Rx:RN: Dying Patients Who Refuse Nutrition and Hydration: Holistic Nursing Care at the End of Life

2005 ◽  
Vol 11 (2) ◽  
pp. 100-102 ◽  
Author(s):  
Stacy Lundin Yale
2016 ◽  
Vol 1 (13) ◽  
pp. 89-93 ◽  
Author(s):  
Justin Roe ◽  
Rob George

Nutrition and hydration are emotive topics in many fields of health care. This can present particular challenges towards the end of life where reduced hydration and nutritional needs are a natural part of dying. Speech-language pathologists (SLPs) are increasingly involved in the care of dying patients. It is essential that they work as part of a dedicated, multidisciplinary team delivering a comprehensive package of specialist palliative care. In this paper, we will review the role of the SLP at the end of life and present information that will support the SLP to recognise and understand dying, and how medical and SLP interventions may compound rather than relieve symptoms. It is paramount that interventions are ethically sound and decision making is shared, respecting the autonomy of patients. In the event patients lack capacity, any advance directives/decisions and statements should be considered in consultation with caregivers. At the end of life, the focus of our intervention may shift from the patient to the caregiver, ensuring that they have a meaningful role in the care of their loved one in the final stages of dying.


2008 ◽  
Vol 15 (2) ◽  
pp. 174-185 ◽  
Author(s):  
Karen S Thacker

Nursing professionals are in key positions to support end-of-life decisions and to advocate for patients and families across all health care settings. Advocacy has been identified as the common thread of quality end-of-life nursing care. The purpose of this comparative descriptive study was to reveal acute care nurses' perceptions of advocacy behaviors in end-of-life nursing practice. The 317 participating nurses reported frequent contact with dying patients despite modest exposure to end-of-life education. This study did not confirm an overall difference in advocacy behaviors among novice, experienced and expert nurses; however, it offered insight into the supports and barriers nurses at different skill levels experienced in their practice of advocacy.


Author(s):  
Danguolė Drungilienė ◽  
Vida Mockienė

Research background. Nursing care for patients with terminal conditions is one of the leading problems in health care. Health care specialists caring for the dying patient are under enormous psychological stress. Before death the patient requires medical and family support because death provokes feelings of fear or anxiety. During nursing care for dying patients the most important issue is to help people to live fully up to the last moment of his life. The aim of the research was to analyse the aspects of care of dying patients. Research methods. The subjects, 250 health care specialists (doctors, nurses), 57 dying patients’ family members and significant others, filled-in a questionnaire consisting of a Frommelt’s approach to nursing care for dying patients, a modified Collet-Lester scale of death fear, and a questionnaire for the dying patients’ family members and significant others. Results and conclusions. The vast majority (92.4%) of respondents were religious, had experienced bereavement, care for person with incurable illnesses and have knowledge about death. The most important concern of respondents related to the process of death of themselves or their close relatives was due to the pain in the process of death. The majority of respondents (93.1%), especially with higher education, had a good attitude towards nursing care for dying patients. Respondents with the experience of bereavement more often noted that families caring for the patient with incurable disease need for emotional support and that close relatives should participate during the patient’s process of death. Respondents who had work experience with the dying patients significantly more often believed that possibility of the dependence on painkillers should not be considered when it comes to the dying person. According to them, the family members who remain with the dying patient disturb the nursing care. Respondents who have had knowledge about death significantly more often noted that the care for patient’s family members should continue throughout the period of mourning and bereavement, and indicated that they were upset when their patient ceased to believe that he would recover. Respondents who felt threatened by the current bereavement and were more worried about their own death significantly more noted that the stress was the most common psychological problem in the end of life. As proved by the survey outcomes, the majority of the patients (75.4%) were frequently visited by family members. During the time of their disease, most of the patients (77.2%) stayed alone just for short periods of time. At the time of death, the majority of the respondents (61.4%) stayed at the bedside of their family member, 38.6% of the respondents indicated that the dying person frequently felt pain, and 19.3% of them stated that the pain was felt for a short or an insignificant period of time. About half of the respondents claimed that their family member could not eat or bree the independently. Over half of the patients who passed away (52.6%) did not discuss their nursing requirements, such as reanimation or intensive care, at the end of their lives, however, 35.1% of the patients did that. Approximately half of the patients discussed their funeral-related wishes and said good-bye to their family members or significant others. The majority of the survey participants-patients’ family members and significant others (82.5%) indicated that the patient in hospital had been properly cared for.Keywords: dying patient, death, nursing care.


2021 ◽  
pp. 003022282199734
Author(s):  
Guobin Cheng ◽  
Chuqian Chen

Objective To map the current research status and understand existing findings regarding end-of-life care needs in Mainland China. Method First-hand, empirical studies on the needs of dying patients and/or their families in Mainland China were searched in Web of Science, Scopus, Proquest, Taylor & Francis Online and CNKI in December 2019. Findings were synthesized. Results A total of 33 (10 qualitative) studies were involved. Chinese dying patients and their families had physical, psychological, social, and spiritual needs and needs for knowledge and information. Prevalent needs of dying patients were mainly symptom control and decent look, being treated kindly by professional caregivers, family accompany, dignity, and comfortable environment. Families mainly need healthcare professionals to take good care of patients and wishes for information, knowledge, and facilities to help themselves become better caregivers. Conclusions Findings lay the foundation for effective and tailored services for Chinese clients and provided insights for future investigations.


2021 ◽  
Author(s):  
Yolanda Barrado-Martín ◽  
Pushpa Nair ◽  
Kanthee Anantapong ◽  
Kirsten J Moore ◽  
Christina H Smith ◽  
...  

Author(s):  
Molly K Bigford ◽  
Roschelle Heuberger ◽  
Erica Raymond ◽  
Viki Shayna ◽  
James Paauw

Objective: To analyze and compare the knowledge and opinions of registered dietitian nutritionists (RDNs) about artificial nutrition and hydration (ANH) in a terminal illness. Beliefs of speech-language pathologists (SLPs) were also considered and compared against RDN data. Methods: This is a descriptive analysis utilizing survey responses from RDNs and SLPs regarding ANH in a case study patient with advanced dementia. Results: There was a strong belief among RDNs that ANH at end of life (EOL) would improve nutritional status, although a correlation was found between those in favor of ANH and believing it was ethical to withhold ANH at EOL (R2 = 0.109, p = 0.002). Responses indicated that SLPs need more education regarding ANH techniques, while RDNs felt ANH would improve aspiration risk. Place of employment, religion and age of respondents were also found to impact beliefs. Conclusion: Clinicians, specifically RDNs, working with patients at EOL need more evidenced-based education on the risks and benefits of ANH. Decisions regarding care of patients at EOL should be void of clinicians’ personal bias which may affect ethical treatment in the clinical setting. Further controlled trials must be performed before claims can be made regarding ANH at EOL.


Author(s):  
Inmaculada Corral‐Liria ◽  
Miriam Alonso‐Maza ◽  
Julio González‐Luis ◽  
Sergio Fernández‐Pascual ◽  
Ricardo Becerro‐de‐Bengoa‐Vallejo ◽  
...  

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Xhyljeta Luta ◽  
Baptiste Ottino ◽  
Peter Hall ◽  
Joanna Bowden ◽  
Bee Wee ◽  
...  

Abstract Background As the demand for palliative care increases, more information is needed on how efficient different types of palliative care models are for providing care to dying patients and their caregivers. Evidence on the economic value of treatments and interventions is key to informing resource allocation and ultimately improving the quality and efficiency of healthcare delivery. We assessed the available evidence on the economic value of palliative and end-of-life care interventions across various settings. Methods Reviews published between 2000 and 2019 were included. We included reviews that focused on cost-effectiveness, intervention costs and/or healthcare resource use. Two reviewers extracted data independently and in duplicate from the included studies. Data on the key characteristics of the studies were extracted, including the aim of the study, design, population, type of intervention and comparator, (cost-) effectiveness resource use, main findings and conclusions. Results A total of 43 reviews were included in the analysis. Overall, most evidence on cost-effectiveness relates to home-based interventions and suggests that they offer substantial savings to the health system, including a decrease in total healthcare costs, resource use and improvement in patient and caregivers’ outcomes. The evidence of interventions delivered across other settings was generally inconsistent. Conclusions Some palliative care models may contribute to dual improvement in quality of care via lower rates of aggressive medicalization in the last phase of life accompanied by a reduction in costs. Hospital-based palliative care interventions may improve patient outcomes, healthcare utilization and costs. There is a need for greater consistency in reporting outcome measures, the informal costs of caring, and costs associated with hospice.


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