Eating to Health Through Healthy Eating; Patients Are a Virtue – When They’re Well Fed; FACT FILE

Hospital food has a tough reputation to live down – but those days are long gone, and patients are better for it.

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THE BUTT of many jokes, hospital food is often supposed to be unappetising or inedible.

However, Wellington Public Hospital dietitian Olwyn King says hospital food has come a long way from the stodgy mass- produced meals that were once hospital fare, served from bulk food trolleys.

Today, she says, the sophistication of the meals and the method of service would rival many restaurants. And with good reason.

Mrs King believes food, and the goodness it provides, plays an enormously important role in the patient’s progress and ongoing good health.

“In many cases it helps the medications patients are receiving to work better,” says Mrs King, who believes food drives the metabolic pathway while medications tweak it.

“What you eat has a flow-on effect to all body functions.”

The importance of food as part of a health recovery and maintenance plan is such that in the United States, it is called “medical nutrition therapy” and today it is gaining increased recognition here too, she says.

The challenge in the hospital setting is that often the illness the patient is suffering from means they have little or no appetite. The treatment they are receiving may make them feel nauseous. Many patients may be tired or depressed and simply don’t feel like eating.

“The last thing they want is a huge, unfamiliar meal placed in front of them.”

There are a variety of ways in which Mrs King, who specialises in the nutrition of renal patients at Wellington Hospital, encourages sick people to eat.

“First, you have to listen to what they say. Ask them about their favourite comfort foods; tempt them with small tastes.”

She will often disappear down to the food service area in the hospital to assemble treats such as a patient’s favourite fruit; two or three sorts of biscuits, or a fruit drink.

“It has to be small to start with and you have to find the right buttons to push. The people who do best are those who manage to put a little something in their tummy every hour to bring up their blood sugar. Not eating when you feel sick makes you feel even more nauseated.”

She explains to patients that their medications will work better if they eat.

“You also need to take into account that the medications a patient is taking can influence how they feel and how food tastes.”

As a hospital dietitian, Mrs King plays an integral role in the team of health professionals who work together as part of a patient’s management plan. Patients who need their nutritional needs assessed are referred to the dietitian.

While the Food Services Department is responsible for the development of the menus – and keeping them within budget – it is the dietitian’s role to ensure they meet individual nutritional needs.

While the meals have to be appetising, they also have to meet a patient’s medical requirements and, in the development of hospital menus, this can mean a huge array of modifications.

“The basic menu has up to 18 different modifications. These special menus include gluten free, pureed, salt- or sugar- reduced diets, post-operative and light diets. Being a dietitian is not about saying ‘no’ or ‘go without’, it’s about finding a healthy plan that works for the individual. Those people who need to follow their diet long-term are given written guidelines to help them at home or when eating out.”

The hospital menu even takes into account different ethnic preferences, including such options as fish in coconut milk or a lamb boil-up.

Of the 320 patients in Wellington hospital at any one time, 40 to 50 per cent of the meals delivered to patients will be modified in some way.

Mrs King agrees hospital food is not perfect, but the kitchen always strives to improve.

“People eat with their eyes first, so colour, presentation and portion sizes are very important, and there is still more work that could be done in these areas. But it has to be done within certain constraints. While it might be nice to put a sprig of parsley on a pureed dish for appearance’s sake, it could choke a person having difficulty swallowing.”

Growing up on a dairy farm in Whangarei where food was a very real culture, as well as having an interest in medicine, Mrs King decided at an early age that hospital dietetics would be her chosen career.

At 17 she took the brave step of travelling to Dunedin to the University of Otago’s Home Science School. In her day, students graduated with a diploma that required a vast volume of work in labs and lectures, with years two and three including physiology and biochemistry lectures at the School of Medicine.

“It certainly wasn’t all about making the perfect scone.”

In New Zealand, no one can call themselves a dietitian if they are not registered to practise under the Health Practitioners Competence Assurance (HPCA) Act 2003. Only registered dietitians are allowed to practise in clinical health settings, such as hospitals, in New Zealand.

To be registered, they must fulfil competency standards which include completion of a post-graduate qualification, abide by a code of ethics and complete ongoing professional development under a continuing competency programme.

Today, dietitians must hold a bachelor of science (BSc) or a bachelor of consumer and applied science (BCApSc) majoring in human nutrition and food service management. This is followed by a post- graduate diploma in dietetics.

“You never stop learning,” says Mrs King, who has also undertaken tutor training, chef training and an advanced nutrition course for renal patients.

With her qualifications, Mrs King has never wavered from her earliest ambitions – to use food to help people recover and stay well.

So does Mrs King eat the hospital food herself? “Yes, indeed. If someone complains and says ‘have you tried it?’ I’ll go straight down to the kitchens and see what they’re talking about. Complaints are rare and there are many compliments.”

It’s all about getting the patient home.

For more information about dietitians, go to:

dietitians.org.nz

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FACT FILE

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Name: Olwyn King

Career: Hospital dietitian

Employer: Capital Coast District Health Board

Attributes: Likes food; empathy for patients; willingness to be flexible; likes working in a team; interest in the science of food and nutrition.

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