Documenting Patients?? End-of-Life Decisions

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

“…A consent form, signed by the patient or family member should always be obtained. To prevent decisions being made hastily and under pressure, pre-signed consent forms for tube feeding initiation or a "living will" requesting that tube feeding not be initiated, should be obtained (23,50). Fourth, initiation of nasogastric tube feeding did not necessitate patient or family consent.…”

“…It appears that current DNR practice does not include any discussion of other life support measures. Deciding to implement tube feeding is deciding to support life, a contrary direction from that of the DNR decision (23,32). Thus, it is reasonable to suggest that DNR decisions should be made at the time that tube feeding decisions are made.…”

“…The implications of this finding are enormous. Patients and families should be informed prior to tube feeding initiation, that tube feeding tends to be a permanent, longterm, therapy (23) and is difficult to stop. Failure to inform patients and families of this would mean that a fully informed decision and thus consent to tube feeding initiation could not be obtained.…”

“…Landmark U.S. court decisions have generally formed the basis of discussion (10,11,12,13,14,15,16,17,18,20). Research has sought perceptions of caregivers and the public about life support issues (21,22,23,24) and tube feeding (22,25,26,27). More research is required to assist with the resolution of issues and to support or improve current practices relative to LTTF.…”

The experience of long‐term gastrostomy tube feeding: a phenomenological case‐study

“…Concerns, however, are now being raised over the use of tube feeding when its only benefit appears to be the maintenance of life (Wilson, 1991). Subsequently, tube feeding has been criticized for prolonging the dying process (Slater, 1987;Johnston & Justin, 1988;Norberg et af, 1988;Davis & Slater, 1989;Beaton & Degner, 1990;Wilson, 1991). Previous research has found tube feeding capable of sustaining life (Flynn ct al., 1987;Brown ct al., 1989;Kirby et al, 1990;Wilson, 1991), while demonstrating that complications are common and life threatening (W alike et al, 1977;Cataldi-Betcher et al, 1983;Kelly et al, 1983;Prichard, 1988).…”