During basic nursing education, few nurses have classes
or clinical experience in caring for the dying patient and her or his
family. Yet, hardly a week goes by where you don't deal with issues related
to death and dying on some level. Most nurses learned these skills from
other nurses and from clinical experience itself. Unfortunately, nurses
may feel powerless to help people who are at the end of their life.
Historically, malnutrition and dehydration typically accompanied deaths
from prolonged illness because sick and dying people could not consume
adequate amounts of food or fluid. In the past, little could be done to
prevent these conditions until the development of IV fluids, tube feedings,
and total parenteral nutrition (TPN). Now, malnutrition and dehydration
can be corrected in nearly every patient who would otherwise have died
from the effects of these conditions. Nutritional support improves survival
after acute renal failure, improves post-operative outcomes, protects
from cancer therapy toxicity, and improves survival of cancer patients.
There is no proof of benefit to the terminally ill patient.
When it comes to the use of food and fluids at the end of life, multiple
perspectives exist. In Mealtime Difficulties for Older Persons: Assessment
and Management, one of the National Guidelines Clearinghouse's guidelines
(2003) that provide clinicians with "best practice" recommendations,
the point is made that it is critical that nurses refer back to a patient's
advance directive regarding the administration of or the withdrawal of
food and fuids, and the goals of treatment.
© 2004 NYSNA, all rights reserved.
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