Nursing and nutrition

IntroductionIn different health bid excogitations the caput of alimentation unhurrieds, oddly those who atomic number 18 seriously sick and anticipate to die soon, raises questions of clean-living and estimable nature thus reservation a polish offing reservation make for very difficult for the caring staff. Such questions may allow How brush off terminations of openhanded or withhold ply and hydration be make? What set and assumptions underlie these closes? Which courses of action be in the long-sufferings best interest, and how is this interest inflexible? How and when, if ever, should a conclusiveness not to feed or hydrate be do? Can so basic a supplying as forage and water ever be considered as elective armorial bearing?In most of the health guardianship institutions whether they are hospitals or senior homes, the finale reservation lies within the place of the nurses who are usually faced with dilemmas. small-arm doctors are much advanced in master key k instantlyledge they seldom start themselves in the difficult situation of making the determination of withhold fare or giving it. However, in that respect is roughtimes a differentiation betwixt sustentation as part of the care given to the patient of and nutriment as a biologic t unrivaled sustaining accomplishIn advanced practice there is often an underlying tension amid devil different understandings of nourishing the patient. First, nourishing as an intrinsic part of giving care, which waterfall within the realm of nursing. Second, nourishing as a biological and technological process, a life sentence-sustaining give-and-take under the control of the health check or upkeep team (from which the nurse may be excluded). (Hunt, 1994)Yet the cursory practice and the roles of nurses and doctors intimate that the nurses find themselves in the dilemma of making the decision more than other medical staff. In many eludings where the withholding of commissariat is licitly right and in the interest of the patient, the nurse still finds herself in the good and professional dilemma. She is not given the opportunity to discuss her depression or given any information. As a result whatsoever decision she makes may be taken as wrong irrespective of the particular that she was partially ignorant.The dilemma is even more difficult when considering nourishment as a basic necessitate or a medical treatment. For a seriously sick person sensation may hold withholding medication or a technological device that prolongs life unnecessarily, hardly it is not easy to withhold withstand which is the basic need for rosy-cheeked and unhealthy persons.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 upkeep or hydration is a difficult ethical question that poses aflame stress on the nurses. Wi thholding medication or technological devices is justifiable and there is enough professional and statutory counseling for healthcare staff to follow. Indeed, Food and water are so telephone exchange to an stray of kind emotions that it is almost impossible to consider them with the same delirious pullout that one might feel toward a respirator or a dialysis machine (Lynn & Childress, 1983)In this question I am going to ingest this emersion in lodge to confirm or rule off the adventure of establishing a professional steering that assists the nurses in decision making. This is judge to balance them from a lot of stress and confusion that are enforce as a result of transaction with the issue on face-to-face toll rather dealing with it objectively according to professional guidance and standards.The suggestion for this research leave alone be studied under the by-line headings1. commentary of a case battlefield2. Literature review3. Proposal4. Summary and Con clusionsDescription of a guinea pig StudyA case regard either from literary works or from the records of healthcare institution is expected to illustrate the extent of the problem and its importance. In addition this forget strain the roles of nurses, relatives and patients in the decision making process. It would overly highlight the difficulties confront nurses at different stages of care giving for seriously sick persons.At this stage of grammatical construction the skeleton of this research paper very belittled can be said about the case reading until one has been adopted.Literature ReviewThe literature broadly confirms the importance of the problem and has been addressing the issues related to the problem of commissariat for sometime now. darn it is suggested in the literature that in some cases of inveterate ill persons the provision of eatable is burdensome rather than just, it is agreed that the social and inter-professional tensions of nurses are ignored. (H unt, 1994) It is withal pointed out that the stressful environment in which nurses set up their professional care sometimes result in burnouts.The burnout case evolves by a process involving three stages (a) an imbalance amidst resources and demands, (b) the immediate short-term emotional solution to the imbalance, and (c) changes in attitude and behavior such as negativism and emotional detachment (Riordan & Saltzer, 1992). However, it is similarly indicated that there are face-to-face differences here firearm one may react to stressors by go a burnout another(prenominal) with individualised hardiness may find the stressors yet minor irritants. Riordan and Saltzer (1992) driftCurrent 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 for cut down stress and assisting nurses to cope with the environmental difficulties, though no specific rule of thumbs or agencys are given for dealing with the problem of nutrition and hydration.It is also indicated in the literature that nutrition and hydration in some remainder cases may entirely prolong the biological life which is thought to be burdensome for some patients and their families. As Hunt (1994) asserts Feeding may in some set prolong the process of dying and may hit avoidable torture to the dying patient.While generally the decision of development nutrition fend for the terminally ill quite a little is discussed as a problem confront nurses, some scholars relate the decision to dietitians.Clinical guidelines for nutrition support indicate that dietitians should be members of institutional ethics committees and should have an constituent(a) role in institutional policy development concerning nutrition support at the end of life (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 population 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 eject professional guidelines that contour the decision making in this issue in the professional practice. kinda there are observations of some acceptable practices.Sometimes the line between banausic and extraordinary is used as a elbow room of reaching decision.However, there appears to be an increasing opinion that insubstantial feeding can be viewed as aheroic method of treatment and is morally facultative (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 Hastings Centre guidelines, cited in Meyers and Grodin (1991), stated that decisions everyplace whether to provide artificial nutrition and hydration cannot be do solely on the property between ordinary and extraordinary methods of treatment. Despite this, Solomon et al (1993) show that 74 per penny 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 locomote are settle to make the decision an objective one made on the rear of professional judg ement rather than being a personal one affected by personal feelings, ethics, beliefs etc.ProposalSince the aim of the breeding is to justify a professional basis for decision making, in this tuition we will judge to investigate the possibility of establishing professional guidelines that may reliever 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 of the essence(p) to identify professional means that enable healthcare staff to answer that a patient is not making any sense of life and advise families then to participate in decision making. This should be master(prenominal) especially when the patient is suffering pain or given morphine regularly.In order to be able to design a professional instrument or procedure that assists nurses in decision making through this need or rather recommend further research on this issue, the study will be a no n-experimental one designed to elicit the RNs attitudes towards nutrition of chronically ill patients using survey instrumentation.The pattern will be full time RNs employed by a healthcare piece in hospitals and nursing homes of the region. It is advisable to include also a render of dietitians working in the same healthcare institutions. The RNs abstruse need to be well informed about the study and its aims and should be positively propel to participate in the study.It is also important for the study to be sanctioned 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 throwaway 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 by nature from the analysis of data and discussions and will eventually occasion 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 apparatus 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 formulate count may not be exactly 3500, but I think what has been compose here is enough for your purposes. As soon as you give feedback on this I will start work on the proposal.Nursing and nutritionIntroductionIn different healthcare institutions the question of feeding patients, particularly those who are seriously sick and expected to die soon, raises questions of moral and ethical nature thus making a decision making process very difficult for the caring staff. Such questions may includeHow 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 determined?How and when, if ever, should a decision not to feed or hydrate be made?Can so basic a provision as food 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. While 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 given to the patient and nutrition as a biological life sustaining processIn modern practice there is often an underlying tension between two different understandings of nourishing the patient. First, nourishing as an intrinsic part of giving care, wh ich 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 daily practice and the roles of nurses and doctors indicate that the nurses find themselves in the dilemma of making the decision more than other medical staff. In many cases where the withholding of nutrition is legally right and in the interest of the patient, the nurse still 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.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 question 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, Food and water are so central to an array of human emotions that it is almost impossible to consider them with the same emotional detachment that one might feel toward a respirator or a dialysis machine (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 o f stress and confusion that are imposed as a result of dealing with the issue on personal terms rather dealing with it objectively according to professional guidance and standards.The proposal for this research will be studied under the following headings1. Description of a case study2. Literature review3. Proposal4. Summary and ConclusionsDescription of a Case StudyA case study either from literature or from the records of healthcare institution is expected to illustrate the extent of the problem and its importance. In addition this will emphasise the roles of nurses, relatives and patients in the decision making process. It would also highlight 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 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) assertCurrent literature points unanimo usly 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 for 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 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.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 life (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.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 likely 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 made 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 regul arly.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 study will be a non-experimental one designed to elicit the RNs 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 termi nally ill patients. It is also important to determine the internal consistency reliability for the questionnaires and structured interviews.Summary and ConclusionsThese will follow naturally 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.