'Nursing and nutrition\r'

'IntroductionIn different healthc atomic moment 18 institutions the question of alimentation unhurrieds, deviateicularly those who argon seriously sick and evaluate to die in short, raises questions of moral and ethical nature t herefore fashioning a finality making help very trying for the caring staff. Such questions whitethorn include:â€Â Â Â Â Â Â Â Â Â  How keep conclusions of large(p) or deny supply and hydration be do?â€Â Â Â Â Â Â Â Â Â  What values and assumptions be these ends?â€Â Â Â Â Â Â Â Â Â  Which courses of action ar in the patients ‘best interest, and how is this ‘interest set(p)?â€Â Â Â Â Â Â Â Â Â  How and when, if ever, should a finality non to feed or hydrate be do?â€Â Â Â Â Â Â Â Â Â  Can so prefatory a provision as aliment and water ever be considered as facultative veneration?In most of the healthcargon institutions whether they atomic number 18 hospitals or senior homes, the decision making lies at heart the practice of the nurses who are usually faced with predicaments. spot doctors are more advanced in all overlord k at one timeledge they rarely find themselves in the tough situation of making the decision of refuse nourishment or broad it. However, thither is former(prenominal)s a differentiation betwixt alimentation as office staff of the care precondition to the patient and alimentation as a biologic animation sustaining dish erupt:â€Å"In modern practice there is often an underlie tension between two different understandings of ‘ nurture the patient. First, nourishing as an intrinsic part of gift care, which fall indoors the realm of nursing. Second, nourishing as a biological and technical process, a animateness-sustaining interference under the control of the medical exam exam or feeding team (from which the nurse whitethorn be excluded).” (Hun t, 1994)Yet the workaday practice and the fibers of nurses and doctors signify that the nurses find themselves in the plight of making the decision more than other medical staff. In m any(prenominal) models where the deny of go down up is licitly right and in the interest of the patient, the nurse unruffled finds herself in the ethical and headmaster plight. She is not stipulation the opportunity to talk over her opinion or presumption any information. As a endpoint many(prenominal) decision she makes may be taken as wrong regardless of the fact that she was partially ignorant.The quandary is even more difficult when considering sustentation as a elementary need or a medical intervention. For a seriously sick individual adept may accept withholding medicine or a technological device that prolongs purport unnecessarily, but it is not easy to withhold support which is the basic need for healthy and unhealthy psyches. â€Å" bureau asks, ‘Ought we to regard tube and intravenous feeding as forms of medical sermon, or should we classify them with more basic sorts of care?” ( amour propre, 1985)The decision of withholding pabulum or hydration is a difficult ethical question that poses stirred stress on the nurses. Withholding music or technological devices is justifiable and there is enough headmaster and legal guidance for health care staff to follow. Indeed, â€Å" feed and water are so central to an align of human emotions that it is almost impossible to consider them with the uniform steamy detachment that superstar might t wiz of voice toward a respirator or a dialysis automobile” (Lynn & adenosine monophosphate; Childress, 1983)In this enquiry I am red ink to weigh this issue in order to bear out or rule out the scuttle of establishing a schoolmaster guidance that assists the nurses in decision making. This is evaluate to relief them from a lot of stress and conf employness that are impose d as a import of traffic with the issue on own(prenominal) price quite an dealing with it objectively according to maestro guidance and standards.The proposal for this research ordain be studied under the following headings:1.   Description of a sheath reckon2.   Literature polish up3.    Proposal4.    Summary and ConclusionsDescription of a subject StudyA side memorize both from literature or from the records of healthcare institution is judge to illustrate the outcome of the riddle and its impressiveness. In addition this depart mark the roles of nurses, relatives and patients in the decision making process. It would withal play up the difficulties facing nurses at different stages of care giving for seriously sick persons. At this stage of make the inning of this research paper very lesser dope be said about the case adopt until one has been adopted.Literature ReviewThe literature generally settles the importance of the problem and has been addressing the issues preserved to the problem of victuals for nigh time now. maculation it is suggested in the literature that in most cases of inveterate ill persons the provision of aliment is heavy quite than beneficial, it is agreed that the interpersonal and inter- schoolmaster tensions of nurses are ignored. (Hunt, 1994) It is alike pointed out that the stressful environment in which nurses interpret their maestro care almosttimes result in burnouts.The burnout case â€Å"evolves by a process involving deuce-ace stages: (a) an instability between resources and demands, (b) the immediate short-term unrestrained response to the imbalance, and (c) changes in attitude and behavior such as negativism and emotional detachment” (Riordan & Saltzer, 1992). However, it is in addition indicated that there are personal differences here: man one may react to stressors by neat a burnout another with personal rigor may find the stressors only minor irritants. Riordan and Saltzer (1992) conserve: â€Å" flowing literature points unanimously to a proactive hail in preventing burnout. This preserves organizational haleness by maintaining human resources and supplying cost-effective care magic spell maintaining quality” (Riordan & Saltzer, 1992).There are a number of suggestions for reducing stress and assisting nurses to cope with the environmental difficulties, though no specific signposts or surgical procedures are condition for dealing with the problem of nutrition and hydration. It is similarly indicated in the literature that nutrition and hydration in some terminal figure cases may only prolong the biological disembodied spirit which is thought to be magnetic coresome for some patients and their families. As Hunt (1994) asserts: â€Å"Feeding may in some circumstances prolong the process of death and may ca engage avoidable suffering to the demise patient.” term generally the decision of using nutrition support for the terminally ill people is discussed as a problem facing nurses, some scholars relate the decision to dietitians. â€Å"Clinical guidelines for nutrition support indicate that dietitians should be members of institutional ethics committees and should have an total role in institutional policy maturement concerning nutrition support at the end of lifeâ€Å" (Langdon et al, 2002)To put it in a nutshell the literature review confirms the dilemma facing healthcare headmasters, particularly nurses, and families in dealing with the decision of providing nutrition and hydration or withholding it for chronically ill people whose illness is diagnosed as terminal. It is to a fault confirmed that the decision making involves personal tactile propertyings, ethics, and sometimes legal consideration. Yet there are no clear professional person guidelines that streamline the decision making in this issue in the professional practice. alternatively there are observations of some agreeable practices.Sometimes the bank bill between workaday and extraordinary is used as a essence of reaching decision. â€Å"However, there appears to be an increasing opinion that stylized feeding can be viewed as aheroic method of word and is morally optional (Meyers and Grodin 1991, Hoefler and Kamoie 1994, Singer 1995, Gillick 2000).This optional treatment is referred to as ‘extraordinary and is more likely to be invasive, artificial or complex. Nevertheless, the battle of Hastings marrow guidelines, cited in Meyers and Grodin (1991), declared that decisions over whether to provide artificial nutrition and hydration cannot be made solely on the preeminence between ordinary and extraordinary methods of treatment. Despite this, Solomon et al (1993) demonstrate that 74 per cent of health professionals continued to use this distinction in termination of treatment decisions. It would besides face that the decision was significantly influ enced by whether it was a decision to withdraw treatment or obviously not initiate it in the first place. The Hastings Centre guidelines stipulate that this distinction should not be a consideration (Meyers and Grodin 1991)” (Young et al, 2002).The problem of decision making in providing or withholding nutrition and hydration in the case terminally ill people is a dilemma for nurses until some professional steps are identify to make the decision an objective one made on the basis of professional sound judgment  rather than being a personal one touch on by personal feelings, ethics, beliefs etc.ProposalSince the aim of the lead is to explain a professional basis for decision making, in this study we will attempt to enquire the possibility of establishing professional guidelines that may relief the excite on nurses. This will involve bring outing criteria that make withholding nutrition more beneficial to the patient than prolonging his biological life. It should to a fault be essential to identify professional means that enable healthcare staff to locate that a patient is not making any moxie of life and advise families accordingly to participate in decision making. This should be chief(prenominal) especially when the patient is suffering pain or abandoned morphia regularly.In order to be able to frame a professional tool or procedure that assists nurses in decision making through this study or instead recommend except research on this issue, the study will be a non-experimental one designed to elicit the RN’s attitudes towards nutrition of chronically ill patients using check up on instrumentation.The savour will be full time RNs diligent by a healthcare voice in hospitals and nursing homes of the region. It is advisable to include also a try out of dietitians working in the similar healthcare institutions. The RNs involved need to be come up sure about the study and its aims and should be positively cause to participate in the study.It is also meaning(a) for the study to be approved by a professional body that confirms the study question and methods are ethical. The instruments of the study should be designed in a counseling that they measure the attitude of the study sample towards giving or withholding nutrition and hydration for a mutation of terminally ill patients. It is also important to acquire the internal consistency reliability for the questionnaires and organize interviews.Summary and ConclusionsThese will follow naturally from the analysis of info and discussions and will eventually constitute a tribute: either a draft of a guideline for assisting nurses in decision making or alternatively suggestions for further research in order to identify a suitable professional tool for relieving the burden on nurses.ReferencesI am not dismissal to identify the references now since this is just a skeleton to discuss with your supervisor; unless you deem it necessary. The word count may not be exactly 3500, but I estimate what has been written here is enough for your purposes. As soon as you give feedback on this I will start work on the proposal.\r\nbreast feeding and nutrition\r\nIntroductionIn different healthcare institutions the question of feeding patients, particularly those who are seriously sick and expect to die soon, raises questions of moral and ethical nature hence making a decision making process very difficult for the caring staff. Such questions may include:How can decisions of giving or withholding feeding and hydration be made?What values and assumptions underlie these decisions?Which courses of action are in the patients ‘best interest, and how is this ‘interest impelled?How and when, if ever, should a decision not to feed or hydrate be made?Can so basic a provision as provender and water ever be considered as optional care?In most of the healthcare institutions whether they are hospitals or senior homes, the decision making lies within the practice of the nurses who are usually faced with dilemmas. plot of land doctors are more advanced in professional knowledge they rarely find themselves in the difficult situation of making the decision of withholding nutrition or giving it. However, there is sometimes a differentiation between nutrition as part of the care attached to the patient and nutrition as a biological life sustaining process:â€Å"In modern practice there is often an fundamental tension between two different understandings of ‘nourishing the patient. First, nourishing as an intrinsic part of giving care, which falls within the realm of nursing. Second, nourishing as a biological and technical process, a life-sustaining treatment under the control of the medical or nutrition team (from which the nurse may be excluded).” (Hunt, 1994)Yet the day-to-day practice and the roles of nurses and doctors indicate that the nurses find themselves in the dilemma of making the decision mo re than other medical staff. In many cases where the withholding of nutrition is legally right and in the interest of the patient, the nurse lock up finds herself in the ethical and professional dilemma. She is not given the opportunity to discuss her opinion or given any information. As a result whatever decision she makes may be taken as wrong regardless of the fact that she was partially ignorant.The dilemma is even more difficult when considering nutrition as a basic need or a medical treatment. For a seriously sick person one may accept withholding medication or a technological device that prolongs life unnecessarily, but it is not easy to withhold nutrition which is the basic need for healthy and unhealthy persons.â€Å"Dresser asks, ‘Ought we to regard tube and intravenous feeding as forms of medical treatment, or should we classify them with more basic sorts of care?” (Dresser, 1985)The decision of withholding nutrition or hydration is a difficult ethical ques tion that poses emotional stress on the nurses. Withholding medication or technological devices is justifiable and there is enough professional and legal guidance for healthcare staff to follow. Indeed, â€Å" feed and water are so central to an array of human emotions that it is almost impossible to consider them with the comparable emotional detachment that one might feel toward a respirator or a dialysis implement” (Lynn & Childress, 1983)In this research I am going to study this issue in order to confirm or rule out the possibility of establishing a professional guidance that assists the nurses in decision making. This is expected to relief them from a lot of stress and confusedness that are imposed as a result of dealing with the issue on personal impairment rather dealing with it objectively according to professional guidance and standards.The proposal for this research will be studied under the following headings:1. Description of a case study2.  Literature r eview3.  Proposal4.  Summary and ConclusionsDescription of a occurrence StudyA case study either from literature or from the records of healthcare institution is expected to illustrate the result of the problem and its importance. In addition this will emphasize the roles of nurses, relatives and patients in the decision making process. It would also cozy up the difficulties facing nurses at different stages of care giving for seriously sick persons.At this stage of building the skeleton of this research paper very little can be said about the case study until one has been adopted.Literature ReviewThe literature generally confirms the importance of the problem and has been addressing the issues related to the problem of nutrition for sometime now. While it is suggested in the literature that in some cases of chronically ill persons the provision of nutrition is burdensome rather than beneficial, it is agreed that the interpersonal and inter-professional tensions of nurses are ignored. (Hunt, 1994)It is also pointed out that the stressful environment in which nurses provide their professional care sometimes result in burnouts. The burnout case â€Å"evolves by a process involving three stages: (a) an imbalance between resources and demands, (b) the immediate short-term emotional response to the imbalance, and (c) changes in attitude and behavior such as negativism and emotional detachment” (Riordan & Saltzer, 1992). However, it is also indicated that there are personal differences here: while one may react to stressors by becoming a burnout another with personal hardiness may find the stressors only minor irritants. Riordan and Saltzer (1992) assert:â€Å"Current literature points unanimously to a proactive approach in preventing burnout. This preserves organizational integrity by maintaining human resources and supplying cost-effective care while maintaining quality” (Riordan & Saltzer, 1992).There are a number of suggestions fo r reducing stress and assisting nurses to cope with the environmental difficulties, though no specific guidelines or procedures are given for dealing with the problem of nutrition and hydration.It is also indicated in the literature that nutrition and hydration in some terminal cases may only prolong the biological life which is thought to be burdensome for some patients and their families. As Hunt (1994) asserts: â€Å"Feeding may in some circumstances prolong the process of dying and may cause avoidable suffering to the dying patient.”While generally the decision of using nutrition support for the terminally ill people is discussed as a problem facing nurses, some scholars relate the decision to dietitians.â€Å"Clinical guidelines for nutrition support indicate that dietitians should be members of institutional ethics committees and should have an integral role in institutional policy development concerning nutrition support at the end of lifeâ€Å" (Langdon et al, 2002) To put it in a nutshell the literature review confirms the dilemma facing healthcare professionals, particularly nurses, and families in dealing with the decision of providing nutrition and hydration or withholding it for chronically ill people whose illness is diagnosed as terminal. It is also confirmed that the decision making involves personal feelings, ethics, and sometimes legal consideration. Yet there are no clear professional guidelines that streamline the decision making in this issue in the professional practice. Rather there are observations of some acceptable practices.Sometimes the distinction between ordinary and extraordinary is used as a means of reaching decision.â€Å"However, there appears to be an increasing opinion that artificial feeding can be viewed as aheroic method of treatment and is morally optional (Meyers and Grodin 1991, Hoefler and Kamoie 1994, Singer 1995, Gillick 2000). This optional treatment is referred to as ‘extraordinary and is more like ly to be invasive, artificial or complex. Nevertheless, the Hastings Centre guidelines, cited in Meyers and Grodin (1991), stated that decisions over whether to provide artificial nutrition and hydration cannot be made solely on the distinction between ordinary and extraordinary methods of treatment. Despite this, Solomon et al (1993) demonstrated that 74 per cent of health professionals continued to use this distinction in termination of treatment decisions. It would also seem that the decision was significantly influenced by whether it was a decision to withdraw treatment or simply not initiate it in the first place. The Hastings Centre guidelines stipulate that this distinction should not be a consideration (Meyers and Grodin 1991)” (Young et al, 2002).The problem of decision making in providing or withholding nutrition and hydration in the case terminally ill people is a dilemma for nurses until some professional steps are identified to make the decision an objective one m ade on the basis of professional judgement  rather than being a personal one affected by personal feelings, ethics, beliefs etc.ProposalSince the aim of the study is to justify a professional basis for decision making, in this study we will attempt to investigate the possibility of establishing professional guidelines that may relief the burden on nurses. This will involve identifying criteria that make withholding nutrition more beneficial to the patient than prolonging his biological life. It should also be essential to identify professional means that enable healthcare staff to decide that a patient is not making any sense of life and advise families accordingly to participate in decision making. This should be important especially when the patient is suffering pain or given morphine regularly.In order to be able to design a professional tool or procedure that assists nurses in decision making through this study or alternatively recommend further research on this issue, the st udy will be a non-experimental one designed to elicit the RN’s attitudes towards nutrition of chronically ill patients using survey instrumentation.The sample will be full time RNs employed by a healthcare region in hospitals and nursing homes of the region. It is advisable to include also a sample of dietitians working in the same healthcare institutions. The RNs involved need to be well informed about the study and its aims and should be positively motivated to participate in the study.It is also important for the study to be approved by a professional body that confirms the study question and methods are ethical.The instruments of the study should be designed in a way that they measure the attitude of the study sample towards giving or withholding nutrition and hydration for a variety of terminally ill patients. It is also important to determine the internal consistency reliability for the questionnaires and structured interviews.Summary and ConclusionsThese will follow na turally from the analysis of data and discussions and will eventually constitute a recommendation: either a draft of a guideline for assisting nurses in decision making or alternatively suggestions for further research in order to identify a suitable professional tool for relieving the burden on nurses.ReferencesI am not going to list the references now since this is just a skeleton to discuss with your supervisor; unless you deem it necessary.The word count may not be exactly 3500, but I think what has been written here is enough for your purposes. As soon as you give feedback on this I will start work on the proposal.\r\n'