ANH in dying patients

[samhlh]

I am working on a paper examining nursing issues. From my research (and my own practice) I have found that ANH for dying persons is not appropriate in most cases. How do you deal with clients, family, and other HCP's who want or insist on IV for hydration or feeding tubes, etc. when you know that they may prolong death and increase suffering? I know this isn't always the case, but I'm looking for strategies to handle this when it is.

Thanks.

[doodlemom]

When I explain that it will make the patient more uncomfortable and that their lungs will fill up with fluid, therefore "drowning", families always foregoe the idea of IV hydration. What is ANH?

[samhlh]

When I explain that it will make the patient more uncomfortable and that their lungs will fill up with fluid, therefore "drowning", families always foregoe the idea of IV hydration. What is ANH?

ie. IV's, SQ, G-tube, NG, J-tube, etc.

[katwoman7755]

I am working on a paper examining nursing issues. From my research (and my own practice) I have found that ANH for dying persons is not appropriate in most cases. How do you deal with clients, family, and other HCP's who want or insist on IV for hydration or feeding tubes, etc. when you know that they may prolong death and increase suffering? I know this isn't always the case, but I'm looking for strategies to handle this when it is.

Thanks.

I believe you have to take each case totally individually. Some families are more receptive to education than others. For some families, the thought of not feeding/hydrating their loved one is more than they can handle. This really hit home with me once when my dtr was sick...it seemed like for days she would barely eat...and I was really having to enc fluids...I remember how distressed I was that she wasn't eating...and it was then that it occurred to me how the families must feel, given that my example was just a fraction of what they were dealing with. I have had some families that never wanted to nutrition or hydration turned off...the best we could do sometimes was get them agree to turn it down...as usually they could see some of the negative effects it was having, but couldn't bring themselves to stop it all together. I usually tried to remind families that as long as a patient could tolerate nutrition or hydration and they wanted it, it was fine. I would then educate them of some of the signs of the patient not tolerating it....sometimes as they were occurring. This usually led to them agreeing to turn it down, as most people do view comfort as more important in regards to their love on than hydrating. I think the most important issue to be there with the family as they are experiencing this....be there for support and be there to gently educate....there are some moments were they are "hearing" you better than others. Ultimately, let them know you respect their wishes and want to help any way possible to keep their loved one comfortable. When the time is right, they will decide. Until then, continue to support the family and gently advocate for the patient.

Kathryn RN CHPN

[leslie :-D]

i have to agree w/you kathyrn....for most families, seeing is believing. you can tell them what the pt will likely experience, should they be hydrated, fed through a g/j tube but they just can't believe it until they start seeing signs of distress. that's when education is key and the presence of a sensitive hospice nurse's experience is invaluable. then you still continue to witness the anguish as they agree to decrease or stop the fdgs/iv's as they feel responsible for their loved one's death. but being present while the pt's lungs are filling up or seeing the distended abd w/decreased bowel sounds and educating, educating and education are the only ways the family is going to correlate your input with what they witness.

leslie