I didn’t realize it was their last meal. This is a thought that has repeatedly played in my mind.
Throughout nursing school, I was taught about the importance of drug calculations, administration of medications, nursing interventions, and care plans. I can remember learning about feeding patients with a variety of dietary precautions and the importance of preventing aspiration.
When caregiving becomes a checklist
Delegation to nursing assistants, certified nursing assistants (CNAs), and patient care technicians was also taught with an emphasis on delegating bed baths, linen changes, and patient feedings. As a novice nurse in a very busy medical-surgical unit, I had a lot of priorities and responsibilities.
My thoughts for the day included administering medications, completing my nursing tasks, checking off the boxes, and, of course, charting. These tasks were at the forefront of my thoughts. However, tasks such as bed baths and feeding weren’t a main priority to me at the time. I have delegated these tasks countless times without a second thought.
An overreliance on task-oriented, checklist-based nursing care can profoundly influence patient outcomes. In talking with nursing students, common reasons for choosing their career path include phrases such as “I want to make a difference,” “I like to help people,” or “I felt a calling to this profession.”
If you ask a nurse working on the unit, "What is your priority for the day?" You may hear responses such as “getting out on time,” “not having any admissions, or “eating lunch.” The purpose of nursing quickly changes from supporting the patient to getting your tasks completed.
The shift that changed everything
I can remember working second shift at the hospital. We were in a nursing shortage, and I was caring for the maximum number of patients. Alarms were ringing, IV machines beeping, and time pressures to deliver patient medications on time, every time. We also did not have a unit secretary or any nursing assistants, CNAs, or patient care technicians during this shift.
It was just three other nurses on the unit and me answering phones, completing our nursing duties, and being unable to delegate “simple” tasks to personnel. I never realized at that moment that this “simple” task would be a defining moment in my career.
I had been assigned two dependent patients who were older adults and placed in the same room. They were both bedbound and unable to feed themselves. The dinner trays arrived on the floor, and I had to distribute them to my patients.
When I had my last two trays to deliver, I realized that I would have to feed both patients, since there was no care on the floor. At this point, I am mentally exhausted and hungry. I can remember standing between the two patients, feeding them back and forth. Reflecting on my nonverbal behaviors, I was rushing the patients to eat, unsympathetic, and frustrated at the situation. I finished my shift and left the hospital, grateful to be done with another day.
What I didn’t realize
The next day, as I was preparing for my shift, I was hopeful for a better night but also dreading another tough night. I walked into the unit for my assignment and noticed that one of my patients from yesterday was not on my assignment sheet. I asked if the patient was transferred to another unit, and that is when I heard the words, “He passed away last night.”
I almost sank to my knees at that moment. The entire previous shift played throughout my mind. What could I have done better to support this patient? How were his last moments? It then dawned on me. I fed him his last meal, and I didn’t even do a good job.
I instantly felt guilty, sad, and disappointed in myself. I forgot about the true meaning of providing compassionate nursing care for a patient. It is not always about measuring medications and completing wound changes. Something as small as a meal can be the most important duty that a nurse can provide for a patient.
What I learned and carried with me
This moment has stuck with me throughout the years. It has allowed me to treasure mealtimes more meaningfully, both in the clinical unit and in my own personal life. We never truly know when it will be someone’s last meal. It is important to recognize the “person” before the “patient” and provide them with this most basic need.
Moving forward, I have made a personal commitment to improvement. This has caused me to take a pause and remember that these simple acts sometimes make the biggest difference. I started to focus on being present with the patient, instead of just checking the boxes.
A commitment to patient presence, not just patient care
This patient taught me more than I ever learned in the classroom. On the clinical unit, I pause and remember this patient every time I feel overwhelmed or feel as though I will never get out on time. Did those extra 15 minutes that it would have taken to feed the patient truly make a difference in my personal life? The answer is easy — no.
As a nurse educator, I share this story with my students each year. Honestly, I hold back tears because the thought of it is still so raw. I share this story to help my students prevent the same mistake. To always advocate for patients and take the time to be present. Now, I try to treat every meal like it could be someone’s last, not out of sorrow, but out of respect for every patient.
