The Case for Strawberry Yogurt: A Patient-centered Approach

Over my nursing career, I have noted that what patients say is not even half the story. As a lover of art and literature and indeed a nurse writer, I have a habit of seeing the story behind the story. I have been on the opposite side of the consultation desk and I know that I too, did not give the story. That is the case we are looking at today. Moreno* was a fifty-six-year-old gentleman who came to the hospital with acute on-and-off abdominal pain. What was meant to be an overnight stay for investigations turned out to be an inflamed appendix that required immediate surgery.

The ward doctor and the consultant spoke to him about the surgery. This is standard procedure to gain consent. Moreno spoke English rounded off to the nearest French. I knew because I had asked him about past medical history after I noted a curious rise in his blood pressure and he had had to call his beloved daughter to speak to me. His daughter spoke both French and English. Moreno was in London for a short holiday. His daughter was in France.

I was about to log off from my computer and go see another patient when the consultant approached me saying Moreno was not keen to have surgery. I love Brit-speak. It is English with just the right amount of British humility and shyness. When they say ‘not keen,’ they mean ‘absolutely NOT!’ From the CT scan I had seen, Moreno’s appendix was soaked in pus. It needed to come out immediately lest he develop sepsis. There is nothing as terrible as sepsis on a Friday afternoon. Not that any other day would be better but weekends tend to be slow in most hospitals as there are fewer members of staff.

Moreno had spent the day asking for strawberry-flavored yogurt but for some reason, the hospital had every flavor known to man apart from what Moreno wanted. He had put in a complaint already that his nutritional needs were not being taken care of. He wanted to go home; he had told the consultant. He was not happy with us.

As the consultant and the resident doctor weighed their options, I went to speak to Moreno. I spent about half an hour with him talking about strawberry yogurt and why it mattered to him.

When he was a child, he told me through Google Translate, his mother left him at the hospital, never to come back. He was only six and he remembers. She had bought him a box of strawberry yogurt. That is the only thing he remembers. Though he grew up climbing the corporate ladder of IT in France, Moreno felt that strawberry yogurt was what comforted him when he needed comfort. He was here in a foreign hospital, with new doctors and nurses who did not know him as well as his French doctors and all we could do was tell him he needed to go to the theatre but could not afford one box of strawberry yogurt! I almost cried.

I had to personally promise strawberry yogurt after he was cleared as safe to eat after the operation. I made sure to escalate this to my manager who pushed what needed pushing and strawberry yogurt was delivered in thirty minutes to the hospital at 1825 hours on Friday evening. Moreno only signed the consent form after seeing the strawberry yogurts safely in the hands of my manager.

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This incident made me think about the Patient Centred Nursing Framework (PCNF). In PCNF, the most important member of the team is the patient. However, we easily miss that patients are t just diseases and illnesses. They are not problems that need fixing. They are people with unique stories that influence their interaction with whatever services we are offering as a medical team. It does not matter how advanced our services are if the people they are meant to help cannot embrace them.

The main theme in PCNF is holistic assessment. This is not just for the bodily systems but to listen to the story the patient is not saying. Perhaps had we followed up quickly earlier in the day on why strawberry yogurt mattered to Moreno, he would have had surgery hours earlier in the day.

Effective communication is fundamental to PCNF, it follows that we must know what to do when people are sick but we also need to know how to say what we know. As medics, we make calamitous mistakes when we focus on talking to the patient instead of. While services like Language Line and AI tools are available to overcome the language barrier in medical spaces, the human aspects of care and nurture cannot be replaced by the touch of a button or a phone call to repeat the same thing over and over in a different language.

Shared decision-making is another tenet of PCNF. Patients know what they want to do about their health and well-being. They need our input, not patronage. We can suggest, we can present evidence but ultimately, people can decide for themselves. The best we can hope for is that they will make the right decisions with the information available to them.

We cannot do all these without empowerment and education. This is not on for patients but also the staff. We cannot achieve PCNF if we are constantly short-staffed. How else will we listen to the story behind the story while we are swamped with ten patients for one nurse? We need to improve our staffing ratios to ensure that we achieve PCNF. I have a stubborn belief that great concepts like PCNF should not gather dust in expensive offices. ?We need to implement the recommendations and it all starts with ensuring that nursing teams are not only continuing with education but that they are empowered enough to free up their time to listen to the patient holistically.

*Moreno is not his his real name.