Nursing Home Feeding Controversies

Posted by nurse on September 1, 2011 under Critical Care, patient health | Be the First to Comment

Over five million people currently have dementia as a clinical problem or side effect of a similar degenerative disease. These patients will either be cared for in a nursing home environment or caregivers will give them nursing support at home. But challenges to traditional nursing roles in the face of today’s healthcare issues and treatment conventions make for conflicted caregivers, patients and patient families n the context of nursing home care.

Many people with relatives in a nursing home complain of uncaring nurses, patients who are mistreated, and even missed or stolen pharmaceuticals. These challenges are what staff must face even while expending daily effort on patient care 24 hours a day. And issues regarding feeding patients and administering meals and nutrition are not the least of these concerns.

Many caregivers argue the patient is not aware n late stages of dementia of anything other than basic sensation. But can healthcare providers skip a step that is cost intensive, hard to manage, and rife with staffing problems and complexity to administrate?

Dementia is not curable and 70% of the patients currently suffering from this medical problem will never recover. But can intravenuous nutrients replace the role of oral meals, and will the replacement of a social construct like mealtimes restrict the patient from other benefits of community events like mealtimes and conversational exchange? And what burden does this expectation place on nursing homes and nurses, and managerial staff who must address the issue daily?

An examination of the institution’s goals is important. Does the nursing home intend to provide a home-like setting? Does the staff promote a hospital type facility environment? Does family visitation assist or distract patients from eating properly? While ideally nurses would give each patient all the time they need to eat the full meal apportioned to the, few nurses can command such time periods without answering questions from critical staff. Many family and friends of patients with dementia mistakenly place blame on nurse, who are not making the decisions.

Nursing staff must manage a ward of patients with a variety of challenge for daily interaction and sociability in nursing homes. But end-stage dementia patients must be fed efficiently in order for a staff to service other clients in a timely manner. Nurse must ignore requests from interactively sound patients with communications facultys in order to literally spoon-feed patients who may not know any better. While often challenged as a heartless solution, IV nutrition can solve both time efficiency issues and overcome difficulty with a patient who is averse to feeding.

To make matters more difficult, weight loss and sedentary bed rest can obfuscate weight gain or loss doctors need to know about. The significance of a mealtime may matter to a patient with dementia one day, yet the next they may be completely unaware of appetite, satiety, or nutrition intake as a anything other than a curiosity. How are nurses to cope? Models of behavioral response in patients wit dementia are being developed to more adequately rate the ability of the patient to benefit from spoon feeding versus IV course of nutrition therapy.

Many a nurse will look at themselves in the mirror after a feeding session with a particularly difficult patient, and wonder, “Did I go to nursing school for this?”Likewise, many patients are simply not in possession of their faculties and nurses who know better may refuse to spend time getting a patient with little or no motor skills, recognition, or interactivity responses to participate in feeding. Yet nurses are blamed when they label a patient with dementia difficult or uncooperative.

Nurses have had conventional healthcare problems with patients with dementia spitting out food, refusing to eat it, chew or swallow, resenting myriad difficulties for healthcare providers. Feeding patients comes under the auspices of the certified nursing assistant or “orderly” in most nursing homes. End stage dementia patients often are fed through tubes as a matter of convenience, which can often shock family and visitors to end stage patients with dementia conditions in nursing homes. Sights like these give rise to a nursing home culture and negative perception.

For reasons such as those listed above, home are nursing has become much more popular. In part this is due to the family’s wish to monitor caregiving on a one to one basis with the nurse practitioner of certified nursing assistant. In this way a dedicated nursing resource can be scaled to the total care plan for one patient with dementia.