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?
The best we can do in a situation like this is let the doctor know, educate the patient of the importance of adhering to his diet, and DOCUMENT in the nursing notes, maybe a dietary consult( I am sure this was done) As a nurse we are usually too busy to notice if someone brought food on the unit or sent someone down to pick it up. Our doctors do talk to their patients about it ,but they are there 5-10 min/day and a nurse is assigned to the patient 24hrs/day.
Specializes in Med nurse in med-surg., float, HH, and PDN.
When I worked Home Health, I walked into a popular cafeteria for an early take-out supper, and the first thing I saw was an 80-ish diabetic patient trying to cover her plate of Boston Cream pie with her hand (guilty!). I shrugged and said to her, "I'm not the Food Police. You're the one who has to pay the consequences of your actions, not me." and not giving it another thought, I went on to get in line for my food. I'm over fretting about a grown-up person who KNOWS what to do to take care of him/her self in a situation like that. There are also a few things in MY life where I chose quality over quantity, and do it knowingly, and even *I* hate to get the finger-wagging lectures.
You can't stop them from ordering, so document everything about the situation. I have had people order food and since the doors are locked demand I go down and get it. I refused to do that. Under no circumstances help them get the food into their room. They want to cheat on their diet against medical advice, they are completely on their own and I won't lift a finger or give a single penny to help them do it.
My hospital doesn't allow delivery people up on the units anymore so if a friend/family aren't able to go to the lobby and the patient's diet ORDER is low sodium, or low fat or renal or anything other than regular, we can and do, tell them we are not going get the food. I've never seen as aid for 3 yr and a nurse for 1 yr, a patient not be told before they ordered that no one could pick it up.
Even if it's a regular diet, and we are slammed or over ratio or 1 aid or no aid, no one is is under any obligation to take time away from patient care to get food when it's already provided for them.
If I were family of another patient and something happened to my loved when that was "avoidable" and serious and found out their nurse or aid was off the unit for food delivery, I might have an issue. Now, I know that even with the perfect number of staff things happen since no one has 1:1 care on the floors but we all know that there are families that would sue and have a good chance of winning if all that could go wrong did.
I remember when I was an aid, an elderly woman asked me if I could go to down to our giftshop to play the lottery for her. I told that I didn't think that I was allowed and after asking, I wasn't.
Specializes in Psych, Corrections, Med-Surg, Ambulatory.
When I worked Home Health, I walked into a popular cafeteria for an early take-out supper, and the first thing I saw was an 80-ish diabetic patient trying to cover her plate of Boston Cream pie with her hand (guilty!). I shrugged and said to her, "I'm not the Food Police. You're the one who has to pay the consequences of your actions, not me." and not giving it another thought, I went on to get in line for my food. I'm over fretting about a grown-up person who KNOWS what to do to take care of him/her self in a situation like that. There are also a few things in MY life where I chose quality over quantity, and do it knowingly, and even *I* hate to get the finger-wagging lectures.
Just say, "Here's your sign" and be on your way.
And once they've made it to 80, surely they get to skip the occasional vegetable and enjoy a tasty slab o' pie. Diabetic or not. What's the point of a long life if you can't enjoy the odd thing?
I really think that compulsive eating is a form of addiction and a psychiatric illness and that they self medicate with food. Food is their mother lover and only friend.The anxiety panic agitation and aggression these people
exhibit when NPO is pitiful. We need to be generous with the benzos and provide a lot of structure along with a healthy snack every two hours. The RD should be responsible for the meal plan and provide healthy substitutes for the pizza burgers fries and greasy chinese.
Specializes in Med-surg, telemetry, critical care..
I agree. I have pressure ulcers on my toes. Being a type two diabetic and a former nurse, I know the only way I am going to heal is to wear these ugly duck shoes, keep my appointments and change my diet. Drastically. Be compliant with my insulin. Keep down my A1c. SO, I make sure I take a good quality multi, my antioxidants, keep good fats in my diet and pile on the protein. I remain overweight, but I am researching the effects of gluten on my body. My blood nephew went off gluten completely and has lost weight, gained muscle and looks great. The moral of the story? ALL RDS need to go back to school. Do some research and be able to intelligently educate their patients about their needs. And, yes, the hospitals need more RDs. Properly educated ones. An in patient can get PLENTY of food and properly sourced calories and healing proteins. It REALLY cut back on my personal cravings.
When I worked Home Health, I walked into a popular cafeteria for an early take-out supper, and the first thing I saw was an 80-ish diabetic patient trying to cover her plate of Boston Cream pie with her hand (guilty!). I shrugged and said to her, "I'm not the Food Police. You're the one who has to pay the consequences of your actions, not me." and not giving it another thought, I went on to get in line for my food. I'm over fretting about a grown-up person who KNOWS what to do to take care of him/her self in a situation like that. There are also a few things in MY life where I chose quality over quantity, and do it knowingly, and even *I* hate to get the finger-wagging lectures.
Just say, "Here's your sign" and be on your way.
So this patient was in her eighties and ambulatory? Not 30 and needing an army of staff to turn them only for them to spout off about their "right to make choices" ? I agree that they have rights. Let them OD on food if they wish, if someone doesn't care that they can't even wipe their own butt let them suicide slowly. It is THEIR choice.
Specializes in Med nurse in med-surg., float, HH, and PDN.
And once they've made it to 80, surely they get to skip the occasional vegetable and enjoy a tasty slab o' pie. Diabetic or not. What's the point of a long life if you can't enjoy the odd thing?
To the OP and all others using the term, noncompliance,†PLEASE STOP! This is a slur against patients and harkens to the archaic paternalistic system of medicine that has lead healthcare to its current sad, state. Continuing to use this term is indicative of the problems of why patients are ordering in food and of most problems in our system. (Reference: Handbook of Community Psychiatry)
First there is the issue that hospital food generally sucks. This is mostly due to cost cutting measures. If we can't have enough nurses on a floor, what makes one think that the food will be any better than MREs?
Next is an issue that medicine has historically (and continues to) overlook; that is the psychology. Do you think that diabetics don't know what 2 liter bottles of soda do to them? Why do they continue to drink them?
For those people, that may be the ONLY enjoyment that they have in life. Sad , but true. How many of us get to cuddle up to our spouse/partner/significant other? We have family and friends who offer us support when we face difficult situations. We have our pets that reduce stress and depression (Looking Into Dog's Eyes Triggers Release Of Love Hormone Oxytocin). Despite all the obstacles healthcare providers face at work, at the end of the day, their lives are much better than those of their difficult,†complex, or non adherent patients.
This, there is the issue that what the physician believes is the patient's goals are NOT necessarily so:
Patient noncompliance with commonly prescribed medication and selection of alternative medical treatment is less a matter of denial of their diagnosis or the severity of theirillness, but more a matter of choice informed by evidence-based rationality…
…The issue of compliance with prescribed medication regimens has traditionally been dominated by the perspective of the health professional. Increasingly, however, medical anthropologists and sociologists have started to present the patient's point of view.
Evans and Spelman [26] argue that the patient's level of compliance is influenced by psychologic factors, such as anxiety, motivation to recover, attitude towards the illness, the drug and the doctor, as well as the attitudes and beliefs of significant others. The authors conclude that, contrary to widespread medical belief, the evidence do not support the view that medication noncompliance is a deviant form of behavior influenced by patient characteristics.
Mühlhauser and Lenz's study [27] of noncompliance suggests that it is rarely provoked intentionally or by laziness, concluding that patients should not be the first to be blamed for lack of therapeutic success. Noncompliance on the part of health care providers when supplying patients with necessary information and skills is also an important cause of poor treatment outcomes. Patient knowledge, when evidence-based and relevant to the patient, can enable patients to assume an important part in their disease management. This can improve health outcomes, although it may lead to intelligent noncompliance and a worsening of treatment outcomes according to conventional assessment criteria.
My grandfather (in his 90's) went to the hospital almost once every 6 weeks during his last 2 years of life for his sugar levels (diabetes). Against the advice of his doctors, he continued to smoke and drink soda until the end. As a family, we did not intervene other than paying for his healthcare. At that point, the 3 things that gave him the most pleasure in life were smoking, eating, and his cat (which I promised him I would take if anything happened to him).
How could we deny him these in the face of the hard life that he endured? This is the exact same situation as the person with lung cancer refusing a 5th round of chemo. If life were all about health and safety, we would have no firefighters, no explorers, no martyrs, and no heroes. The Buddhist monks seek enlightenment, even at the cost of their own lives. (See: Sokushinbutsu)
We all want what is best for others, but who gets to define what is best? Some issues of equal opportunity†stem from this. The issue of "women in combat†is not so much about women not being able to do the job as much as a gentleman would never subject a woman to such a degradation. This comes from the rules of combat when armies marched on to a field to face each other in a massive duel. (See: Gentlemans' War)
It was not from a degradation of women but from holding them in esteem. Yet, it has been argued in our enlightened society that denying women that opportunity (if they so choose) is wrong. It is time to apply this thinking to the patient encounter.
The most recent issue related to this comes from mammograms and colonoscopies for people in their 80s. (See: NY Times, "Too Many Colonoscopies in the Elderly") Would one label someone in their 80s refusing these tests nonadherant? Yet, people in their 80s are pushed for these tests.
Remember, when ever you point a finger to blame someone, 3 fingers point back at YOU!
Again, your grandfather was 90 years old he should be able to eat and drink whatever he wants. That's a far cry from someone who is destroying themselves at a young age and then forcing the staff around them to break their backs taking care of them. And to be honest I think non-compliant has a nice ring to it. Sugar coating has never helped anyone.
To the OP and all others using the term, noncompliance,†PLEASE STOP! This is a slur against patients and harkens to the archaic paternalistic system of medicine that has lead healthcare to its current sad, state. Continuing to use this term is indicative of the problems of why patients are ordering in food and of most problems in our system. (Reference: Handbook of Community Psychiatry)
First there is the issue that hospital food generally sucks. This is mostly due to cost cutting measures. If we can't have enough nurses on a floor, what makes one think that the food will be any better than MREs?
Next is an issue that medicine has historically (and continues to) overlook; that is the psychology. Do you think that diabetics don't know what 2 liter bottles of soda do to them? Why do they continue to drink them?
For those people, that may be the ONLY enjoyment that they have in life. Sad , but true. How many of us get to cuddle up to our spouse/partner/significant other? We have family and friends who offer us support when we face difficult situations. We have our pets that reduce stress and depression (Looking Into Dog's Eyes Triggers Release Of Love Hormone Oxytocin). Despite all the obstacles healthcare providers face at work, at the end of the day, their lives are much better than those of their difficult,†complex, or non adherent patients.
This, there is the issue that what the physician believes is the patient's goals are NOT necessarily so:
My grandfather (in his 90's) went to the hospital almost once every 6 weeks during his last 2 years of life for his sugar levels (diabetes). Against the advice of his doctors, he continued to smoke and drink soda until the end. As a family, we did not intervene other than paying for his healthcare. At that point, the 3 things that gave him the most pleasure in life were smoking, eating, and his cat (which I promised him I would take if anything happened to him).
How could we deny him these in the face of the hard life that he endured? This is the exact same situation as the person with lung cancer refusing a 5th round of chemo. If life were all about health and safety, we would have no firefighters, no explorers, no martyrs, and no heroes. The Buddhist monks seek enlightenment, even at the cost of their own lives. (See: Sokushinbutsu)
We all want what is best for others, but who gets to define what is best? Some issues of equal opportunity†stem from this. The issue of "women in combat†is not so much about women not being able to do the job as much as a gentleman would never subject a woman to such a degradation. This comes from the rules of combat when armies marched on to a field to face each other in a massive duel. (See: Gentlemans' War)
It was not from a degradation of women but from holding them in esteem. Yet, it has been argued in our enlightened society that denying women that opportunity (if they so choose) is wrong. It is time to apply this thinking to the patient encounter.
The most recent issue related to this comes from mammograms and colonoscopies for people in their 80s. (See: NY Times, "Too Many Colonoscopies in the Elderly") Would one label someone in their 80s refusing these tests nonadherant? Yet, people in their 80s are pushed for these tests.
Remember, when ever you point a finger to blame someone, 3 fingers point back at YOU!
Thanks for the condescending lecture, but I'm going to exercise my autonomy and right to continue using the term "noncompliant." I am all about people's autonomy and right to make their own life choices. If people want to smoke, drink, or eat themselves to death, that is 100% okay with me. But I wish, for the love of all that is holy, that they would at least have the courage of their convictions, and not come to the ED when it becomes apparent that this isn't working out for them and ask us to please fix it. Please, by all means, feel free to eat, drink, or smoke yourself to death -- but, when you start crumping, stay home and let nature run its course. We all make choices, and we all have to live with the consequences.
(PS, the hospitals I work for have excellent food! :))
1056chris
73 Posts
The best we can do in a situation like this is let the doctor know, educate the patient of the importance of adhering to his diet, and DOCUMENT in the nursing notes, maybe a dietary consult( I am sure this was done) As a nurse we are usually too busy to notice if someone brought food on the unit or sent someone down to pick it up. Our doctors do talk to their patients about it ,but they are there 5-10 min/day and a nurse is assigned to the patient 24hrs/day.