General Rules

In no branch of her work can the nurse be of more service than in her ability to feed a very sick patient properly. There are many details which can only be mastered by extensive bedside experience and close observation, and so much depends upon tact and discretion, which can never be learned from text-books or lectures, that it is impossible to formulate rules for feeding which shall cover all cases; but the following suggestions will be found applicable in many instances.

Miss Nightingale wrote that "to watch for the opinions which the patient's stomach gives, rather than to read ' analyses of foods/ is the business of all those who have to settle what the patient is to eat - perhaps the most important thing to be provided for him after the air he is to breathe".

The Appetite

In judging of the patient's appetite it must be remembered that what is supposed to be a lack of desire for food is possibly due merely to defective cooking, to serving meals at inopportune moments, or to selecting food which is not to his liking. There may be appetite enough for food, but not for the particular food offered, and it is the province of the nurse to differentiate such matters. She should not only save the patient from physical exertion, but from the effort of thinking as well.

It is the function of the nurse to observe and record all the conditions of the patient's appetite, digestion, and likes and dislikes for different foods, and when her instructions have not been specific, or have not provided for emergencies, she should make it a point to have them understood at the next visit of the physician. A thorough practical knowledge of dietetics should be the foundation of the nurse's education, and this subject should receive much more attention in the curriculum of training schools than is at present bestowed.

The nurse has a far better opportunity than the physician to judge of the patient's appetite and study his whims and fancies in regard to food, and she should nor fail to report them and understand very positively from the physician in charge to what extent she is to be permitted to humour them and substitute one form of food or drink for another. Directions are apt to be given too indefinitely to the nurse, and with the best intentions, from lack of instruction, she may neutralise the effects of medicines by overfeeding, or by irregularities in feeding which disorder digestion and interfere with the action of the drugs, besides making the patient worse. She is often merely told to give "soft diet" or "fluid food," and she promptly resorts to milk and eggs, which may or may not agree and nourish. Or instead of such vague orders she may be directed to give only some one form of food, which she conscientiously does, offering it in spite of the patient's accumulating nausea and disgust, with the result of half starving him, because the physician has forgotten to allow the nurse any latitude or discretion.