2020 Volume 2 Issue 5 Pages 307-315
Objective: Home care team discussions with elderly patients and their families are crucial in deciding whether to use artificial nutrition and hydration at the end of life. The purpose of this study was to clarify, from the perspective of shared decision making, the support needed from visiting nurses for consensus building in a home care team involved in nutrition therapy for elderly patients at the end of life.
Subjects and Methods: Semi-structured interviews of 11 visiting nurses were analyzed using a qualitative and descriptive method.
Results: Six major categories of consensus building activities by the visiting nurses were found in the interviews: (1) grasping the wishes of patients and their families in relation to eating; (2) sharing patients’ and their families’ wishes about nutrition therapy with healthcare professionals in preparation for discussions; (3) adjusting the direction of nutrition therapy among patients, their families, and the home care team; (4) supporting patients and their families in their wish for nutrition therapy during the team discussion; (5) supporting the decision to stop eating and stop IV fluids for hydration so that patients can have a peaceful end of life; and(6) evaluating the nutrition therapy taking into consideration the thoughts of patients, their families, and the home care team members.
Conclusions: Visiting nurses grasped changes in patients’ eating, used that information to bring the wishes of the families and healthcare and long-term care professionals close to the wishes of the patients, and continued communicating to build team consensus. Such support appears to reflect Japanese culture, where the relationships of patients with their families and others around them is as well respected as the patients’ wishes.
