Nutritional care

摘要

A nurse's role in nutrition is deeply linked to the caring, compassion, nurture and commitment of nursing through feeding and providing fluids (Schmidlin, 2008). However, patients often experience nutritional problems and may become unable to make decisions and not have completed an advance directive. Thus, the decision to start or cease artificial nutrition and hydration (ANH) may arise for the healthcare professional involved in their care. It is important to ask whether we have encouraged a multidisciplinary discussion on ethical decision-making processes in the field of palliative care. Enhancing the role of palliative care nurses in the decision-making process is crucial to deal with the uncertainty surrounding ANH. In addition to formulating their own clinical judgement, nurses should take steps to resolve conflicts between the opinions of professionals, the patient and the family. Although the contribution of palliative care nurses in decision-making about ANH is still unclear, it is important that we stand together with other professionals. By doing that, we can play the role of privileged patient advocate in the defence of the ethical principles of decision-making (Afonso et al, 2019). On the one hand, evidence supporting the use and non-use of ANH is weak, with some studies indicating that resorting to ANH does not necessarily lead to improvements in comfort, survival or wound healing (De and Thomas, 2019). On the other hand, forgoing ANH, especially withdrawing ANH, is emotionally and ethically taxing (Somers et al, 2016), and might sound like causing death by 'starvation and dehydration' (Kitzinger and Kitzinger, 2018).