The provision of medically administered nutrition and hydration (MNH) for the terminally ill patient is a controversial issue and there has been much debate in the literature concerning this sensitive subject. This article reports on a qualitative research study that explores palliative care nurses' and doctors' perceptions and attitudes to patient nutrition and hydration at the end of life. Participants were from an urban and rural palliative care service. Three main discourses were identified: carers' distress at the non-provision of MNH; palliative care doctors' and nurses' position that terminal dehydration lessened the burden of suffering for dying patients; and polarisation between the acute care setting and the palliative care setting. Overlaying these three main discourses are contesting discourses involving cure vs comfort, and acute care vs palliative care. Importantly, the findings of this study reveal that palliative doctors and nurses believe that medically assisted nutrition and hydration at the end stage of life rarely benefits patients, and as long as adequate mouth care is given, patients do not suffer. However, family members do experience emotional distress in dealing with this situation. In caring for dying people, the nurse's and doctor's role is one of education and communication, involving a team approach to manage this difficult issue.
Medical and nursing staff have different attitudes and beliefs towards end of life care. Tensions arise when decisions need to be made based on quality of life or prolongation of life. The successful merging of curative and palliative care is not without challenges. There has been little exploration of this situation.
This study explored the perceptions of doctors in acute care settings regarding the use of medically assisted hydration (MAH) in end-of-life care. The use of MAH at the end of life is controversial, and practice varies across health care settings. A qualitative study using discourse analysis was carried out. Eight medical practitioners in the acute care setting were interviewed individually. MAH has been associated with care, comfort, and standard medical intervention to save lives. Medical officers have some concerns about the benefits or adverse effects of MAH at the end of life. In acute care settings, it can be difficult to recognize and diagnose dying. Often, family discussions regarding end-of-life care do not occur due to pursuit of cure and, therefore, continuation of futile and burdensome treatment such as MAH can occur in the last few days of life.
Nurses in acute care settings need to be involved in decision-making and advocate for patients and family during the dying phase. Nurses in acute care need better understanding about the palliative approach to care and nutrition and hydration for people who are dying.
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