Hospital Dietetics, Whangarei Hospital

Kai Tiaki : the journal of the nurses of New Zealand, Volume XII, Issue 4, 1 October 1919, Page 176

Hospital Dietetics, Whangarei Hospital

The problem of hospital dietetics has been coming under review more and more during the past decade. To the average patient of our public hospitals the disturbing anticipation is mainly one regarding his food. His medical and nursing treatment he takes for granted, but his feeding he regards with misgiving. The restrictions of diet are possibly sometimes a necessary part of the treatment, but sometimes possibly the result of the economical tendencies of those boards who emphasise the " Charitable Aid '* part of their administration of our hospitals. As this view of hospitals is gradually being replaced by another that regards them as State or Community Institutions to provide medical and nursing services that cannot be conveniently obtained at home, it follows that the public is demanding something more than a " charity " standard, and that the cooking and serving of an improved dietery is an essential improvement required. The complaint of patients and doctors that nurses doing private nursing had very

little knowledge of cooking arrangements, resulted some years ago m the addition of a course of invalid cooking to the nurses' curriculum, but patients do not subsist long on purely invalid diet, and the whole question of the scientific preparation and economical distribution of food has come so specially under consideration during war conditions that an effort has been made by this hospital to make a start m facing the problem.

The first essential is to provide a suitable kitchen. This must be very airy and well-lighted, but should not be too large else it will accumulate things that have no business m a kitchen — which is a place to cook food m. Along one side of the room stand the cooking appliances — steam ovens, kettle and stock-pot, and a gas range, and near the exit door the steam- jacketted plate-warmer. In the centre of the room should be the cooking table, with pan shelves next the range, etc., and on the other side the bins for flour, oatmeal, sugar, etc., and drawers for knives, spoons, and small articles. Overhead a rack with

hooks for small culinary articles that hang. Close by open the pantry and larder. This arrangement saves a great deal of walking. The ideal wall is tiled, but a plastered wall covered with washable paint is a good and less expensive substitute. A " Fama " or similar composition is an easy floor to clean, but lacks the resiliency of a good linoleum and is tiring for standing. The preparation of potatoes by mechanical means is found to be satisfactory, saving both time and waste of potatoes. Vegetables are still prepared by the hands. The greatest source of waste is bread and meat, and no real solution of its reduction has yet been found. This is a source of great concern because the abundance of supplies m a hospital and the difficulty of tracing the dilinquent has a tendency to make nurses form habits that constitute the main complaint later on of private employers, who say that nurses are extravagant, and lack regard for the resources of families of moderate means. Only the plates are washed m the scullery, and after warming are taken back m the food trolley at meal time. Cups and bowls are washed and stored m the ward kitchens. The system m use starts m the wards where individual diets are prescribed and ward summaries made by the sister. A provision ticket is made up by the matron for the kitchen, which is controlled by a certificated dietitian with the status of a sister, who is responsible for her department

to the matron just as a ward sister is responsible for her ward.

In order to secure a proper understanding and interest m the dieting of patients the subject is dealt with m the pupil nurse's first year, and all lectures and demonstrations are given m the hospital kitchen, where also she is obliged to spend a month learning the ordinary cooking and preparation of hospital meals. This obviates the necessity of having to go out to the technical school, where she cannot, of course, acquire the same practical knowledge of hospital and nursing requirements.

The main difficulty m a general adoption by hospitals of such a scheme is the scarcity of trained dietitians. We were exceptionally fortunate m being able to initiate it through the good will of a lady who had had a three years' domestic science course at London, England, and was exceptionally qualified by training and teaching experience for the position, and who secured a former pupil to continue it for us. Such a teacher, however, is not commonly to be found, and a knowledge of food values and mere theoretical training are not sufficient for the purpose, because the ordinary course of domestic science suitable for the making of a technical school teacher is not altogether such as would make a hospital dietitian.

Perhaps if sufficient hospitals would take up the idea the schools of domestic science might make a special course for hospital work and include a practical class under a lady who had had experience of hospital requirements.