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How to improve food intake of hospitalized patients

Is improvement necessary?
  • Disease-related under nutrition is common among patients in India hospitals
  • Hospital food has an image problem
  • The ”food chain” is complicated by a lot of stages
  • Responsibility for food service and nutritional care are not highly regarded
Most frequent reasons why patients do not eat enough:
  • Lack of appetite
  • Patients are not motivated to eat more
  • Fasting procedures
Can hospital food increase energy and protein intake?

Serving meals is not a hotel service - it is a part of treatment Succeed in improving food intake is related to attitudes and professional expertise in serving meals

How is appetite different from hunger?
  • Is it essential to the patient that a nurse distinguishes between hunger and appetite?
  • How is food intake influenced by this?

Hunger is...

  • A physiologic signal that nutrients are needed to maintain body functions
  • The opposite of hunger is satiety
  • Hunger and satiety are expressions from a natural science approach to eating

Appetite is...

  • Appetite connects to food and meals
  • Appetite and hunger does not necessarily go together
  • Appetite is a sociological as well as a biological expression
Meals at hospital
  • Hospital food was not served as a part of a meal
  • Sociological and cultural aspects of the meal were not systematically used to improve food intake
  • Patients expected to be served meals - not only nutrients and that effected how much they eat
Observational study of meals

Intervention :

Change of eating environment, food and catering system to children with cancer

Fraction of children Before After reaching requirement by eating food % Before After
49 70
What can encourage appetite?

A qualitative interview study :

  • 8 in-patients at nutritional risk by purposeful sampling: – Various experience with food and cookinga – Different values from food culture
  • Median age (IQR): 52 years (46 – 62)
  • 4 men / 4 women
What can encourage appetite?

3 consistent themes:

  • Expectations to the catering system
  • Nursing procedures in serving meals
  • The meaning of relations in nursing procedures
What can encourage appetite?

1. Expectations to the catering system :

  • Flexibility
  • Choice of different menu's
  • Food presentation on the plate – security of supply
What can encourage appetite?

2. Clinical nursing procedures

  • Recognition of values from their own food culture in serving a meal
  • Initiative and drive
  • Serving skills
  • Explicit professional judgment
What can encourage appetite?

3. The meaning of relations in nursing procedures

  • To serve a meal is communication
  • Serving a meal is an act of due care
  • Patients do notice and it makes a difference

Effect on food intake

  Unit 1 (Surgical) Unit 2 (BMT)
Catering system: Room service Usual catering system
Nutrition care organised : Usual organisation Trained “nutrition nurse”
Intervention: ROOMSERVICE
  • Call the kitchen from the bed and order from a menu
  • The meal is delivered ready to eat within one hour at the ward
Intervention:”Nutrition nurse”
  • Nutritional guidance of patients
  • Daily follow up on nutrition plans
  • Serving snacks between meals twice a day to all patients
  • Teaching, guiding and helping out the staff in all nutrition matters
  • Responsible for ordering food

Key messages

  • Meals is much more than the food
  • Food intake can be increased by using hospital food as a tool
  • Nutritional care is depending on recognizing the person in the patient
  • Serving meals requires nursing skills

Key words

  • Nutritional care
  • Appetite
  • Hospital food
  • Food intake