"Force Feed"

  1. 72 yo patient, 12 days post hemicolectomy, ileus 5 days post-op. Finally up and around, but p.o. intake poor. Patient weights 125#, so no reserve there. Also PSA 500+, so he definately has other issues!
    Surgeon writes: Force Feed.
    This patient is alert and oriented x 3, very able and competent to make decisions and understand his options. Just how are we to "force feed" this man? Does he really expect a nurse to sit at the bedside and nag until his plate is clean, or to force a syringe between clenched teeth to do the deed?
    Even a feeding tube requires the patient's consent!
    What do you think about force feeding?
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  2. 21 Comments

  3. by   ktwlpn
    Originally posted by ceecel.dee
    72 yo patient, 12 days post hemicolectomy, ileus 5 days post-op. Finally up and around, but p.o. intake poor. Patient weights 125#, so no reserve there. Also PSA 500+, so he definately has other issues!
    Surgeon writes: Force Feed.
    This patient is alert and oriented x 3, very able and competent to make decisions and understand his options. Just how are we to "force feed" this man? Does he really expect a nurse to sit at the bedside and nag until his plate is clean, or to force a syringe between clenched teeth to do the deed?
    Even a feeding tube requires the patient's consent!
    What do you think about force feeding?
    well-I think the surgeon is an AZZ....."force feeding" this fella would be assault and battery,wouldn't it? I am sure that you are doing all that you can with supplements and goodies and maybe an appetite stimulant if not contra-indicated...Docs just hate to not be in control....I remeber well the days of "syringe feeding" in ltc-until the dept of health decided it is force feeding and against the rights of the residents.....And there was no dignity there-when the day comes that I can not sit up,chew and swallow then that's IT for me....
  4. by   susanmary
    To start, your patient needs a nutrition consult. He may also have some depression (small wonder -- doesn't mean he's got major psych issues -- but depression might be caused by his surgery, and prostate cancer. He needs support -- not ultimatums.

    I would refer this case to your manager, and the ethics committee. Encourage a patient to eat, wonderful. Assist a patient with meals & snacks, wonderful. Force feed a patient -- never. Unethical, humiliating. Does he have any family? I would also start documenting verbatim when the patient states he is not hungry, etc, & his refusal to be "force fed."

    Our patients deserve to be treated with respect and dignity. This kind of case makes me very sad -- but I would follow up the chain of command if he were my patient. Good luck. He's lucky to have such a caring, compassionate patient advocate for a nurse!!!!
    Sue
  5. by   renerian
    God awful..............how about hyperal/MVI?

    renerian
  6. by   Flynurse
    I thought the term force feed had become extinct. Literally.
    Not since I very first became an aide in 1998 have I actually seen that written on a piece of paper.
    Last edit by Flynurse on Apr 29, '03
  7. by   gwenith
    Force feeding is assualt and battery and you have a right to refuse to carry out a medical order that contravenes your personal beliefs and or the law of the land. I would tell the doctor this, invite him to take the issue up with management but you yourself are not going to be part of it.

    Legally you have this right of refusal. No-one can force you to perofrm a task that is contrary to the interests of the patient or runs counter to your beliefs. (i.e. A Catholic nurse cannot be forced to assist in an abortion even if it is legal to do so in that state). Unless it is clearly illegal (I.e Doctor is about to murder the patient) we cannot stop a doctor from carrying out an action.

    We often "forget" or a pressured into forgetting this basic right. But be careful and cover your butt. Speak to management before you speak to the doctor. Tell management that you cannot in all consience carry out this order and state that you are worried about legal ramifications. DO NOT tell them that you "just don't want to do it." Then speak to the doctor.

    I would bet a small pile of Mars Bars that this Doctor will back down and in a hurry. He will bluster and he may threaten but whatever he does STAY COOL.

    LOTS AND LOTS OF LUCK TO YOU!!!!
  8. by   Nursie30
    OMG............
    The one thing that they are in control of........dying.........and they can't even do it with respect and dignity.......I thought force feeding or syringe feeding was long gone too, but we had one of our residents that was refusing to eat, and we had an order to syringe feed, I did refuse, and suffered no repercussion from it.......I then got Hospice in there and she passed away a week later........You could tell she was wanting to go, she was in there somewhere, making a decision to stop her suffering and get some rest, God help me if I ever get to that point.......God help us ALL!!!!!
  9. by   Desert Rat
    We have a surgeon who yells at the nurses if the patients don't eat as much as he thinks they should. One day he decided to show us how to feed a patient. After the patient told him several times he didn't want any more. he spit it in the doc's face. Really hard to keep from laughing. :roll:roll:roll Other times he caused the patient to aspirate, then blamed the nurses.
  10. by   Chiaramonte
    Back in the 70's when I was an aide, we "forced" our elderly patients to eat. I remember mixing pureed meat, potatoes and pureed veggies altogether with milk and butter. We would draw this concoction up into a bulb syringe and squirt it into their mouths. Thought it was barbaric then and certainly think it would be barbaric now. Absolutely hated the indignity of it all...besides I would wind up wearing half of it on my clothes and face as the patients gave me the razzberry.
    Glad to see patients' rights have changed all this and this should be respected at all costs.
  11. by   Care Assistant
    Force feeding isn't allowed in England. At work there are some Elderly people that need help with feeding, There is one lady that hardley eats anything and sometimes I am put on feeding. I just sit with her and encourage her to eat even if it ONLY A FEW MOUTHFULLS it is better then nothing.

    At work we have feeding and Fluid charts do other work places use these. Just to mark down what and how much fluid and food the person eats. This is done on a daily basis even if it only a cup of tea and a biscuit.
  12. by   silvermoon
    I've only seen one case where a doctor told a nurse to feed a patient against their wishes and the ward nurses refused so the doctor opted to feed her himself.
    After one attempt and a fair covering of mash potato he decided it was her right to decide not to eat!!
  13. by   Nurse Ratched
    I think the doc may want to reconsider his choice of words:

    "Encourage po intake."

    I, too, remember doing the syringe thing with pureed foods "back in the day", nightmoon. If I had to do it over again, I wouldn't.
  14. by   Flynurse
    Originally posted by Desert Rat
    One day he decided to show us how to feed a patient. After the patient told him several times he didn't want any more. he spit it in the doc's face. Really hard to keep from laughing. :roll Other times he caused the patient to aspirate, then blamed the nurses.
    I used to work at a private facility (retirment community with one floor dedicated to sub-acute and LTC) in which we branched into many areas. From Rehab to Hospice. Anyhow, a patient came to us who had surgery and just went down hill one day. It was obvious to us she could not eat or drink. Her living will simply stated no heroic measures to try and save her life. So with her wishes and her families "blessing" we didn't feed her. We didn't put in a tube, etc.

    One day her primary MD came to the facility and started ranting and raving that we were starving her to death. He started feeding her and of course she aspirated. Needless to say the police were called and arrived shortly after she had aspirated to escort the MD out of the building. All the while he was yelling, "You are trying to kill her!"

    Well, wouldn't you know it for the next week or two the woman had gone down hill even further and we were all sure she wasn't going to make it. But then one day she started talking again. She was asking for food and water. Her swallowing reflexes had returned!

    The following week I was working on Sunday during the day shift as a favor for someone. The nurse who was taking care of this woman and I were sitting at the station reading the Sunday paper (relaxed atmosphere ) when she nearly fell over in her chair. She shouted, "You guys, you'l never believe this!" Stunned we all wanted to know what and gathered near. "Remember the doctor who came and tried to feed Mrs. X and nearly killed her? He's dead! His obituary is in the paper."

    Wouldn't you know it. The man dropped dead before his patient had. We don't know what of, but we suspected he aspirated on something.

    Makes ya think.
    Last edit by Flynurse on Apr 29, '03

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