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Sometimes a simple 'no' requires a little more understanding  

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We all know nutrition can be a key factor in aiding recovery, but how can you help a patient when they point blank refuse meals?

Colin Phillips-SNT

Put yourself in this situation.

Imagine a patient says they don’t want dinner. Fine, fair enough, they don’t want dinner tonight. But what if you know that patient should have dinner? They may be underweight and have refused food for the past two days.

You have technically asked them if they want to eat. And ‘technically’ in this instance is fine, isn’t it? Because you’ve done your job and asked the patient if they want food and they’ve said ‘no’.

Anything wrong with this situation? Plenty. The patient doesn’t get dinner.

Often the skill is in the delivery not in a tick box. Nutrition is too important to be dimissed with ‘technically I asked them’.

I always enjoy being a part of the food delivery on wards. I enjoy the opportunity to interact with patients and the occasional challenges to encourage eating. The reasons for “no” are rarely the same but can be grouped into certain categories:

  1. “That’s not what I ordered”
  2. “I don’t feel hungry”
  3. “I don’t want to eat”

Simply asking why can give you a response you can work with.

For example, it’s often possible for patients to swap for an alternative if they’re not happy with their meal. Whether they really did order what you gave them or not, they need to eat something so there’s nothing to stop you pulling out a menu card out and going through the options.

If they don’t feel hungry now, do they think they’d like something else later? Or do they prefer lunch to dinner? I’ve known patietns be put off by large portions so don’t try any of it. When you know this is the problem you can address it or suggest “just see what you can manage”.

Once you’ve gained insight into that “no”, you can start to tailor your response. Despite improvements in hospital food, if patients are staying more than a week there can be a sense of repetition. To try to offset the lack of excitement around the eating experience and I tend to go through my maitre’d spiel, presenting the food with a ‘voila’, enthusiastically stating “look at this food the chef has cooked for you today, we’ve got soup, wonderfully followed by chicken with mashed potatoes…”.

Conversations around food can help you get to know patients and build trust. A patient once told me she wasn’t into savoury food but that she loved cakes. She told me that at Christmas time her family used to have so many cakes that she couldn’t get into the house!

I told her that after dinner I’d make her a hot drink and I’ll have the chef whip something up for her, noting to get her something from the cake tin after dinner. She tucked into her food and was delighted to get coffee and a cake afterwards and I was delighted that she’d made a big dent in her dinner.

And if all of that doesn’t work then I throw in a couple of snippets in a conspiratorial voice “and you know you can eat the courses in any order you like”, “you don’t even have to do the dishes”and “it’s free”.

Usually there’s something in there that works, although I did have a patient start to worry how we made any money if we gave away all this food for free!


Colin Phillips is in his first year studying adult nursing at King’s College, London; with previous experience as a HCA

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