Hostname: page-component-7479d7b7d-qlrfm Total loading time: 0 Render date: 2024-07-11T11:05:33.615Z Has data issue: false hasContentIssue false
  • English
  • Français

Long-Term Tube Feeding Practices and Involvement of Nurses in Tube Feeding Decisions

Published online by Cambridge University Press:  29 November 2010

Donna Wilson
Donna Wilson
Affiliation:
University of Alberta
Get access Rights & Permissions [Opens in a new window]

Abstract

Tube feeding is a common, and frequently long-term, form of life support. Currently, no distinction is made between short-and long-term tube feeding; the latter being a replacement of the ability to eat on an ongoing, possibly permanent, basis. Little research has focussed on long-term feeding. Consequently, the implications and practices of long-term feeding remain undetermined. Hospital charts of ten accessible patients, who had long-term tube feeding were examined in order to answer pre-determined questions. Reporting includes: feeding solution types, tubes, and methods; medical diagnoses and functional reasons for tube feeding; changes in mental and physical conditions since initiation of tube feeding; involvement of nurses and others in tube feeding decisions, and decisions to continue tube feeding after initiation. Tube feeding was demonstrated to be capable of sustaining life over long periods of time. Despite improved nutrition, patients' overall levels of mental and physical capacity and self-care abilities were found unimproved. Maintenance of life may be the only goal of long-term tube feeding.

Résumé

Le gavage est fréquemment utilisé pour supporter la vie à long terme. Actuellement, aucune distinction est faite entre le gavage à court terme et celui à long terme, ce dernier étant un remplacement de l'habilité de manger sur une base continuelle et permanente. Très peu de recherches ont été faites sur le gavage à long terme. Conséquemment, les implications et pratiques du gavage à long terme demeurent indéterminées. Les dossiers hospitaliers de dix patients ayant été alimentés par gavage à long terme ont été examinés pour répondre à des questions prédéterminées. Le rapport de ce travail inclut plusieurs sujets: les types de solutions pour alimenter les patients, les types de tubes, les différentes méthodes utilisées, les diagnostics médicaux et les raisons qui justifient ce type d'alimentation, sans oublier l'implication des infirmières et des autres intervenants dans la décision d'initier et de continuer le gavage. On a pu démontrer que le gavage permettait la survie du patient à très long terme. Cependant, en dépit de l'amélioration de la nutrition, aucun progrès n'a pu être constaté ni sur le plan des capacités physiques et mentales des patients, ni sur le plan de leur prise en charge. Maintenir en vie semble être le seul but du gavage à long terme.

Keywords

Enteral FeedingTube FeedingLong-term Tube FeedingPractices Of Tube FeedingNurse InvolvementNurse Decision-makingNutrition entéralgavagegavage à long termepratiques de gavageimplication de l'infirmièreprise de décision par l'infirmière
Type
Articles
Information
Canadian Journal on Aging / La Revue canadienne du vieillissement , Volume 10 , Issue 4 , Winter/hiver 1991 , pp. 333 - 344
Copyright
Copyright © Canadian Association on Gerontology 1991

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Flynn, KT, Norton, LC, Fisher, RL. Enteral tube feeding: indications, practices and outcomes. IMAGE: Journal of Nursing Scholarship 1987; 19(1). 16–19.Google Scholar
2.Kirby, D, Turner, H, Barrett, J, Clitton, G, Ward, J. Early enteral feedings with PEG/J's in severe head injury. Supplement to Journal of Parenteral and Enteral Nutrition. 14 Clinical Congress. San Antonio, Texas 1990; 14(1): 18s.Google Scholar
3.Brown, RO, Vehe, KL, Kaufman, PA, Rogers, R, Kudsk, KA, Luther, RW. Long-term enteral nutrition support in pregnant patient following head injury. Nutrition in Clinical Practice 1989; 4(3): 101–3.CrossRefGoogle Scholar
4.Cataldi-Betcher, E, Seltzer, M, Slocum, B. Complications occurring during enteral nutrition support: A prospective study. Journal of Parenteral and Enteral Nutrition 1983; 14: 32–42.Google Scholar
5.Davenport, RR. Tube feeding for long-term patients. The American Journal of Nursing 1964; 64(1): 121–3.Google Scholar
6.Heitkemper, M, Hanson, R, Hanson, BC. Effects of rate and volume of tube feeding in normal human subjects. In: Batey, MV ed. Communicating nursing research: critical issues in access to data. Boulder, Colorado: Western Interstate Commission for Higher Education, 1975.Google Scholar
7.Kelly, TW, Patrick, MB, Hillman, KM. Study of diarrhea in critically ill patients. Critical Care Medicine 1983; ll(1): 7–9.CrossRefGoogle Scholar
8.Prichard, V. Tube feeding — related pneumonias. Journal of Gerontological Nursing 1988; 14(7): 32–6.CrossRefGoogle Scholar
9.Walike, BC, Padilla, G, Bergstrom, N, Hanson, RL, Kubo, W, Grant, M, Wong, HL. Patient problems related to tube feeding. In: Batey, MV ed. Communicating nursing research. Volume 10: optimizing environments for health: nursing's unique perspective. Boulder, Colorado: Western Interstate Commission for Higher Education, 1977.Google Scholar
10.Annas, GJ. Do feeding tubes have more rights than patients? Hastings Center Report 1986; 16(1): 26–32.Google ScholarPubMed
11.Bolton, MA. Who can let you die. Canadian Journal on Aging 1989; 8(3): 238–43.Google Scholar
12.Cohen, CB. ed. Casebook on the termination of life-sustaining treatment and the care of the dying. Bloomington: Indiana University Press, 1989.Google Scholar
13.Emanuel, EJ. A review of the ethical and legal aspects of terminating medical care. The American Journal of Medicine 1988; 84(2): 291–301.CrossRefGoogle ScholarPubMed
14.Green, W. Setting boundaries for artificial feeding. The Hastings Center Report 1984; 14(6): 8–13.Google Scholar
15.McCormick, RA. Caring or starving? The case of Claire Conroy. Americana 1985; April 6: 269–73.Google ScholarPubMed
16.Ruark, JE, Raffin, TA. In itiating and withdrawing life support. Principals and practices in adult medicine. The New England Journal of Medicine 1988; 318(1): 25–30.CrossRefGoogle Scholar
17.Skelton, E. Rights of patients strengthened with court ruling, experts say. Globe and Mail 1990; April 2: A4.Google Scholar
18.Steinbock, B. Recovery from persistent vegetative state?: The case of Carrie Coons. Hastings Center Report 1989; 19(4): 14–15.CrossRefGoogle ScholarPubMed
19.Steinbrook, R, Lo, B. Artificial feeding — solid ground, not a slippery slope. The New England Journal of Medicine 1988; 318(5): 286–90.Google Scholar
20. The Associated Press, Mount Vernon, MO. Woman in right-to-die battle dies after 12 days without food. The Edmonton Journal 1990; December 27: A11.Google Scholar
21.Beaton, JI, Degner, LF. Life & death decisions: the impact on nurses. The Canadian Nurse 1990; 86(3): 18–22.Google ScholarPubMed
22.Davis, AJ, Slater, PV. U.S. and Australian nurses' attitudes and beliefs about the good death. IMAGE: Journal of Nursing Scholarship 1989; 21(1): 34–9.Google ScholarPubMed
23.Johnson, RA, Justin, RG. Documenting patients' end-of-life decisions. Nurse Practitioner 1988; 13(6): 41: 46: 48–9: 52.CrossRefGoogle ScholarPubMed
24.Slater, P. The good death: registered nurses' concerns about ethical issues. The Australian Journal of Advanced Nursing 1987; 4(4): 16–28.Google ScholarPubMed
25.Mumma, CM. Withholding nutrition: a nursing perspective. Nursing Admin Quarterly 1986; 10(3): 31–8.Google Scholar
26.Norberg, A, Backstrom, A, Athlin, E, Norberg, B. Food refusal amongst nursing home patients as conceptualized by nurses aides and enrolled nurses: an interview study. Journal of Advanced Nursing 1988; 13(3): 478–83.Google Scholar
27.Norberg, A, Hirschfeld, M. Feeding of severely demented patients in institutions: interviews with care-givers in Israel. Journal of Advanced Nursing 1987; 9(5): 551–7.Google Scholar
28.Eisenburg, P. Enteral nutrition. In dications, formulas, and delivery techniques. Nursing Clinics of North America 1989; 24(2): 315–37.Google Scholar
29.Dormire, SL. Models for moral response in care of seriously ill children. IMAGE. Journal of Nursing Scholarship 1989; 21(2): 81–4.CrossRefGoogle ScholarPubMed
30.Alberta Association of Registered Nurses. Position statement on palliative care. Edmonton, Alberta: Author, 1984.Google Scholar
31.Battin, MP. The least worst death. Biotechnology and the right to die. National Forum. The Phi Kappa Phi Journal 1989; 69(4): 36–8.Google Scholar
32.Bedell, SE, Pelle, D, Maher, PL, Cleary, PD. Do-Not-Resuscitate orders for critically ill patients in the hospital. How are they used and what is their impact? JAMA 1986; 256(2): 233–7.Google Scholar
33.Brown, P, Chekryn, J. The dying patient and dehydration. The Canadian Nurse 1989; 85(5): 14–16.Google ScholarPubMed
34.Flood, DM. Handle with care. The Canadian Nurse 1989; 85(4): 24–6.Google Scholar
35.Fowler, MD. On killing patients. Heart & Lung 1988a; 17(3): 322–3.Google Scholar
36.Fowler, MD. Legislation to legalize active euthanasia, Heart & Lung 1988b; 17(4): 458–9.Google Scholar
37.Lamm, RD. High technology healthcare. National Forum. The Phi Kappa Phi Journal 1989; 68(4): 14–17.Google Scholar
38.O'Rourke, K. The A.M.A. statement on tube feeding: an ethical analysis. Americana 1986; November 22: 321–32.Google Scholar
39.Smith, DH, Veatch, RM. eds. Guidelines on the termination of life-sustaining treatment and the care of the dying. Bloomington: Indiana University Press, 1987.Google Scholar
40.Veatch, RM. Bioethics discovers the bill of rights. National Forum. The Phi Kappa Phi Journal 1989; 69(4): 11–13.Google Scholar
41.Starkey, JF, Jefferson, PA, Kirby, DF. Taking care of percutaneous endoscopic gastrostomy. American Journal of Nursing 1988; 88(1): 42–5.Google Scholar
42. Iverson-Carpenter, MS, Haskin, D, Maas, M, Hardy, M, Button, M. Fulfilling nutritional requirements. The critical role of nutrition for the well-being of older persons makes it imperative for the nurse to diagnose and intervene with nutritional problems. Journal of Gerontological Nursing 1988; 14(4): 16–23.Google Scholar
43.Michaelson, E, Norberg, A, Norberg, B. Feeding methods for demented patients in end stage of life. Geriatric Nursing 1987; 8(2): 69–73.CrossRefGoogle Scholar
44.Wade, DT, Skilbeck, CE, Hewer, RL. Predicting Barthel ADL score at 6 months after an acute episode. Archivals of Physical Medicine Rehabilitation 1983; 64(1): 24–8.Google Scholar
45.CNA Project Report. Development of a definition of nursing practice and standards for nursing practice. The Canadian Nurse 1980; 76(5): 11–15.Google Scholar
46.Alberta Association of Registered Nurses. Guidelines for registered nurses as clinical advocates. Edmonton, Alberta: Author, 1983.Google Scholar
47.Buckley, J. How doctors decide who shall live, who shall die. U.S. News and World Report 1990; January 22: 50–8.Google Scholar
48.Macklin, R. Ethical principals, individual rights and medical practices. National Forum. The Phi Kappa Phi Journal 1989; 69(4): 25–7.Google Scholar
49.Hofferber, BE. On discontinuing high-tech life supports: Who decides? Nursing Management, Critical Care Management Edition 1985; 16(1): 34L–34N.Google ScholarPubMed
50.Olsen, LL. Shades of code blue: an ethical framework. Nursing Management 1985; 16(1): 34D–34K.Google Scholar
51.Gibbs, N. Love and let die. Time 1990; March 19: 52–8.Google Scholar
52.Rozovsky, LE, Rozovsky, FA. No code orders and the law. Canadian Critical Care Nursing Journal 1985; 2(2): 16–18.Google Scholar
53.Jonsen, A. Benthan in a box. Technology assessment and health care allocation. National Forum. The Phi Kappa Phi Journal 1989; 64(4): 33–5.Google Scholar
54.Alberta Senior Citizens Secretariat. Older Albertans. Edmonton, Alberta: Author, 1989.Google Scholar
55.Government of Canada. Canada's seniors. A dynamic force. Canada: Minister of Supply and Services, 1988.Google Scholar
56.McDaniel, SA. Prospects for an aging Canada: Gloom or Hope? The Centre for Gerontology Newsletter, University of Alberta, Edmonton 1989; Fall: 1–3.Google Scholar
57.National Advisory Council on Aging. 1989 and beyond. Challenges of an aging Canadian society. Canada: Minister of Supply and Services, 1989; February.Google Scholar
58.Skelton, D. Grapes or raisins … A geriatician's reflections upon the future of health care for the elderly. Edmonton, Alberta: Alberta Hospital Association, 1987.Google Scholar
59.Molzahn, A. “Quality of life.” What is it? Can it be measured? The Bioethics Bulletin, a Publication of the Joint-Faculties Bioethics Project, Edmonton 1990; April: 1–2.Google Scholar