Katja Kuehlmeyer1, Anna F Schuler1, Christian Kolb2, Gian Domenico Borasio3, Ralf J Jox1. 1. Institute for Ethics, History and Theory of Medicine, Ludwig-Maximilians Universität München, Munich, Germany. 2. Institute of Psychogerontology, Friedrich Alexander Universität, Erlangen-Nuremberg, Germany. 3. Chair in Palliative Medicine, Centre Hospitalier Universitaire Vaudois, Université de Lausanne, Lausanne, Switzerland.
Abstract
OBJECTIVES: To determine how nursing staff evaluate nonverbal behavior related to hand and tube feeding of residents with dementia. DESIGN: Cross-sectional survey. SETTING: A stratified sample of nurses and nursing assistants in residential nursing homes in a major German city. PARTICIPANTS: Nursing staff members (N = 131) in 12 nursing homes. MEASUREMENTS: Nursing staff perception of nonverbal behavior of residents with dementia in response to hand and tube feeding. RESULTS: Ninety-three percent of survey participants considered the nonverbal behavior of residents with advanced dementia crucial for decisions about artificial nutrition and hydration (ANH). The same percentage had at some point encountered residents who did not open their mouths when feeding was attempted. Fifty-three percent of the participants interpreted residents' expressions of pleasure while eating as a will to live. The most frequent interpretation of residents' aversive behavior was discomfort. When residents did not open their mouth during nurse's hand feeding, 41% of the participants inferred a will to die. CONCLUSION: Most nurses and nursing assistants consider residents' behavior during hand or tube feeding to be important, but their interpretations are heterogeneous. Various professional caregivers assume a will to live or die. Further reflection is necessary to determine how behavioral expressions should be factored into treatment decisions.
OBJECTIVES: To determine how nursing staff evaluate nonverbal behavior related to hand and tube feeding of residents with dementia. DESIGN: Cross-sectional survey. SETTING: A stratified sample of nurses and nursing assistants in residential nursing homes in a major German city. PARTICIPANTS: Nursing staff members (N = 131) in 12 nursing homes. MEASUREMENTS: Nursing staff perception of nonverbal behavior of residents with dementia in response to hand and tube feeding. RESULTS: Ninety-three percent of survey participants considered the nonverbal behavior of residents with advanced dementia crucial for decisions about artificial nutrition and hydration (ANH). The same percentage had at some point encountered residents who did not open their mouths when feeding was attempted. Fifty-three percent of the participants interpreted residents' expressions of pleasure while eating as a will to live. The most frequent interpretation of residents' aversive behavior was discomfort. When residents did not open their mouth during nurse's hand feeding, 41% of the participants inferred a will to die. CONCLUSION: Most nurses and nursing assistants consider residents' behavior during hand or tube feeding to be important, but their interpretations are heterogeneous. Various professional caregivers assume a will to live or die. Further reflection is necessary to determine how behavioral expressions should be factored into treatment decisions.
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