[Sidenote: Diet Lists and Blanks]
For the housekeepers’ guidance in preparing meals for the patients, a
diet list showing the number of patients to be provided for and the
classes of diets required, needs to be prepared. The duty of preparing
this list usually devolves upon the head nurses in charge of the wards
and the lists should be sent in either at night or early in the morning
of each day. Special articles for individual patients will usually
be prepared in the diet kitchen, and may or may not be placed on the
diet sheet sent to the general kitchen. In large institutions where
there is a pantry on each floor in which special diets are prepared,
special requisition blanks are used in many hospitals in procuring
the supplies. The amount of eggs, milk and beef juice and the various
articles that are expensive and perishable, are estimated by the person
in charge, and the requisition is signed by the superintending nurse
before it is sent to the kitchen or store room. Such a requisition
blank is usually about the size of a doctor’s prescription blank, and
they are most convenient when prepared in blocks similar to letter pads.
The housekeeper will, of course, superintend the carving of meats and
the dispensing of food from the main kitchen. This is one of the most
important of her duties and many a dollar can be saved or lost by
neglect or attention at this point. Proper carving of meats results in
a substantial saving in the course of a year. Dr. W. Gilman Thompson
says that an “undesirable tendency among American hospital dietaries is
to include too much meat. Not over four ounces of cooked meat (without
bone) should be allowed in the meal for men.” Unless specially ordered
meat should never be served more than twice a day in a hospital and
once for the average patient is sufficient.
[Sidenote: Serving of Food]
In the serving of food to the patients, provision must be made for
serving cooked food that is intended to be hot, really hot. If this
is to be accomplished successfully, it must have special attention
and special facilities. If there is no diet kitchen or nurses’ pantry
on each floor, and the trays are prepared in the main diet kitchen
adjoining the general kitchen and sent on the dumb waiter, it means
that plates must be heated thoroughly and every article of hot food
covered with a hot plate or saucer. The food must be really hot when
served on the plates, and delay at the other end of the line guarded
against. This method is the only one that can be pursued in small
hospitals, or where mistakes in construction have resulted in there
being no facilities for serving food convenient to the wards. It is
hardly necessary to say that each tray should have on it a ticket
bearing the name of the patient for whom it is intended. Neglect of
this precaution might cost a life, as for instance if a convalescent
typhoid patient (famished with hunger as they usually are in that
stage) who was allowed only custard or broth, had served to him a
tray laden with fruits, meats and vegetables. Such accidents are not
unknown, and may happen in any hospital where laxity about the serving
of food exists.
Where there is provision on each floor for setting trays and serving
food the same care needs to be exercised about heating the dishes. The
food will be served in bulk from the main kitchen, usually in large
covered vessels, which should be hot before the food is put in. A
steam table in the diet kitchen will suffice to keep them hot till the
serving is completed. In winter it may even be necessary to heat the
cups, for what is more insipid than a cup of lukewarm tea or coffee?
Equal care needs to be observed to serve cold things really cold. Ice
may be a luxury to some people, but the free use of ice in a hospital
is an urgent necessity. Not only is it needed to preserve the food,
but it has its place in adding relish to a meal especially in hot
weather. When a patient is hot and restless and uncomfortable even
the clink of a piece of ice in a glass is refreshing and will help to
create a desire for the milk itself. It ought not to be necessary to
add that cold food should be kept as far as possible from the hot food
on a tray, and yet having more than once found a nurse carrying a tray
with a dish of ice cream covering a bowl of steaming hot soup, or the
butter crowded as close to the teapot as it could be, it may be that
such reminders are not out of place. If only everybody lived up to the
best they knew; if only one could be sure that what was taught would
always be acted out, the housekeeper’s anxiety about the serving of
food would be greatly lessened. As it is, “line upon line and precept
upon precept” is needed, and in addition that “eternal vigilance” that
is said to be “the only price of safety.”
[Sidenote: Tray Setting]
In the setting of a tray there is a right and wrong method, as in
everything else. It is not sufficient to have the dishes and the tray
cloth spotlessly clean, but the method of arranging the various dishes
should have in view the patient getting the food with the greatest
ease. A moderate size tray is preferable. The very large trays are
cumbersome and awkward and it is difficult to arrange the small trays
to advantage. In the center of the side of the tray that will be placed
nearest to the patient should be the plate, with the knife, fork and
spoons, arranged in their proper places on either side. At the right
hand should be placed the teacup and saucer, and on the left the bread
and butter plate, or the individual butter dish. Back of the teacup is
placed the small tea or coffee pot. Thoughtless nurses often reverse
the position of the teapot and teacup, making it necessary for the
patient to reach over the teapot to the back of the tray every time he
wants a drink. In the center of the back part of the tray, or the part
farthest from the patient, the little sugar and cream vessels should
be arranged, and in the left-hand corner of the same side the dessert.
The pepper and salt bottles and other small articles may be arranged
as space will permit. It is well to have a regular custom established
of emptying the sugar vessels and washing them after each meal. Crumbs
are dropped in or they become smeared with a wet spoon, and unless
the regular emptying and washing after each meal is insisted on, the
housekeeper can never be sure they are properly clean. Salt and pepper
bottles should be examined daily, and the outside washed after each
meal also. It is so easy to overlook this small matter and send empty
salt bottles on the tray. The food may be served hot and really be
appetizing, save that it needs more salt to suit the patient’s taste.
If a bell has to be rung, and a nurse summoned to get the salt, the
meal may have cooled and the appetite for it have waned, before it
arrives. These may seem small things to dilate upon, but in reality
they are the real test of the quality of management. A chain is no
stronger than its weakest link, and real success in a hospital demands
attention to these apparently trivial details. These trivial details
are large to the patient and have much to do with keeping him happy and
comfortable. It is not sufficient to provide good food and prepare it
carefully. It is only what the patient really eats and assimilates that
is a factor in his recovery, and the best meal may be spoiled by lack
of attention to the details of serving. The idiosyncracies of patients
are nowhere more in evidence than where their food is concerned,
and while they are sick, these idiosyncracies and tastes should be
considered as far as possible with their highest interest in view.
Another very important point to observe in serving food is not to
serve too much at one time. In dealing with a capricious appetite, the
sight of a quantity of food often repels when a small portion of the
same food daintily prepared and attractively served would be eaten
with a relish and an appetite for more created. At the same time no
cause should be given for the criticism that a patient did not get
sufficient to satisfy him, when his doctor allowed him to have plenty.
In planning for regular diets, the fact needs to be kept in mind that a
larger quantity of food, proportionately, will be consumed in the men’s
ward than in the women’s wards, and sufficient to replenish the supply
should be sent from the kitchen.
[Sidenote: Bills of Fare]
A settled bill of fare for the different days of the week is never a
good plan in a hospital. The patients will soon learn the rotation of
the different dishes. Old patients will tell new ones, and the matter
will come up for discussion. Frequently before the food is served,
some patient who has heard objections to some food stated has decided
she does not want it, when if it had been taken unexpectedly to her it
would have been eaten without question.
[Sidenote: Dishes]
The prettiest, daintiest dishes the house can afford should be provided
for the private rooms. The constant breakage of dishes and especially
of dainty china, which goes on in a hospital makes it out of the
question to provide this kind of ware for the wards, and here beauty
must give place to durability. But a few dainty cups, especially for
the women’s wards, will be greatly appreciated, for there are refined,
sensitive people in the free wards, as elsewhere. These special cups
can be used in serving hot effects. Indeed it is astonishing how
few nurses know attractiveness to the food which is in itself an
aid to digestion. Care must be observed to avoid partiality in this
matter, for patients, like children, are quick to discern symptoms of
favoritism.
Glasses are now so inexpensive that every hospital can afford to supply
a sufficient quantity for all the patients.
A writer in Table Talk thus describes from a patient’s point of view
the invalid’s tray in a certain hospital and shows not only what
delightfully dainty effects may be secured in serving the commonest
articles of food, but how the memory of those effects remained long
after the hospital experience was ended:
“A couple of weeks spent in an up-to-date, twentieth century hospital,
has opened my eyes on many points connected with nursing, and
especially in regard to the setting forth in an appetizing way of the
tray for an invalid.
“At breakfast, dinner and supper these trays were artistic creations
of the highest order. One dinner tray was a study in golden greens
and white as to china and food, with the needed touch of color given
by wreathing the salver with racines of flowers in soft old pink, a
flower whose old-fashioned name I could not remember, but whose color
and fragrance took me back through more years than I care to count to a
sweet, old New Jersey garden.
“There was a golden brown chop in a circle of riced potato; crisp,
yellow-green lettuce leaves, ivory white at the base; strips of white
and gluten bread spread with golden butter and piled log-cabin fashion
on a pretty fluted dish of green and white china; pale green squash;
a quivering mold of yellow custard and a pretty teapot in green and
gold, with fragrant amber tea and a tiny pitcher of yellow, thick
cream.
“A supper tray which stands out pre-eminently in my memory, by reason
of its exquisite tones of color, contained a plate with four luscious
oysters on cracked ice, the bivalves laid in the form of a star, and
between the rays yellow wafers and discs of lemon. There was a plate
of lettuce sandwiches in strips an inch wide by three long; a mould
of farina, with its attendant pitcher of cream, a glass dish of apple
sauce whipped to a foam with white of an egg; triangles of white and
gluten bread buttered and cut in the thinnest of slices; a pitcher of
cocoa and three Reve D’or roses.
“Sometimes dainty sprays of Cecil Bruner roses lay among the tempting
viands, and fell in delicate profusion over the edge of the tray.
Again, little clusters of violets peeped over its rim and perfumed
the whole atmosphere, or the ruddy glow of crimson strawberries would
be accentuated by the deep red of roses of Sharon nestling in their
glossy, dark green leaves.”
[Sidenote: Hints on Serving]
An ordinary fruit, vegetable, or meat may be quite transformed by
the manner in which it is being served. An orange may be cut through
crosswise and served with a very small dish of powdered sugar and an
orange spoon, or it may have the whole fruit cut in carpels or sections
from pole to pole and the skin drawn back from each enough to loosen
it, and then again drawn into shape. If a baked potato form a part of
the meal, cut a slice from the upper side, take out the potato with a
small spoon, mash with butter, cream, and salt, whipping light with
a fork; fill the skin again, and stand in the oven long enough for
the little cone of potato exuding from the top to take a golden brown
tinge.
Fruit foams are digestible and dainty for invalids. Any sort of stewed
fruit—apricots, apples, peaches, or prunes—should be whipped smooth
while warm, and when thoroughly smooth beat in the white of an egg
whipped to a stiff froth; serve in thin glass, a pretty cup, or low
Japanese bowl.
A patient may be beguiled into eating nutritious food simply through
the manner of its preparation. To speak of raw beef sandwiches would
doubtless destroy the appetite of a delicate person, but if you will
prepare them as follows he will eat them without knowing, probably,
what he is eating: Lay a thin slice of round steak on a clean board,
and with a rather dull knife scrape off the meat, leaving the tough
fibers remaining; do the same on the other side, laying the scraped
beef on a dish. Spread two slices of very thin bread with the beef,
seasoning plentifully with salt; lay on these two slices of plain
bread, and cut into very small triangles, squares, or strips. Arrange
these prettily on a fringed napkin laid on a pretty dish, and garnish
with very small inner leaves of lettuce or with watercress.
Another way of serving beef which is digestible, palatable, and
nutritious, is to mould the beef, scraped as above, into small olives;
heat a small frying pan very hot, sprinkle with salt; lay in these
olives and shake over a hot fire for a minute or two until the outer
surfaces are heated; turn onto a hot dish and garnish with strips of
buttered toast.
Now in a general hospital where a hundred or more or less trays have
to be prepared for each meal, it is out of the question to devote as
much time to artistic serving as could be wished, but one thing is
certain, if nurses are not impressed with the importance of taking
pains to serve food attractively, and taught how to do it while in
the hospital, they cannot be expected to secure the best results in
serving food in private practice. Even a thing as simple of preparation
as a slice of toast gives room for the production of dainty and
artistic and wholesome meal more attractive. Butter should be rolled in
little balls between wooden spatters and can be prepared hours
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how to prepare a slice of buttered toast so that it will be just right.
A good deal of the time the toast served in hospitals is either burnt,
half done or soggy, buttered over much or in patches and served in
slices so that the patient cannot possibly manage to eat it without
getting his hands well greased. It would cost no more either of time or
money to toast it a golden brown, put the right amount of butter on it,
and serve it cut in small squares between hot plates.
The time element is a very important point to be considered in serving
food and requires careful calculation. Custards as a rule are better
served quite cold, and should be cooked a sufficient length of time
before the meal to allow for cooling. Baked potatoes are delicious and
easily digested when cooked just right and promptly served, but what is
more unappetizing than a baked potato that has remained after cooking
in a slow oven till it was soggy and half cold?
Tea is another article that is spoiled if prepared too long before it
is served, and this list might be multiplied indefinitely. There is no
question but that this lack of forethought in calculating the time that
should elapse between cooking and serving of food is responsible for
many insipid, unattractive, indigestible meals in hospitals. When so
much of the food has to be prepared in bulk, the problem is much more
difficult than in dealing with an individual patient, and only goes to
show the necessity of having not only first class facilities for prompt
serving, but first class trained brains to calculate and first class
hands to handle it if the best results are desired.
If the one in charge has had personal experience in dealing with
invalids, many little touches will suggest themselves to her that will
tend to make the invalid’s
[missing text]
in advance of the meal and allowed to stand in water. Even a dish
of bread and milk may be made a dainty meal if the bread is cut in
half-inch dice and piled lightly on a plate. Milk toast may be accepted
as a delightful treat if a little thought is given to its preparation
and serving. As for all toast the bread should be thoroughly and evenly
browned before a moderate coal fire. The toast, cut in neat squares,
with the crust removed, may then be placed in a deep saucer (the
daintiest and prettiest the establishment affords) and covered with
a small plate which with the saucer should first be heated. When the
tray cover is spread, set on it a small knife and fork and teaspoon, a
little silver teapot of _hot_ milk, a ball of butter and a salt shaker.
If the patient is able to butter his own toast and pour over it the hot
milk he will enjoy doing it.
When a single dish is to be served use a small round tray or a large
plate covered with a doily rather than the regular tray used for meals.
Avoid putting so many dishes on a tray that it will seem crowded. It is
better to use a second tray for serving dessert or fruit than to pile
too much on one tray and have it lack in order and neatness.
Cracked cups or china and broken-nosed teapots are distinctly out of
place on any invalid’s tray and in these days of inexpensive dishes
are inexcusable in any hospital. Special care should be used to
avoid filling cups and glasses to the brim. When this is done, it is
impossible to avoid an overflow if it has to be carried any distance,
the neat appearance is spoiled, a portion of the contents is lost and
it is difficult for the patient to handle without spilling.
A nurse who has an eye for harmonious effects in colors will not
be guilty of setting a tray with a green cup and saucer and an old
fashioned blue plate. A sense of the fitness of things will also keep
her from placing together a cup and saucer that were never intended for
each other. Such blunders in setting a tray are indicative either of
ignorance or carelessness.
It is always a mistake to leave food beside a patient any length of
time after the patient has had time to eat it. If he has no desire for
it when it is first presented, the chances are small that the desire
will come if the food is allowed to stay in sight. Besides the exposure
to the floating dust made up of the undesirable elements of a sick room
will render the food unfit for use at another time. Food substances are
the soil in which bacteria flourish.
A spray of maiden hair fern or any of the dainty green effects is
always suitable for decoration, as are many flowers. The use of flowers
on a tray should be restricted to a single blossom with a touch of
green, or a full bloom flower of the dainty varieties. Large bouquets
on an invalid’s tray are in bad taste, as are many flowers that
elsewhere would be appreciated.
Every hospital experience ought to be a practical lesson to the patient
in how to serve food. A taste for the dainty and beautiful, for
wholesome and simple things, may be created there that will permanently
influence the sick one to higher ideals of living. And certainly the
manner of serving food is a pretty fair indication of the tone of the
institution. Refinement or absence of refinement will be detected at a
glance by one who has a keen appreciation of the aesthetic.
The best results in food service will never be secured in any
hospital until some one person is appointed whose chief business is
the preparation of special diets and the oversight of serving. In
many large or well-regulated hospitals this matter is in the hands
of women specially trained in dietetics, and there one has a right
to expect better service than in institutions where one overworked
woman must attend to that and a dozen other things, or where the
responsibility of serving food is divided among many. If the person
in charge has had in addition to the training in dietetics practical
experience as a hospital nurse, still better service may be expected.
A genuine sympathetic interest, or as some one else has termed it, “an
affectionate interest,” in the people for whom the food is prepared, a
keeping in mind the Golden Rule in serving and preparing food, as in
other departments of the hospital, is fully as important as a knowledge
of the science of nutrition. The soul life of the individual can find
abundant opportunities for its expression in the diet kitchen as in the
ward. There is a field here for specializing which is fully as worthy
of a nurse’s attention as some of the other lines of nursing.