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TERMINAL DEHYDRATION

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TERMINAL DEHYDRATION

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    1. TERMINAL DEHYDRATION Presented by Andrea J. Carpitcher, R.N. Northeastern State University EBP Symposium April 23, 2010 henson_andi@yahoo.com

    3. IDENTIFICATION OF PROBLEM TERMINAL DEHYDRATION vs. ARTIFICIAL HYDRATION In end of life care

    4. PICO Among terminally ill patients, does terminal dehydration, as compared to continuing or initiating artificial fluids, therapeutically benefit the patient and family and foster a more peaceful death?

    5. Maslow’s Hierarchy of Needs

    6. Lack of Communication Skills Doctors Medical Students (Mutto, et al., 2009) Dr.’s Personal Experience (Schmidlin, 2008)

    7. Lack of Communication Skills Nurses Need for EBP Foundation Teach unbiased research Convey compassion with confidence Time Management Enhance intimacy of Nurse-Patient Relationships

    8. End of Life Decisions Abandoned

    9. REVIEW OF LITERATURE Terminal Dehydration vs. Artificial Hydration

    10. Support of TERMINAL DEHYDRATION (Plonk & Arnold, 2007) Dry Mouth - with otherwise peaceful death

    11. Support of TERMINAL DEHYDRATION (Sutcliffe & Holmes. 1994) Cerebral Anoxia Extreme Electrolyte Imbalances Natural Analgesia High Quantity Release of Opioid Peptides Caloric Deprivation = Ketone Accumulation

    12. Support of TERMINAL DEHYDRATION (Morita & Satoshi, 2003) Inconclusive Data to Support cause of Terminal Delirium Concluded Artificial Hydration does not likely enhance quality of life in the terminally ill

    13. Nursing Considerations with Terminal Dehydration Decreased need for Catheters Decreased risk for IV infiltration Decreased risk for Skin Breakdown Increased need for Oral Care

    14. Support of Artificial Hydration (Lanuke, Fainsinger, & deMoissac, 2004) Is not life-prolonging = Standard of Care Without Artificial Hydration Renal Failure Opioid Metabolite Accumulation Confusion, Irritability, Agitation

    15. Support of Artificial Hydration (Blakely & Millward, 2007) Moral Dilemma

    16. Nursing Considerations with Artificial Hydration Increased Need for Catheters Increased Risk for IV infiltrations Possible Decrease of Dry Mouth Possible Decrease of Family Anguish associated with Moral Dilemma of hydration

    17. RECOMMENDED PROTOCOL

    18. STUDENT RECOMMENDATION Nurses need to be well educated on what the research is and their findings and seek to develop a relationship of trust with the patient and family. Then use the knowledge of the research findings to help guide decision making. Nurses must express intuitiveness in knowing patients and their caregivers as individuals

    19. Rationale (Mok & Chin, 2004) Fosters therapeutic Nurse-Patient Relationship TRUST RAPPORT Greater sense of Reward

    20. Strategic Approach Informative In-Service for Staff of GSH To gain sound knowledge of EB Reviews Inclusion of topic to Admission Process to GSH Graceful initiative to discuss patient and caregiver Informative Literature for patients and caregivers Pamphlets, Videos, Websites

    21. Methods of Evaluation QAPI System of Good Shepherd Hospice Data collection upon patient surveys Patient Interpretation of Nurse-Patient Relationship Was Artificial Hydration addressed at admission Nursing Self-Evaluation Tool Knowledge Competency Level of EB Research Assess depth of patient relationship

    22. SUGGESTIONS for FURTHER STUDY

    23. Further clinical research needed to conclude position Likely, topic will remain in controversy Research vs Patient Perception Cultural Sensitivity Illness before Disease

    24. NEW RESEARCH QUESTION Among terminally ill patients, do affects of terminal dehydration vary among different terminal diagnoses and foster a peaceful death for some and burdensome one for others?

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