End-of-life care, clinical ethics and nutrition therapies
Though
this article was issued in 2013 the information presented remains relevant. In
this article, Denise Baird Schwartz, MS, RD, FADA, CNSC explored the effects of
preventive ethics and impact of intravenous nutrition therapy at the end-of-life.
Schwartz also discussed various strategies RDs can implement into their practices
as a way to promote better healthcare delivery. Some examples of these
strategies are illustrated below:
1.
Incorporate
ethics in the decision-making process
2.
Promote
conversations about nutrition with patients and their families
3.
Learn
about cue-based patient/family discussion as a way to educate them about
nutrition therapies
4.
Become
aware of cultural diversity and health literacy
5.
Utilize
the teach-back method to improve health literacy
6.
Practice
preventive ethics to avoid future conflicts
7.
Educate
yourself on policies, procedures, and guidelines regarding clinical ethics and nutrition
therapies
8.
Become
aware of the available resources and tools (i.e., National
Healthcare Decisions Day; Speak up Campaign; Aging with Dignity’s Five Wishes)
Planning
for end-of-life is a team effort. When planning for end-of-life the healthcare
teams should “provide appropriate and effective patient-centered care based on
the individual’s wishes” (Schwartz, 2013). The patient-centered care approach
is being increasingly used in the clinical setting. This approach empowers
patients to make their own decisions with regards to treatment preferences and
terms of care. Providing patient-centered care is also about preventing
clinical ethics dilemmas. Preventing ethical conflict as it relates to “advance
care planning and end-of-life discussion” (Schwartz, 2013) is often about strategic
interventions like initiating nutritional support. This is a big part of the
job for dietitians.
For
dietitians involved in end-of-life care, initiating nutrition therapy is
challenging especially if said therapy does not respect patients
quality-of-life goals (Schwartz, 2013). Such dilemmas are something you want
avoid. One effective measure is screening for those goals “before initiating the nutrition care process” (Schwartz, 2013). Advance
directives are available for review and can be communicated between the RD, the
physician, nurse, social worker and other members of the healthcare team
(Schwartz, 2013).
Schwartz, D. (2013). Ethical decision making - The dietitian’s role in end-of-life healthcare when considering enteral and
parenteral nutrition. Today’s Dietitian,
15 (1), 18.
CP
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