Ethics of feeding tube

DelightRN · Feb 16, 2005

I would say no. What you are proposing is that this person have an invasive procedure done, and an alternative way of nourishment for the convenience of the staff. Just because the person eats slowly? No. Maybe they should have smaller, more frequent meals that wouldn't take as long, or maybe this person's family would be available to come feed every now and again, to take the pressure off the staff.

sarahmarion123 · Feb 16, 2005

I don't know about the ethical implications, however, when we did our rotation in long-term care and I think it would be so sad for a patient to be deprived of eating his/her meal. Enjoying food is one of the things the patients looked forward to, in my experience. I hope your management will rethink placeing the g-tube just for convience.

-sarah

misti_z · Feb 16, 2005

I can't imagine that actually being considered by the doctors as an option.

If the pt is receiving their daily nutritional requirements per PO intake I don't think insurance would even approve payment for such a procedure.

I could, however, hear that being mentioned on a lunch break between the nurses/techs as a way of expressing our often sick sence of humor or venting frustrations.

Smaller more frequent meals and family involvement sounds like the key.

Purple Princess · Feb 16, 2005

this is a skilled nursing unit and most times we have just two aides for 34 residents and occasionally one aide. Anyway; during meal time dinner gets there at 5 and we have until 6:15 to get everyone fed. It wouldn't be so bad but on d hall half of the residents need fed. so really we can only spend 5-10 minutes trying on each one. sometimes less than that. And at our facility we also are answering call lights, changing diapers and either giving the bed pan or taking someone to the toilet! We get in trouble if we tell them to wait 10 minutes until the trays are collected, it's aweful! I tried to tell the nurses it wasn't sanitary and no wonder all the residents are sick half the time. They told me to do it and it was neglect if I didn't. I was actually in the middle of feeding someone and was told that I needed to jump up and clean someone that just messed themselves and then take another resident to the toilet. I could see getting yelled at for ignoring a residents needs for over an hour and they mess themselves but 10 minutes is reasonable i think. not that i'm in favor of feeding tubes but half the residents eat poorly even when we've spent 30 minutes and doing all the tricks like making " shakes" to fruit smoothies. one woman won't drink her milk straight so i mix milk, juice, and pureed fruit. She likes it!

germain · Feb 16, 2005

Don't new regulations allow LTC institutions use cleaning/ other staff to help feed? At first I thought this was awful, but with training there is no reason others couldn't pitch in. Also, as a home care aide I once had a job coming in for 2 hours to help feed/ toilet/ help out a very slow fellow with CP, so maybe that is an option the family would consider. Okay, your laughing because you know there is NO WAY there is a money tree available for this person, which is just SAD.

Stories about people being rushed in nursing homes and getting S!&*^tty care because management is so stingy make me SICK and VERY SAD. :angryfire We should be much kinder to our old folks. There but for the grace of God...

knockandhello · Feb 16, 2005

Just wondering what the residents dental health is like?Do they have healthy teeth and gums?Had a similar situation where one guy had such awful caries that it was no wonder he screamed and took so long to eat a meal.Also if the resident has dentures are they ill fitting as this can also impact upon their ability to eat.I know you said that this person had no physical problems but sometimes dental health is overlooked.

sharann, BSN, RN · Feb 16, 2005

This is an ethical dilemma I was presented as part of a course dealing with bioethical situations, death and dying strategies for nurses. I have been pondering this for a while and I personally don;t see justification for a feeding (G-tube) to be placed. I think that a volunteer from the community or the family could be arranged. I understand that time constraints are a reality but this "patient" is able to eat and is not terminally ill.

Your responses were all wonderful. I'm glad that you are all caring for these special patients so well and thinking about THEIR welfare.

**canoehead, BSN, RN** · Feb 16, 2005

The other side of that coin is, as the resident, would you want to spend 6 hours a day trying to eat? Or having people come by and "encourage" you all day? That would get old fast. He/she is missing out on other activities. I agree that frequent snacks would be great, but if someone is just not into eating and other health issues have been ruled out....

If this is a dementia patient I have heard some docs say that slowing down or stopping eating is part of the process of deterioration. They present it to the family as a natural death vrs prolonging life for another year with tubes.

In any case you could feed them what they want during the day and supplement with a G tube at night.

donmomofnine · Feb 16, 2005

I sure wouldn't be in favor of it.

Long Term Care Columnist / Guide · Feb 16, 2005

No, no, NO!!! There is no way on earth I would ever support putting in a feeding tube for someone who is capable of eating. So it takes them 2 hours to finish a meal---food is the only pleasure some of these dear old folks have left!!

I've worked in LTC, and I've seen how residents are rushed through meals by staff who are task-oriented and thus do everything by the clock. It's not the aides' fault; it's the fault of tightwad administrators and CEOs who don't staff their facilities adequately at mealtimes (and other times as well) because their priority is making a profit. :angryfire

Don't even get me started on that.........it absolutely infuriates me that so many frail elderly---who paid into the 'system' their entire working lives---cannot be afforded even the simple dignities of being allowed to eat their meals in peace and to be clean and dry and comfortable at all times, just because they have the misfortune to live in an institution owned by some big corporation (or a stingy businessman). I'm sure there are good facilities somewhere; but I've worked in both bad ones and OK ones, and let me tell you, if I ever get to the point where I can't take care of myself anymore, I'll just gulp a handful of pills and hope God understands why. :stone

CoffeeRTC, BSN, RN · Feb 16, 2005

Heck no!!! Who is this for..the staff or the resident? I can see both sides to the argument, but what else is being done? Changing meal texture, offer small high calorie meals more often, give supplements (milkshakes, puddings) enlist the family, ID team to help feed....I'm sure there are other options...

Ethically no...sounds like a convience or time saver to staff. Feeding tubes are invasive and take time and money...(supplies, feeding,dressing and tube chages etc)

Meal time, eating and snacks are the few things older residents actually look forward to each day...taking this away from someone...not good!