Artificial hydration: the role of the nurse in addressing patient and family needs

Abstract

When caring for terminally ill patients and their families, nurses are confronted with the subject of terminal dehydration and the question of artificial hydration at the end of life. Terminal dehydration and artificial hydration are still controversial topics of discussion and, to this day, data remain insufficient to reach a final conclusion on the benefits or harm of dehydration in terminally ill patients (Ersek, 2003; Fainsinger, 2008). Nurses, just like physicians, have different attitudes about the usefulness of artificial hydration. Personal and professional experiences, cultural influences, and the place of care, as well as education and available resources, are guiding clinical practice (Morita et al, 2002; Pasman et al, 2004). Since there is no ethically or medically based gold standard, each decision for or against hydration at the end of life needs to be taken on an individual basis. This article reflects on the meaning of dehydration for the patient and their family, and reviews the role of the nurse within the decision-making process. Arguments for or against artificial hydration are illuminated through patient situations which took place in the clinical setting of a hospice. The article further highlights the importance of recognising dehydration in frail and elderly patients, and critically assesses policies that may hinder its optimal palliation in different settings in Switzerland.

Beneficência e Não-maleficência em Fim de Vida: O Caso da Nutrição e Hidratação Artificiais.

“…Outros autores são da opinião que a NHA é inquestionavelmente um cuidado humano básico, pois não restaura nenhuma função básica de vida à qual têm direito todos os seres humanos, simplesmente porque estão vivos (CNECV, 2005). Se são considerados tratamentos (Winter, 2000;Bennett, Eidsness, & Young, 2008;van de Vathorst, 2014), há a obrigação de lhes oferecer os meios necessários para que o possam fazer (Tapiero, & Martinez, 2003;Fernández-Roldán, 2005;Pinho-Reis, 2012;Reis, 2011;Pinho-Reis, & Coelho, 2014a;de Andrade, Almeida, & Pinho-Reis,2017;Pinho-Reis, Sarmento, & Capelas, 2018 (Schmidlin, 2008;Pérez-Camargo, Allende-Pérez, Domínguez-Ocadio, & Verástegui-Avilés, 2013), que inclui valores culturais (Eberhardie, 2002;Holmes, 2010), sociais (Shannon, & Walter 1988;Easson, Hinshaw, & Johnson, 2002;Hopkins, 2004;Fernández-Roldán, 2005), religiosos (Eberhardie, 2002;A.D.A, 2008;Geppert, Andrews, & Druyian, 2009), e espirituais (Holmes, 2010).…”

Artificial Nutrition and Hydration at the End of Life

“…Many persons at the end of life do not understand that ANH is a medical intervention and not just provision of food and water (167). In a study of currently healthy older adults (age l ¼ 79 years), several diagnoses and EOL scenarios were presented and 86% overwhelmingly rejected the use of ANH in treatment plans (p < 0.001) (168).…”

Exploring Nurses’ Involvement in Artificial Nutrition and Hydration at the End of Life: A Scoping Review

“…The provision of ANH to end‐of‐life patients still represents a debated and controversial topic . This is due to the contrasting views that consider ANH either a form of basic care that should not be denied to anyone or a medical treatment about which no clear indications are available . Moreover, the great variability of prognostication at end of life creates a sense of uncertainty among healthcare professionals on what are the right actions to take .…”

“…The act of feeding and the act of providing fluids are actions closely tied to human care . When patients are unable to complete the natural oral intake of food, appropriate nursing care becomes fundamental to the individual's vital need for nutrition . Although nurses are moving toward an advancement of their competences in this clinical area, an undefined role and a vague understanding of their involvement in decision making regarding ANH are still evident in the literature .…”