What influences attitudes towards clinically assisted hydration in the care of dying patients? A review of the literature

Gent, M.J. van; Fradsham, Sarah; Whyte, Graham; Mayland, Catriona

doi:10.1136/bmjspcare-2013-000562

Cited by 23 publications

(16 citation statements)

References 30 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…With regard to perceived usefulness, despite some respondents claiming not to have guidelines, algorithms or protocols available, the results show that they consider them to be useful tools. In consonance with other authors, these tools are seen to facilitate decision‐making processes and diminish variability in clinical practice and ongoing training, with the main disadvantages being the lack of potential for personalising care plans (Beghi et al, ; Fischer et al, ; Gundersen, ; Woolf, Grol, Hutchinson, Eccles, & Grimshaw, ) and the perception of such interventions as a basic level of care given the symbolic value of hydration (Cabañero‐Martínez et al, ; Gent et al, ).…”

Section: Discussionmentioning

confidence: 82%

Availability and perceived usefulness of guidelines and protocols for subcutaneous hydration in palliative care settings

Cabañero‐Martínez

Ramos‐Pichardo

Velasco-Álvarez

et al. 2019

Journal of Clinical Nursing

View full text Add to dashboard Cite

Aims and objectives To evaluate the availability of, adherence to, and perceived usefulness of guidelines and protocols for managing hydration and subcutaneous hydration in palliative care settings. Background Hydration at the end of life and the use of a subcutaneous route to hydrate generate some controversy among health professionals for different reasons. Having guidelines and protocols to assist in decision‐making and to follow a standard procedure may be relevant in clinical practice. Design Cross‐sectional telephone survey, with closed‐ended and open‐ended questions designed specifically for this study. Methods Data were obtained from 327 professionals, each from a different palliative care service. Mean, standard deviation, minimum and maximum were calculated for continuous variables; frequency distributions were obtained for categorical variables. A qualitative content analysis was performed on the open‐ended questions. The article adheres to the STROBE guidelines for reporting observational studies. Results Only 24.8% of the participants had guidelines available to assist in making decisions regarding hydration, and 55.6% claimed to follow them ‘always or almost always’. Of the participants, 38.8% had subcutaneous hydration protocols available, while 78.7% stated that they ‘always or almost always’ followed these protocols. The remaining participants considered the protocols as useful tools despite not having them available. Conclusions Only 25% of the participants' services had guidelines for hydration, and less than 40% had protocols for subcutaneous hydration. However, adherence was high, especially in cases where protocols existed. Among the participants who did not have guidelines and protocols, attitudes were mostly favourable, but mainly as a reference and support for an individualised clinical practice. Relevance to clinical practice Guidelines and protocols on hydration in palliative care may be more useful as a solid reference and support for individualised practice than as instruments for standardising care. From this perspective, their development and availability in palliative care services are recommended.

show abstract

Section: Discussionmentioning

confidence: 82%

Availability and perceived usefulness of guidelines and protocols for subcutaneous hydration in palliative care settings

Cabañero‐Martínez

Ramos‐Pichardo

Velasco-Álvarez

et al. 2019

Journal of Clinical Nursing

View full text Add to dashboard Cite

show abstract

“…The article has attempted to highlight the importance of meticulous record keeping in some of the key areas of palliative care nursing. Scrupulous record keeping still provides the vehicle to ensure consistence and compassionate care is delivered through clear, concise and unambiguous communication [15][16][17].…”

Section: Resultsmentioning

confidence: 99%

Advanced care planning in palliative care coordination: the NMC code and record keeping

Aubyn¹,

Andrews²

2017

Nurs Palliat Care

View full text Add to dashboard Cite

It is essential that nurses adhere to the NMC code in relation to record keeping and documentation in all care arenas. However, this adherence is even more important in the emotional and highly sensitive area of palliative care nursing practise as this group of patients have specific and extra needs that can make their needs more profound and their record keeping requirements more complex. The code explicitly states that nurses must recognise and respond compassionately to the needs of those who are in the last few days and hours of life (NMC 3.2). This article will consider key elements of palliative care practice in conjunction with the four identified standards of the NMC code (NMC 2015). The four standards are: Prioritise people, practice effectively, preserve safety and promote professionalism and trust. The code clearly stipulates that although the standards may be interpreted differently depending on the practice setting, they are not negotiable or discretionary (NMC 2015). The article will focus on the importance of meticulous record keeping in some of the key areas of palliative care nursing. The areas for consideration are advanced care planning (ACP), advanced decisions to refuse treatment (ADRT) and do not actively resuscitate (DNAR). Advanced care planningAbout half a million people die each year in the UK [1] and two thirds of these deaths occur in an institutional setting [2]. Despite death being such a common occurrence, however, no one likes talking about death and dying and death can be seen as a failure of the treatment delivered [3]. There is still a lack of professional expertise and reluctance on the part of patients, relatives and professionals to discuss dying even if this could maximise patients' experience of life in the present-day. Advanced care planning enables this difficult subject to be openly discussed between all parties. Perrin and Kazanowski acknowledge that often there are barriers to commencing candid discussions [4]. These barriers might be a reluctance on the part of the patient or family to recognise the seriousness of the presenting condition but could also be due to a lack of knowledge, a surfeit of professionals or the use of incomprehensible medical jargon. These discussions can occur whilst the people involved are still able to effectively and coherently communicate their preferences for future care. There is also an opportunity for informed consent to be obtained and documented for refusal of specific treatments in the event of the patient is not competent to make such a decision in the future [5,6].Advanced care planning is an aspect of patient care with the potential to enhance quality of life and promote patient autonomy [7]. The treatment and care is often delivered by multidisciplinary teams who can work across local health, social care and voluntary sector services. Communication and sharing of information if therefore crucial to the whole process of establishing and implementing an ACP [7]. The main benefit of ACPs is that they promote timely access to the pr...

show abstract

“…Deep‐rooted cultural and religious beliefs can affect decision making on the use of AH at the end of life. Many believe withholding nutrition and AH equates to “starvation.” 3 Gent et al 30 suggested cultural norms significantly influenced attitudes toward AH at the end of life. Cultures in which AH has a “symbolic meaning” affected its use as AH represented “care, hope, and trust.”…”

Section: Provider Patient and Family Perspectives Of Ah At The End mentioning

confidence: 99%

Artificial Hydration at the End of Life

2017

View full text Add to dashboard Cite

Initiation or continuation of artificial hydration (AH) at the end of life requires unique considerations. A combination of ethical precedents and medical literature may provide clinical guidance on how to use AH at the end of life. The purpose of this review is to describe the ethical framework for and review current literature relating to the indications, benefits, and risks of AH at the end of life. Provider, patient, and family perspectives will also be discussed.

show abstract

What influences attitudes towards clinically assisted hydration in the care of dying patients? A review of the literature

Cited by 23 publications

References 30 publications

Availability and perceived usefulness of guidelines and protocols for subcutaneous hydration in palliative care settings

Availability and perceived usefulness of guidelines and protocols for subcutaneous hydration in palliative care settings

Advanced care planning in palliative care coordination: the NMC code and record keeping

Artificial Hydration at the End of Life

Contact Info

Product

Resources

About