Hospital meal times are hectic, disorganized and complex.

There are many moving parts to getting a meal to a patient.

Having a patient centred approach for meals can clash with the immovable object of other hospital services.

But what is more important – patient meals or other services?

Most nurses would instinctively say that nearly always it is the patient’s meal that comes off second best in the clash of the services.

It is easy to find many instances in a single day on a single ward where a patient’s meal has gone cold because a consultation or ward round has delayed the patient from eating.

There have been studies that looked at innovative ways to improve nutritional status and improved intake of food.

But the studies resulted in little favourable change in the nutritional status.

An Australian study in the Journal of Advanced Nursing investigated the systems in place that impacted upon patient meals.

They found that

“Staff, volunteers and visitors tried to promote patient centredness at mealtimes. The routine and structured nature of the meal and care systems was constantly in tension with providing patients the care they needed.”

All staff acknowledged the importance of being patient-oriented at meal times – along with knowing the needs of the patients and what was best for the patient.

Interestingly what constituted best differed on the professional background and values of the staff.

The structure of the hospital systems also had an impact upon placing the patient at the centre of the process.

Coupled with the routines of hospital rounds, there is a clear process that staff use to ensure that patients are eating adequately.

But these systems and routines do have a deleterious impact upon the patient.

They are not flexible enough to deal with the frequent changes that can occur with the patient and the work situation on a ward.

There was a lack of awareness about the difficulties that food service staff experience in delivering food to patients.

Food services staff may have instruction about food delivery that clash with the need for the patient to do some of those tasks themselves as a part of a therapeutic regime. eg removing lids and opening packets.

The complexity of providing food to patients include

  • Diet code entry
  • Meal ordering,
  • Plating
  • Delivery of food
  • Timing
  • Temperature control
  • Rousing
  • Toileting
  • Clinical observations
  • Medication Administration
  • Positioning.

Going to an eating establishment such as a cafe or restaurant usually provides a seamless service in getting food in front of a customer quickly.

But the number of staff involved in doing that per head is vastly more than is available in a hospital setting.

It is a shame that the one thing that hospitals should be striving to get right, properly fed patients, is the least appreciated.

The jokes about hospital food will continue for some time yet.

To learn more about hospital food service,

Ottrey E, Porter J, Huggins CE, Palermo C. “Meal realities” — An ethnographic exploration of hospital mealtime environment and practice. J Adv Nurs. 2018;74:603–613.