FASTING IN HOSPITAL

 

A core function of nursing practice is the preparation and management of fasting patients.

It is not unusual that patients may have prolonged or repeated periods of fasting for surgery, tests, procedures or for the symptom management of their admitting condition.

Fasting for prolonged periods is detrimental to health outcomes.

But there is more than the physical impact of fasting to consider.

There is also the emotional and psychosocial impact of fasting that affect every patient that has had to endure a period of absence of food or fluid.

The high percentage of patients who are malnourished has been well  documented.

A qualitative study of the patient’s perspective of the impact of fasting has identified the patient-centred care that will improve the patient experience.

It is the first paper to uncover the negative impact prolonged fasting has upon patients.

There were six key areas that were identified about the patient experience:

  1. physical impact
  2. emotional impact
  3. food as structure
  4. nil by mouth as jargon
  5. fear of food re-introduction
  6. dissatisfaction regarding unnecessary fasting.

The most negative occurrence that patients experience were physical.

Especially the thirst and dry mouth.

Skin integrity changes were also another physical manifestation that affected patients’s lips, tongue and throat.

In addition to feelings of weakness.

Interestingly there was a reported positive experience of relief reported for those who had nausea, vomiting or suspected obstruction of the ileum.

In the initial days of fasting, the emotional impact of fasting is manifested by an obsession with food.

This occurs with the loss of personal control about they could eat or drink.

Patients noticed food everywhere when they could not have it.

Food gives structure to the day, which is especially important with the boredom that can occur when hospitalised.

Removing food or fluids breaks down the structure that occurs with regular meals

The structure is further eroded with the use of jargon.

NBM, or nil by mouth, is not understood by most patients.

On a ward, there may be patients who have alternative nutritional support that are NBM.

This leads to patient confusion when they have to fast and they are told ‘NBM’ with minimal explanation.

A lack of comprehension of what seems to be a simple task means providing a clear explanation, which is jargon-free, of why fasting is necessary and the implications of noncompliance.

The obsession with food in the initial days of fasting is soon replaced with a decrease in the desire for food.

Patients develop a lack of interest in food and a complete lack of appetite.

Paradoxically, patients become anxious about recommencing food.

The longer time spent fasting leads to a lack fo confidence about restarting food.

The final impact of fasting that patients experience is frustration at the length of time that they are fasted.

Frustration occurs because there is lack of trust about how the system works.

The scheduling and rescheduling of tests that require fasting when followed with procedures, that also require fasting, is a common worry.

There can be many ways that a patient’s fasting will be unnecessarily prolonged because of poor scheduling.

To ensure patient-centred care, hospital policies should prioritise the reduction in time that patients have to fast.

Nurse can, and do ameliorate the effects upon patients who have to fast.

The paper provides six recommendations that ensure patient-centred care.

.    “1  Signage and communication with patients and their families to ensure simple messages are easily understood, even by those from non-English speaking backgrounds.

    .    2  Regular review of the fasting status of the patient, and regular communication with the patient regarding expected management plans.

    .    3  Highlighting recommended fasting times for tests and procedures, ensuring a system to identify at-risk groups, such as the malnourished or diabetic patient.

    .    4  Strong support for the implementation of evidenced-based practice, including early postoperative nutrition support (oral or enteral), and use of medications for symptoms management.

5 Where a state of fasting or NBM is necessary, ensuring adequate hydration (including IV hydration) and mouth care. 

6 Food service provision to ensure patients have access to food and fluids should they be allowed to take oral food and fluid outside regular meal hours.”

To learn more about fasting in hospital:

Carey, S. K., Conchin, S. and Bloomfield-Stone, S. (2015), A qualitative study into the impact of fasting within a large tertiary hospital in Australia – the patients’ perspective. J Clin Nurs, 24: 1946–1954.