Author: Chan, Yu-hong
Title: Care providers' perspectives of tube-feeding decision-making for patients with advanced dementia
Degree: M.Sc.
Year: 2004
Subject: Hong Kong Polytechnic University -- Dissertations
Dementia -- Patients -- Care -- Case studies
Tube feeding -- Decision making -- Case studies
Department: School of Nursing
Pages: vii, 121 leaves ; 30 cm
Language: English
Abstract: This study was conducted in an attempt to understand how and why artificial nutrition and hydration (ANH) decisions were made for advanced dementia (AD) patients by both health care provider (HCP) and family care provider (FCP) in a practice context. The use of case study method allowed the research question to be addressed appropriately within its real-life context. Five decision-making patterns for feeding were identified which were further divided into two types depending on whether tube-feeding was used. Advance proxy directive was used to indicate the decision of no tube-feeding whereas those patients received tube-feeding were based on clinical decision with family involvement. The results indicate that preference or decision on a particular feeding method is associated with role responsibilities of the care providers. The way how to feed an AD patient with dysphagia is often determined by relative weight assigned to the potential benefits and burdens of hand or tube-feeding. Two observations were noted to explain the preference of HCPs on tube-feeding. First is physicalization of medicine and second is medicalization of dying. On the other hand, FCPs were found favorable on hand-feeding because its use was believed to be able to (1) alleviate the patient's sufferings; (2) satisfy the patient's desire; and (3) maintain an intimate relationship with their beloved family member. Further in-depth analysis indicates that preferences of these two groups of care providers are derived from two major types of ethics traditions. The HCP's view was grounded in the nonmaleficence and paternalism of the medical ethics tradition. The FCP's view was associated with filial piety under Confucianism and non-action of Taoism in the Chinese ethics tradition. According to the Confucian, nurturing 'zhi' (heart) is the essence of filial piety in addition to nurturing 'ti' (body) of our parents. Cross-case comparison of the FCPs indicates that "shun qiziran" (let-it-happen) embedded in the non-action of Taoist philosophy was used to justify the decision of no tube-feeding and to resolve the dilemma resulting from the conformance of filial piety. Based on the acceptance of advance proxy directive of no ANH in this study, it is recommended to explore the possibility of patient-participated advance directive.
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