This section is from the book "Practical Dietetics With Special Reference To Diet In Disease", by William Gilman Thompson. Also available from Amazon: Practical Dietetics with Special Reference to Diet in Disease.
The hospital nurse should be taught that it is as important to give food as medicines at regularly appointed intervals. Punctuality should be carefully observed in serving all meals to the sick. There is much unconscious habit in regard to eating, and an appetite which was ready at the accustomed hour of receiving food may vanish if the meal is delayed. It is well, when possible, to bathe the patient's face and hands before offering a meal. It is best always for the same nurse to have the charge of feeding a definite number of hospital patients. If they are served by a different nurse at each meal it is much more difficult to report those whose appetites are defective or capricious.
Among the first considerations is the proper quantity of food to offer the sick, and the extent of its dilution. Miss Nightingale has said that "an almost universal error among nurses is the bulk of the food, and especially of the drinks, they offer to their patients," and "it requires very nice observation and care (and meets with hardly any) to determine what will not be too thick or strong for the patient to take, while giving him no more than the bulk that he is able to swallow".
By diluting milk, stimulants, and gruels too much, or making beef tea too weak, the quantity of the fluid is so great that the patient soon tires of swallowing, and stops before enough nourishment has been obtained. Predigested milk possesses the decided advantage that it aids the assimilation of the milk without adding to its bulk, as lime water and other substances do.
When the appetite flags it is unwise to ask the patient each time beforehand what he would like to eat. It is often the unexpected which pleases. The smell of cooking and the noise of the preparation of food should be kept from the sick-room. The nurse should never eat her own meals in the presence of the patient.
Hot food should be served very hot and cold articles very cold, for lukewarm food is unpalatable. In serving hot beverages or foods the cups or plates should be first well heated. Milk and butter should be kept cold and well covered. A simple refrigerator is easily improvised by placing a few large lumps of ice in a dish pan or pail kept by an open shaded window, and wrapping them in flannel to prevent evaporation.
Patients may appear too ill to notice details, whereas they are often only too ill to speak of them, and a refined, fastidious, or nervous patient may have the appetite wholly destroyed by the carelessness of a nurse who tastes the food in the patient's presence or with his spoon, or who serves food with unclean hands. Untasted food, dishes after use, or half-emptied cups or glasses should never be left standing about the sick-room. Nothing is more uninviting than to have to drink from a glass to the sides of which stale milk is adhering. If there is any suspicion of the absolute freshness of milk, eggs, butter, or fish, they should never be served.
It is equally important to make all food look inviting by offering it with the most attractive china which the house affords, and with only the cleanest of linen. Dishes should always be wiped dry on the outside, and pains should be exercised not to spill the contents of cups into their saucers.
These may appear trivial details, but it must be remembered that the horizon of the sick-room is very limited, and a patient who has been long confined to bed with a serious illness thinks a great deal of his immediate surroundings. The taking of food is the chief event of the day for him, and too much care cannot be bestowed upon the minutiae of service, while the natural stimulants to appetite - such as fresh air, exercise, and enlivening companionship - are necessarily wanting.
When patients are able to partially sit up for their meals, the nurse should see that they have a comfortable position in the bed, and that the food tray does not cramp the arms or legs. The effort of sitting up may cause fatigue too soon and destroy the appetite before the meal is half done.
As a rule, twice-cooked food should not be served to invalids. This applies especially to meat, fish, and vegetables. Whenever economy is an important consideration, it is better to cook but little food at a time, and serve it fresh and hot. Food is often made unpalatable by being too greasy, and this is one of the chief objections to the use of meat broths, and mutton or chicken broth should always be several times skimmed before they are given, and blotting paper or a bit of bread can be passed over the surface to remove the last trace of oily substance. A chafing dish is invaluable for the convalescent from protracted illness.
When the dietary ordered is very limited in variety, the patient is often gratified by having his food served in "courses," and will eat more than if given everything at once.
In other cases, when a patient is first allowed to sit up for half an hour or more beside the bed, it may be well to utilise this time for giving the principal meal of the day, which will be eaten with more relish, and perhaps better digested in consequence.
Patients having nausea or other gastric disorder or diarrhoea should be given but little food at once. Small, oft-repeated feedings are best for them. As a rule, invalids need more salt as a condiment, but less sugar, than those in health.
When patients are being fed with fluids, wholly different receptacles should be used for holding their medicines, or the association of ideas may be strong enough to destroy what little appetite there is, and even to produce nausea.
The nurse should always have a cheerful manner and a cleanly and tidy appearance, which contribute much towards the patient's appetite. She should never offer nourishment too soon after removing the vessels employed for the patient's discharges or evacuations, but should allow a proper interval to elapse, and let it be evident that she has thoroughly cleansed her hands. No form of perfumery should ever be used by the nurse. Bread crumbs should never be allowed to fall into the bed, especially of a helpless patient.
When possible, it is well to divert the patient's mind from his ailments while feeding him by introducing some cheerful or interesting topic.