Patient Nutrition in the Hospital Setting
My first experience dealing with nutrition in the hospital was when I was working as an extern at a hospital in Philadelphia. A nurse extern is somewhat like a Patient Care Technician (PCT) but with more limited abilities. It gives you the experience of patient care, while being able to learn from other nurses.
At the time, I was working 3-11pm. My sweet tooth was a bit more ravenous back then, especially as the shift wound down. I often found myself in the pantry eating those small ice cream cups anytime a patient would ask for a snack. Late at night, my willpower struggled. But it wasn’t just me. Every shift the breakroom had some candy, pizzas, cakes, or chips and dip for the staff. I don’t think I ever saw a protein heavy dish there to share.
If patients ask for a snack, they’ve got a few options from the pantry. Some hospitals are better than others, but most offer the same things. Saltines, graham crackers, peanut butter, turkey sandwiches, applesauce, low protein high sugar Yoplait yogurt, ice cream, water ice, skim milk, soda, diet soda, and fruit juice cups from concentrate. Now I understand that shelf life is an important factor, but why don’t we have fresh fruit offered? Or maybe some canned tuna fish or chicken? Or baked potatoes? Honestly, any real whole foods that would provide some actual nutrition in the pantry would be nice.
We’re in the hospital. Where people are ill. They come to us to make them better. Practitioners should be trusted to make the best decisions in terms of your treatment and plan of care. But in this planning, nutrition is rarely addressed in detail, despite how much it may be influencing a persons symptoms or disease progression/regression. Patient’s get assigned different diets like a regular diet (no restrictions), a diabetic diet (lower carb/carb controlled), a cardiac or heart healthy diet (limiting daily sodium to 2gr/day), vegetarian, or clear liquid / full liquid if they’re dealing with a gastrointestinal / stomach issue. Their meal trays are built in the kitchen from the foods supplied to the hospital through a 3rd party food vendor (most hospitals don’t cook their meals fresh each day). Each tray must hit certain numbers (carbs, sodium, potassium, etc.) to fit that patient’s diet criteria. But the quality of the foods given to the patients isn’t always the best.
By giving patients lower quality food, it reaffirms that the things they’re eating outside of the hospital are probably okay. But the trays should reflect a nutritious, healthy and balanced meal. It should emphasize protein, since most of these patients are in the aging population and have higher protein needs. It should emphasize whole foods. The way nutrition is modeled to patients in the hospital could be greatly improved, and needs to be to help change the trajectory of our healthcare burden.
Dieticians are consulted for certain patients, depending on their diagnosis. But most patient’s never see one. Most patients are never properly educated on nutrition, or engage in a conversation with a practitioner about their dietary habits. It really is a shame. A genuine and inquisitive 10 minute conversation with a patient can be all they need to help them realign some of their nutritional choices when they go home. Those conversations have been some of the highlights of my time at the bedside. I would keep a case of Fairlife protein shakes in the breakroom and give them to patients instead of their Ensure, and explain to them the importance of protein. If patients were on a clear liquid diet, I’d grab them a packet of bone broth with collagen protein in it, instead of getting them the nutrient lacking chicken bouillon cube in the pantry. Just discussing a patients eating habits, where they came from, discussing potential dogma and stigmas about certain foods or ingredients they believe, and offering easy solutions always seemed to motivate the patient towards change. Now if they actually did something after being discharged is another story, but I feel good knowing I did what I could. The healthcare system clearly needs to evolve if we’re to better the health of our country, and the attention paid to inpatient nutrition could be a good place to start.
