivery places.
I understand that food is an addiction and free will and all of that but he is not complying w/ his prescribed diet which is affecting his ability to heal.
We had a another situation w/ a diabetic dialysis pt. who the doctors allowed to be on a regular diet. He needed to have his gallbladder taken out but refused. He would order burgers and fries and nibble on them all night while at the same time getting Phenergan q6hr and Dilaudid q3hr for his nausea and stomach pain. He'd refuse his Carafate, Reglan and Pepcid. And dialysis for days at a time.
Both of these pt.s could be verbally abusive and demanding to the staff. It is so frustrating that the doctors don't put their foot down and tell them that they cannot have a regular diet. Why can't the docs discharge them for non-compliance? We are basically just boarding these folks
b/c they refuse everything that will make them better.
I've been a nurse for a long time and I know the answer...customer satisfaction. But it feels good to vent.
I'm still curious about the ordering food from outside places, though. And, do you all see any docs that will stand up to these pt.s and not allow them things that are hindering their healing? Or will discharge them if they are refusing all tx. that will make them better?
You may not be able to call it an infection control issue, but the unit/hospital is not obligated in any way shape or form to allow food delivery on their unit. You can't stop a patient from going down to the lobby/outside to pick up delivery, but you are also under no obligation to assist a person down there if they aren't capable themselves. The best solution is, as has been suggested, to ensure that the patient is getting adequate calories from the diet provided.
They may not be obligated, but at least where I am there is absolutely no way to prevent it, and nobody is actually willing to enforce it due to patient's satisfaction issues. Also, as it was said, patients retain their human rights while hospitalized. They are not imprisoned, it is their right to accept or refuse any treatment offered. It is also just not realistic to expect them to break all their bad dietary habits radically within 24 hours. We can educate, document and encourage, but realistically this is the end of our possibilities.
Speaking honestly, after I found out that hospital cafeterias are mostly (if not totally) not equipped to deal with patients requiring "absolute avoidance" of certain products due to severe allergies (meaning -totally separate area and equipment to cook, cleaning before and after, separate personnel for cooking and handling and multiple quality checks), I live totally on takeouts when I am in hospital. I do not generally eat "American" food anyway, so I order from the nearest Whole Foods or any other similar place three times a day. I had enough shocks of those so-called "hospitality ambassadors" and "food service associates" bringing the very things I can literally only look at safely, and that was after big letter notes was posted on the room door and near nursing station. And the reason I'd got there was anaphylaxis to that very product.
My first year in nursing, the unit I worked on admitted a morbidly obese patient who had skin breakdowns everywhere there was a fold of flesh. It took four people to do dsg changes! (She also required two side-by-side beds, pushed together and secured by the Maintenance Dept.)
I think my wrist problems may have started then, as two of us were required to push up or pull up whatever was drooped over whatever spot the other nurses were working on.
She had Dr's orders for milk-shakes and egg-nogs made fresh and sent up from the dietary kitchen between her high calorie meals. That's when I learned a very large person can actually be malnourished! I was floored!
Actually, the wast majority of morbidly obese patients is malnourished. They hardly ever have normal level of albumin, iron, vitamin D metabolites, copper, selenium, omega 6 and 9 and quite a few more important chemicals in their blood. Their huge bodies just require too much of the elements not normally found in cheap junk food they mostly consume. It is one of the reasons why this population has such high tendency to get chronic non-healing wounds.
I'd seen a few cases of full-blown scurvy among people who consumed thousands of calories a day in chips, soda, cookies and such. They were morbidly obese all right, but severely malnourished just as well.
Some folks have mentioned the need for obese pt's to have sufficient calories, which is an excellent point. Unfortunately the compulsion to binge on salt/sugar/fat really isn't driven by a need to meet calorie demands.
We as a society have to crash and burn, financially speaking, when we are over saturated with morbid obesity and all of its precursors and comorbidities. I don't think this one can be fixed a starfish at a time.
As frustrating as it is, how are ya'll and the majority of your colleagues doing with your own weight and fitness mgmt? There will always be someone struggling with dietary discipline. It's all relative.
Over here, in the land of sunshine and plenty, we're seeing obesity in our young physicians coming into the area. How about a morbidly obese pediatrician? Can't blame anything but the obesity creep in those cases.
I think the general we need to clean up our own backyard before pointing at the addicted and dysfunctional, albeit it is maddenly frustrating to physically care for them.
I agree that it can be frustrating to see patients eating food that is counterproductive to their health. At the hospital I work at patients don't order delivery super often, but there is a cookie shop, Wendy's, coffee shop/bakery, gift shop with candy, etc. on site. Plus family quite often brings food in. Really all that we can do as nurses is educate, notify the doctor if the diet order isn't being followed (especially for things such as fluid restriction and renal diet), and ask diabetics to be honest about everything they are eating so that carbs can be accurately covered with insulin.
As far as a patient chowing down on food while giving IV pain and nausea meds go....our doctors actually have developed some pretty good protocols for patient populations that typically exhibit those behaviors on my floor (mostly pancreatitis and crohn's flare admits). Typically if they are eating solid foods they are placed on PO pain and nausea meds. This has worked reasonably well.
Oh, yeah. I liked to see patients being taught by an RD who looked like a concentration camp survivor with wrinkled face of 50+ years old (she was in her 30th) and a nurse of the size of a small whale with uniform about to burst on all seams at once. Quite commonly, those poor victims of great intentions mentioned something about both of them gotta find something else to do with their lives instead of teaching people the crap they couldn't satisfactory manage themselves.
When I have a patient who is actively engaging in self-harm behaviors while admitted to the hospital and the medical team isn't addressing the situation; I write a safety report, formally request an ethics consult be held, then notify the charge nurse that I will no longer take care of that patient.
Sometimes it helps get the medical team off their hands, sometimes it doesn't - but that patient is sure as heck in my rear view mirror.
I'll take care of the most complicated, difficult patients they can find, but I won't help someone actively harm themselves.
Specializes in Med-surg, telemetry, critical care..
There are exceptions. Like the little old ladies that are losing weight due to poor appetite. You will often find out that they have lost their sense of taste. My Mom liked spicy tex-mex and an occasional margarita. She got it, and ate very well. She liked a few jalapeños with her bland nursing home food. I took her a nice spicy meatloaf, some garlicky mashed potatoes, you know the drill. I am diabetic. I only get to have small portions, but I eat what I want. The spicier the better. I want less of something if I can get a taste of a flavor I crave. A tablespoon of something chocolatey. I am adjusting. My herb and spice collection has grown considerably. If a cancer patient craves something, get it for them. In a small portion so they won't get overwhelmed and unable to have a little bit.
Kids, if I ever get offensive, mean or refuse treatment, get me a psychiatrist. If that doesn't work, toss me out on my butt.
I hear your frustration, but on the other hand, even if they followed the Rx'ed diet perfectly...they're still going to be morbidly obese and difficult to move by the end of the hospitalization.
Have you ever seen that show "My 600 Pound Life?" I haven't seen may episodes, but on occasion the bariatric surgeon will admit pts to the hospital pre-op if they can't manage their eating without extra help. Anyway, he did discharge at least one pt due to her constant refusal to do ANYTHING recommended (family brought her outside food, refused PT, refused any effort to get OOB etc.) That I can see, because the whole reason she was admitted was so that she could avail herself of the support that was in the hospital. Her actions were in direct opposition to the purpose of the hospitalization.
I personally don't take care of many pts who are in clear, present, and acute danger from their dietary choices. Say a pt was c/o 10/10 belly pain and constant nausea...dx'ed with gastroparesis and constantly ordering takeout...that would be one thing. Your gallbladder pt, too. However most people's obesity related issues that I've seen were the result of long-time obesity and malnutrition (as KatieMI said, excessive calories does not equal nourishment). For example, 500+ lb man has a giant pressure ulcer on his butt and nec fasc in the groin area (real example; he spent most of his life sitting on his floor.) Say he was not intubated--yes, obesity and extreme overeating was the main contributing factor to his condition, but eating a whole deep-dish pizza wouldn't make his wound acutely worse or cause septic shock. Those kinds of issues will NOT be resolved during hospitalization, and pts are free to refuse Rx's.
Verbal abuse by patients is another matter entirely. I personally, and advise my fellow nurses (or really, anyone in a pt care position) to disengage. I actually do tell people "That speech is unnecessary and rude, and I will not have this discussion" or something to that effect. Carry out nursing duties in silence, with the exception of assessment questions. If they want to add a bunch of f bombs to their answers, that's their choice.
If the patient wants to eat that type of food and they are competent, let them have it. Let them pay for a delivery guy to come to their room. Regarding meds, it they say they are in pain etc., give them the meds the physician ordered. As a nurse, you can't physically obstruct a patient from doing stuff like this, or deny a patient who is stable pain meds based on their presentation.
I gave up fighting these unwinnable battles long ago.
To be quite honest I could bang my head against a brick wall but I don't.
A short admission is not going to change anything. If the pt is competent he can refuse what ever treatment he wants. We can't fix idiotic behavior, they don't allow lobotomies as frequently as they used to.....
Being able to make decisions for themselves and refuse certain aspects of their care/treatment is a patients right. Even when they make really poor choices.
Eating a salad tonight instead of a bunch of fast food isn't going to make your patient drop 100 lbs overnight. People know they are overweight. Patients know this contributes to their health problems. They choose quality of life over quantity. It's their choice to make. In this case, his diet isn't going to impact his hospital stay in the short term.
The second patient sounds very frustrating, and more of a gray area. If he truly needs his gallbladder out and is refusing, but eating aggravating foods, and only staying in the hospital for abdominal pain to be treated, well that seems really questionable. I don't know HOW it would have to be done, but agree that he shouldn't be hospitalized for something is is 100% reusing tx for. He is going to have abdominal pain until his gallbladder is out... He can't stay hospitalized for dilaudid the rest of his life. Patient advocate could possibly get involved.
KatieMI, BSN, MSN, RN
1 Article; 2,675 Posts
They may not be obligated, but at least where I am there is absolutely no way to prevent it, and nobody is actually willing to enforce it due to patient's satisfaction issues. Also, as it was said, patients retain their human rights while hospitalized. They are not imprisoned, it is their right to accept or refuse any treatment offered. It is also just not realistic to expect them to break all their bad dietary habits radically within 24 hours. We can educate, document and encourage, but realistically this is the end of our possibilities.
Speaking honestly, after I found out that hospital cafeterias are mostly (if not totally) not equipped to deal with patients requiring "absolute avoidance" of certain products due to severe allergies (meaning -totally separate area and equipment to cook, cleaning before and after, separate personnel for cooking and handling and multiple quality checks), I live totally on takeouts when I am in hospital. I do not generally eat "American" food anyway, so I order from the nearest Whole Foods or any other similar place three times a day. I had enough shocks of those so-called "hospitality ambassadors" and "food service associates" bringing the very things I can literally only look at safely, and that was after big letter notes was posted on the room door and near nursing station. And the reason I'd got there was anaphylaxis to that very product.