2018 Volume 32 Article ID: 32_watanabe_20180320
Abstract
The aim of the current study was to ascertain the process by which nurses build a consensus to reduce or cease fluids for patients with terminal cancer. Semi-structured interviews were conducted with 10 nurses with at least 5 years of experience in oncology nursing who were identified by snowball sampling. Interview data were analyzed using a modified grounded theory approach. Because of their daily interaction with patients, nurses sensed patient distress related to receiving fluids and they received information on patient QOL. Based on this input, nurses “pondered the point of fluids” and they sought to “consider reducing or ceasing fluids with other medical professionals”. When nurses suggested reducing or ceasing fluids to patients and their families, they sought to build a consensus by fostering “a paradigm shift regarding attitudes towards providing fluids”based on ‘an explanation of the difference between starvation and cachexia’ and by thoroughly “addressing wavering opinions”. While “empathizing with families who were reluctant to reduce or cease fluid and reducing treatment”, nurses “assured families that they were not being forsaken”, i.e. nurses ‘addressed family concerns about being cast aside’. In addition, “nurses provided information on changes in the final stages of life” and they “promoted oral intake to the extent possible”；these actions were factors that promoted the reaching of a consensus regarding reducing or ceasing fluids. Nurses must not blindly consider reducing or ceasing fluids for terminal patients simply because they are in the final stages of disease. Instead, they must reach a decision based on the relationship between providing fluids and various forms of distress and a diminished QOL. Moreover, nurses must inform family members of results and changes that will occur once fluids are reduced or ceased and determine how family members will perceive those results and changes.
