Assistant nurses' experiences of thirst and ethical dilemmas in dying patients in specialized palliative care-A qualitative study.
assistant nurses
ethical challenges
nursing
palliative care
thematic analysis
thirst
Journal
Journal of advanced nursing
ISSN: 1365-2648
Titre abrégé: J Adv Nurs
Pays: England
ID NLM: 7609811
Informations de publication
Date de publication:
Nov 2023
Nov 2023
Historique:
revised:
08
08
2023
received:
20
04
2023
accepted:
23
08
2023
pubmed:
11
9
2023
medline:
11
9
2023
entrez:
11
9
2023
Statut:
ppublish
Résumé
To describe assistant nurses' experiences of thirst and ethical challenges in relation to thirst in terminally ill patients in specialized palliative care (PC) units. A qualitative, reflexive thematic design with an inductive analysis was used. Data were collected during November 2021-January 2023. Twelve qualitative interviews with assistant nurses working in five different specialized PC units in different hospitals in Sweden were conducted. The interviews were transcribed verbatim and analysed with a reflexive thematic analysis. The study was guided by the Standards for Reporting Qualitative Research (SRQR). Two main themes were found in this study. (1) 'A world of practice for thirst relief' where assistant nurses present a task-oriented world where the knowledge of thirst is an experience-based unspoken knowledge where mainly routines rule. (2) Ethical challenges presents different ethical problems that they meet in their practice, such as when patients express thirst towards the end of their life but are too severely ill to drink or when they watch lack of knowledge in the area among other health professionals. Thirst in dying patients is a neglected area that assistant nurses work with, without communicating it. Their knowledge of thirst and thirst relief are not expressed, seldom discussed, there are no policy documents nor is thirst documented in the patient's record. There is a need for nurses to take the lead in changing nursing practice regarding thirst. No patient or public contribution. In palliative care, previous studies have shown that dying patients might be thirsty. Assistant nurses recognize thirst in dying patients, but thirst is not discussed in the team. Nurses must consider the patient's fundamental care needs and address thirst, for example in the nursing process to ensure patients quality of life in the last days of life. The study was guided by the SRQR. WHAT DOES THIS ARTICLE CONTRIBUTE TO THE WIDER GLOBAL CLINICAL COMMUNITY?: Thirst is a distressing symptom for all humans. However, when a patient is dying, he or she loses several functions and can no longer drink independently. The knowledge from this article contributes to our understanding of current practice and shows an area that requires immediate attention for the improvement of fundamental palliative care delivery.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
4292-4303Subventions
Organisme : Sjöbergstiftelsen
ID : 20210114:6
Informations de copyright
© 2023 The Authors. Journal of Advanced Nursing published by John Wiley & Sons Ltd.
Références
Adams, J. D., Myatich, A. I., & McCullough, A. S. (2020). Thirst as an ingestive behavior: A brief review on physiology and assessment. Nutrition and Health, 26(3), 271-274. https://doi.org/10.1177/0260106020916972
Åhsberg, E., & Carlsson, M. (2014). Practical care work and existential issues in palliative care: Experiences of nursing assistants. International Journal of Older People Nursing., 9(4), 298-305. https://doi.org/10.1111/opn.12035
Baillie, J., Anagnostou, D., Sivell, S., Van Godwin, J., Byrne, A., & Nelson, A. (2018). Symptom management, nutrition and hydration at end-of-life: A qualitative exploration of patients', carers' and health professionals' experiences and further research questions. BMC Palliative Care, 17(1), 60. https://doi.org/10.1186/s12904-018-0314-4
Beauchamp, T., & Childress, J. (2020). Principles of biomedical ethics (8th ed.). Oxford University Press.
Braun, V., & Clarke, V. (2019). Reflecting on reflexive thematic analysis. Qualitative Research in Sport, Exercise and Health, 11(4), 589-597. https://doi.org/10.1080/2159676X.2019.1628806
Braun, V., & Clarke, V. (2020). One size fits all? What counts as quality practice in (reflexive) thematic analysis? Qualitative Research in Psychology, 18, 328-352. https://doi.org/10.1080/14780887.2020.1769238
Burge, F. (1993). Dehydration symptoms of palliative care cancer patients. Journal of Pain and Symptom Management, 8(7), 54-64.
Carroll, H. (2020). Redefining thirst: A conceptual four-compartment model characterising types of thirst, and their underlying mechanisms and interactions. NutriXiv. https://doi.org/10.31232/osf.io/q7gvd
Chater, K., & Tsai, C. (2008). Palliative care in a multicultural society: A challenge for western ethics. Australian Journal of Advanced Nursing, 26(2), 95-100.
De Brasi, E. L., Giannetta, N., Ercolani, S., Gandini, E. L. M., Moranda, D., Villa, G., & Manara, D. F. (2021). Nurses' moral distress in end-of-life care: A qualitative study. Nursing Ethics, 28(5), 614-627. https://doi.org/10.1177/0969733020964859
Druml, C., Ballmer, P. E., Druml, W., Oehmichen, F., Shenkin, A., Singer, P., Soeters, P., Weimann, A., & Bischoff, S. C. (2016). ESPEN guideline on ethical aspects of artificial nutrition and hydration. Clinical Nutrition, 35(3), 545-556. https://doi.org/10.1016/j.clnu.2016.02.006
Ellershaw, J. E., Sutcliffe, J. M., & Saunders, C. M. (1995). Dehydration and the dying patient. Journal of Pain and Symptom Management, 10(3), 192-197.
Fee, A., Muldrew, D., Slater, P., Payne, S., McIlfatrick, S., McConnell, T., Finlay, D. A., & Hasson, F. (2020). The roles, responsibilities and practices of healthcare assistants in out-of-hours community palliative care: A systematic scoping review. Palliative Medicine, 34(8), 976-988. https://doi.org/10.1177/0269216320929559
Friedrichsen, M., Lythell, C., Jaarsma, T., Jaarsma, P., Ångström, H., Milovanovic, M., Karlsson, M., Milberg, A., Thulesius, H., Hedman, C., Waldréus, N., Anne Söderlund Schaller, C., & Schaller, A. S. (2023). Thirst or dry mouth in dying patients? A qualitative study of palliative care physicians' experiences. PLoS One, 18(8), e0290075. https://doi.org/10.1371/journal.pone.0290075
Hospice and Palliative Nurses Association. (2019). Value of the nursing assistant in palliative care. Journal of Hospice & Palliative Nursing, 21(3), E13-E14. https://doi.org/10.1097/NJH.0000000000000571
Kingdon, A., Spathis, A., Antunes, B., & Barclay, S. (2022). Medical communication and decision-making about assisted hydration in the last days of life: A qualitative study of doctors experienced with end of life care. Palliative Medicine, 36(7), 1080-1091. https://doi.org/10.1177/02692163221097309
Lokker, M. E., van der Heide, A., Oldenmenger, W. H., van der Rijt, C. C. D., & van Zuylen, L. (2021). Hydration and symptoms in the last days of life. BMJ Supportive & Palliative Care, 11(3), 335-343. https://doi.org/10.1136/bmjspcare-2018-001729
Maffoni, M., Argentero, P., Giorgi, I., Hynes, J., & Giardini, A. (2019). Healthcare professionals' moral distress in adult palliative care: A systematic review. BMJ Supportive & Palliative Care, 9(3), 245-254. https://doi.org/10.1136/bmjspcare-2018-001674
Mélin, M., Amieva, H., Frasca, M., Ouvrard, C., Berger, V., Hoarau, H., Roumiguière, C., Paternostre, B., Stadelmaier, N., Raoux, N., Bergua, V., & Burucoa, B. (2020). Support practices by an interdisciplinary team in a palliative-care unit for relatives of patients in agonal phase. BMC Palliative Care, 19, 173.
Moran, S., Bailey, M., & Doody, O. (2021). An integrative review to identify how nurses practicing in inpatient specialist palliative care units uphold the values of nursing. BMC Palliative Care, 20(1), 1-16. https://doi.org/10.1186/s12904-021-00810-6
Morberg Jämterud, S. (2022). Acknowledging vulnerability in ethics of palliative care - A feminist ethics approach. Nursing Ethics, 29(4), 952-961. https://doi.org/10.1177/09697330211072361
Morita, T., Tei, Y., Tsunoda, J., Inoue, S., & Chihara, S. (2001). Determinants of the sensation of thirst in terminally ill cancer patients. Supportive Care in Cancer, 9(3), 177-186.
NICE Guidelines. (2015). Care of dying adults in the last days of life. NICE.
O'Brien, B. C., Harris, I. B., Beckman, T. J., Reed, D. A., & Cook, D. A. (2014). Standards for reporting qualitative research: A synthesis of recommendations. Academic Medicine, 89(9), 1245-1251. https://doi.org/10.1097/ACM.0000000000000388
Oechsle, K., Wais, M. C., Vehling, S., Bokemeyer, C., & Mehnert, A. (2014). Relationship between symptom burden, distress, and sense of dignity in terminally ill cancer patients. Journal of Pain & Symptom Management, 48(3), 313-321.
Östergötland Region. (2019). Palliative care in the end of life in the west of region Östergötland. (Vårdprocessprogram-palliativ vård i livets slutskede västra Östergötland, in Swedish). Pages 1-28.
Regionala cancercentrum i samverkan. (2021a). Ethical platform (Etisk plattform in Swedish). Kunskapsbanken.
Regionala cancercentrum i samverkan. (2021b). Specialised palliative care (Specialiserad palliativ verksamhet in Swedish). Cancercentrum.
Royal College of Nursing. (2021). Mouth care matters in end-of-life care. Clinical Professional Resource. Royal College of Nursing.
Sandman, L., Molander, U., & Benkel, I. (2017). Developing organisational ethics in palliative care. Nursing Ethics, 24(2), 138-150. https://doi.org/10.1177/0969733015595542
Schofield, G., Brangan, E., Dittborn, M., Huxtable, R., & Selman, L. (2019). Real-world ethics in palliative care: Protocol for a systematic review of the ethical challenges reported by specialist palliative care practitioners in their clinical practice. BMJ Open, 9, e028480. https://doi.org/10.1136/bmjopen-2018-028480
Schofield, G., Dittborn, M., Huxtable, R., Brangan, E., & Selman, L. E. (2021). Real-world ethics in palliative care: A systematic review of the ethical challenges reported by specialist palliative care practitioners in their clinical practice. Palliative Medicine, 35(2), 315-334. https://doi.org/10.1177/0269216320974277
Scottish Palliative Care Guidelines. (2020). Care in the last days of life. Mouth care. 1-11.
Strömqvist, B.-M. (2021). The nursing assistant's central role in palliative care (Undersköterskans centrala roll i palliativ vård). Palliativ vård, 2, 23-24. (in Swedish).
Toto, K. H. (1994). Regulation of plasma osmolality: Thirst and vasopressin. Critical Care Nursing Clinics of North America, 6(4), 661-674.
Wallin, V., Mattsson, E., Omerov, P., & Klarare, A. (2022). Caring for patients with eating deficiencies in palliative care-Registered nurses' experiences: A qualitative study. Journal of Clinical Nursing, 31(21-22), 3165-3177. https://doi.org/10.1111/jocn.16149
World Health Organization. (2015). WHO definition of palliative care. http://www.who.int/cancer/palliative/definition/en/
Wright, D. K., Brajtman, S., & Macdonald, M. E. (2018). Relational ethics of delirium care: Findings from a hospice ethnography. Nursing Inquiry, 25(3), e12234. https://doi.org/10.1111/nin.12234