Nursing Rounds at University of Pennsylvania: Kitty's Dilemma

Scarpinato, Nina; Schell, Ellen; Kagan, Sarah H.

doi:10.2307/3522065

Cited by 1 publication

(2 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Across all decisions, assessments of mental capacity and swallowing were important. This included considering other causes such as depression [ 45 , 48 , 68 ] and clarification of the goals of care for the patients, which usually aimed to promote comfort [ 27 , 44 , 48 , 49 , 67 ] . Initiator of the shared decision-making process …”

Section: Resultsmentioning

confidence: 99%

“…If previous stated directives were absent or unreliable, family caregivers and practitioners mostly relied on the person’s presumed wishes [ 32 , 35 , 45 , 47 ] and interpretations of their current behaviors to maintain their autonomy [ 25 , 40 , 43 , 48 , 49 ]. Interpretation of the persons’ behaviors such as facial expressions and appearing to ‘decline’ food, varied among family caregivers and practitioners, and was challenging to understand [ 25 , 46 , 57 , 68 ]. When the person’s preferences were unclear, the values of family caregivers and social norms would override the decisions [ 39 , 43 , 47 , 50 , 53 ].…”

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Mapping and understanding the decision-making process for providing nutrition and hydration to people living with dementia: a systematic review

et al. 2020

View full text Add to dashboard Cite

Background This systematic review aimed to explore the process of decision-making for nutrition and hydration for people living with dementia from the perspectives and experiences of all involved. Methods We searched CINAHL, the Cochrane Library, EMBASE, MEDLINE and PsycINFO databases. Search terms were related to dementia, decision-making, nutrition and hydration. Qualitative, quantitative and case studies that focused on decision-making about nutrition and hydration for people living with dementia were included. The CASP and Murad tools were used to appraise the quality of included studies. Data extraction was guided by the Interprofessional Shared Decision Making (IP-SDM) model. We conducted a narrative synthesis using thematic analysis. PROSPERO registration number CRD42019131497. Results Forty-five studies were included (20 qualitative, 15 quantitative and 10 case studies), comprising data from 17 countries and 6020 patients, family caregivers and practitioners. The studies covered a range of decisions from managing oral feeding to the use of tube feeding. We found that decisions about nutrition and hydration for people living with dementia were generally too complex to be mapped onto the precise linear steps of the existing decision-making model. Decision-making processes around feeding for people living with dementia were largely influenced by medical evidence, personal values, cultures and organizational routine. Although the process involved multiple people, family caregivers and non-physician practitioners were often excluded in making a final decision. Upon disagreement, nutrition interventions were sometimes delivered with conflicting feelings concealed by family caregivers or practitioners. Most conflicts and negative feelings were resolved by good relationship, honest communication, multidisciplinary team meetings and renegotiation. Conclusions The decision-making process regarding nutrition and hydration for people living with dementia does not follow a linear process. It needs an informed, value-sensitive, and collaborative process. However, it often characterized by unclear procedures and with a lack of support. Decisional support is needed and should be approached in a shared and stepwise manner.

show abstract