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Involvement of hospital nurses in care decisions related to administration of artificial nutrition or hydration (ANH) in patients with dementia: a qualitative study.

Abstract：

BACKGROUND:Nurses that care for patients with advanced dementia are increasingly faced with consequences of disease progression, often requiring them to decide whether to artificially feed these patients. Clarifying how nurses can be better supported in complex care processes involving ethically sensitive decision-making requires that their practice be mapped out. OBJECTIVES:The aims of this study were to explore and describe how nurses are involved in the care that surrounds decisions concerning artificial nutrition or hydration in hospitalized patients with dementia. DESIGN:We used a qualitative interview design. Data collection and analysis were informed by the grounded theory approach. SETTING:Nine hospitals geographically spread throughout the five provinces of Flanders, Belgium. PARTICIPANTS:Twenty-one nurses were purposively selected for interview, with the aim of including nurses that reflected diverse personal characteristics and experiences with the subject matter. METHODS:Between April 2008 and June 2009, we conducted 21 interviews that were audiotaped and later transcribed. Data processing involved (1) simultaneous and systematic data collection and analysis, (2) constant forwards-backwards wave, (3) continuous dialogue with the data, and (4) interactive team processes. RESULTS:Nurses' involvement was characterized by a desire to provide 'good care', which was the basis for their motivation and aspiration during the care process. Early in the process, nurses developed a holistic picture of their patients, laying the foundation of their 'good care' view. During the actual decision-making, nurses fulfilled the roles of messengers and guiding communicators, as they attempted to realize their 'good care' view. Nurses judged the physicians' decisions in light of their care view. If a decision matched their view, they supported the decision. If not, they resisted it openly or covertly. Some nurses remained passively in the background, while others took action to override the decision. Nurses' involvement ended with the intensive aftercare of the patients and their family. CONCLUSIONS:Nurses are closely and continuously involved in the care that surrounds decisions concerning artificial nutrition or hydration in hospitalized patients with advanced dementia. During the care process, nurses play several and specific roles, giving their contribution a unique and variable character.

journal_name

Int J Nurs Stud

journal_title

International journal of nursing studies

authors

Bryon E,Gastmans C,Dierckx de Casterlé B

doi

10.1016/j.ijnurstu.2010.01.011

subject

Has Abstract

pub_date

2010-09-01 00:00:00

pages

1105-16

issue

eissn

0020-7489

issn

1873-491X

pii

S0020-7489(10)00051-9

journal_volume

pub_type

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Involvement of hospital nurses in care decisions related to administration of artificial nutrition or hydration (ANH) in patients with dementia: a qualitative study.