Decision-making Support by Certified Dysphagia Nurses Regarding Gastrostomy of Elderly Patients and Their Families

Abstract

Objective: This study aimed to clarify the decision-making support by certified dysphagia nurses regarding gastrostomy of elderly patients with oral feeding difficulty and their families.

Methods: The participants were four certified dysphagia nurses with over 3 years of clinical experience who were involved in considering gastrostomy for elderly patients. Semi-structured interviews were conducted with the study participants and the results were analyzed using content analysis. The study period was between August and December 2017.

Results: The average years of experience as a nurse was 20.0, and that as a certified dysphagia nurse was 6.8. Analysis of the results led to the creation of 321 codes, 37 sub-categories, and 11 categories. In addition, analysis of the results led to the creation of three core categories: “Support that considered the feelings of elderly patients and their families which wavered after making a decision,” “Professional support with a focus on life after discharge around the possibility of oral feeding and gastrostomy,” and “belief in guiding the best choice for elderly patients.”

Discussion: It is important for families and medical professionals to discuss what they would like to do now, taking into account the past wishes of the elderly patient. It is also necessary to provide support considering the burden on the family in the future.

Conclusion: The results of this study suggest that certified dysphagia nurses valued the wishes of elderly patients who wanted to eat, while struggling to determine the best choice for them. It was found that certified dysphagia nurses are providing decision support using their expertise and practical wisdom.