Hospital housekeeping

by Charlotte A. Aikens

CHAPTER IX.

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.

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.”

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.