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

Abstract

This review aimed to summarize existing nursing literature to provide an overview of the extent, range, and nature of nurses’ involvement in artificial nutrition and hydration (ANH) at the end of life and to map the key concepts underpinning nurses’ involvement in ANH. A scoping review was designed following the methodological framework guidelines of Arksey and O'Malley and the recommendations for advancing the methodology by Levac et al. An inductive qualitative content analysis was conducted according to the guidelines by Elo and Kyngäs. Thirty‐nine articles were identified. Content analysis revealed 1 main category: “nurses’ role in the decision‐making process,” with the 2 subcategories of “mediator” and “activator.” The category and subcategories are influenced by the following generic categories: “being,” “feeling,” and “knowing,” each of them constituted by 2 subcategories in their turn. Nurses perform the roles of activator and mediator. Their ability to establish good relationships and their attitudes enable the creation of teamwork and closeness to patients and family: relationships and attitudes are the subcategories of the “being” category. The category “feeling” represents the ways nurses experience the decision‐making process, which can raise ethical and moral dilemmas and cause emotional responses. For these reasons, nurses have to create the right balance between personal‐self and professional‐self. The category “knowing” includes nurses’ clinical and ethical knowledge about ANH. It emerges that deep clinical and ethical knowledge of ANH is necessary to provide consistent, adequate care at end of life.

Do Nursing Staff Accept no Artificial Nutrition and Hydration for Terminal Patients?

“…Studies have indicated that those who were older had a higher level of education and had longer years of work experience had better knowledge resources as well as better skills in utilizing the resources. Nursing staff who worked at the oncology or hospice unit had more experience in care [18,19,21] and also diligently cultivated clinical talents [13]. In particular, clinical nursing staff who had participated in hospice care training had a more positive attitude towards non-ANH in terminal patients when the patient's body system deteriorates [15,21,22], and a significantly positive correlation was observed when clinical nursing staff had a better understanding of the concept of hospice care and the timing and decision-making for ANH, they had a more positive attitude towards accepting ANH [5,14,15,21,22].…”

“…Hence it is evident that clinical nursing staff lack relevant competencies in palliative care. In clinical practice, the members of a hospice care team are capable of independent thinking and judgment and may discuss the pros and cons of ANH as well as ethical dilemma encountered in clinical practice with physicians, so as to reduce the psychological burden and confusions of family members [1,3,4,6,10,13,14,22], which will affect the conveyance of the knowledge relating to the administration of ANH in terminal patients when the patient's body system deteriorates and help to bring out professional care competence. Therefore, insufficient recognition and unfamiliar attitude of nursing staff on hospice care along with insufficient knowledge of relevant practices in hospice care will affect the quality of hospice care provided to the terminal patients [4,5,13].…”

“…With regard to the attitude of non-ANH to terminal patients, the difficulties as well as obstacles encountered when withdrawing ANH in clinical practice, also reveal the expectations of terminal patients and their family. This issue is a challenge [5][6][7][8][9][10][11][12][13][14]15,20,21] faced by clinical nursing staff everyday and is worth further investigation. Intervention with hospice care from the perspective of Taiwanese food culture allows further investigation of the relationships between local customs, family values and homology of medicine, food, and ANH as well as of the factors relating to these relationships, which can provide a reference for future educational strategy for clinical practice.…”

Nurse and Nursing Students’ Opinions and Perceptions of Enteral Nutrition by Nasogastric Tube in Palliative Care

“…In this respect, it is widely accepted that nursing staff may play a key role in PC in order to promote a consensus between appropriate treatment choices and the patients' preferences that may finally facilitate the decision of applying this process [11,12]. Accordingly, the lack of knowledge and skills in PC from nurses may lead to erroneous perceptions related to approaching these patients [13]. Previous studies have reported that this lack of knowledge or skills referring to end-of-life care started during the academic stage [14].…”

Nursing staff participation in end‐of‐life nutrition and hydration decision‐making in a nursing home: A qualitative study

“…Provision of nutrition and hydration enterally or intravenously, commonly referred to as artificial nutrition and hydration may be considered but, with a few exceptions, is not generally considered best practice near the end of life as numerous studies have identified little benefit and even negative outcomes, from aggressive efforts to maintain “normal” nutrition and hydration in those nearing death (Druml et al., 2016; Good, Richard, Syrmis, Jenkins‐Marsh, & Stephens, 2014a, 2014b; Raijmakers et al., 2011; Teno et al., 2012). The role nurses play in artificial nutrition and hydration decision‐making near end of life varies by setting and country (Albanesi et al., 2020).…”