TRANSITIONS: Refusing artificial nutrition and hydration in advanced illness
Harleah G. Buck PhD, RN, CHPN

September 2012 
Volume 42  Number 9
Pages 12 - 13
  PDF Version Available!

IMAGINE FOR A MOMENT that you're caring for Mr. L, a patient whose advance directives state that he doesn't want any artificial nutrition or hydration if he's been diagnosed with an end-of-life condition. Now imagine that Mr. L has a very large and loving family who are having a hard time accepting this.Maybe you don't have to imagine this scenario. Maybe you've cared for such a patient in your clinical setting.Issues surrounding the initiation or withdrawal of artificial nutrition and hydration (ANH) near the end of life are some of the most difficult issues that nurses face in caring for patients in any setting, inpatient or outpatient. Food and eating have a strong symbolic meaning in many cultures. Withholding food can feel like neglect or worse for both formal and informal caregivers.However, many of us have faced the situation where a patient near the end of life can no longer safely ingest solid or liquid nutrition and the family turns to us for help in decision making. It's important for nurses to have evidence-based information to give these families. Basing our recommendations on outdated information or on our own experiences can mislead the very people that we're trying to help.One review of nurses' attitudes toward ANH found that nurses aren't sure whether to regard ANH as basic care that must be instituted, or as medical treatment that may be refused.1 The review also found that nurses perceive a lack of general consensus in the nursing profession regarding ANH, and that nurses have difficulty making recommendations to families because of this presumed lack of consensus.In a recent research study of nurses' experiences with ANH, nurses reported that when they're part of the decision-making process regarding ANH, they're as likely to experience guilt and sadness as family members. But the study also found that if nurses are practicing in a supportive environment that respects the dignity of the patient, they can experience satisfaction in their contribution

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