34 Nursing staff attitudes to clinically assisted hydration at the end of life in a hospice setting

Abstract

Background Clinically assisted hydration (CAH) at end of life is a contentious issue (Cabanero-Martinez et al, 2016) There is disagreement as to its benefits and this can lead to a lack of concordance between medical and nursing opinions, with nurses feeling unable to challenge doctors (Churchman, 2010; Van Der Riet, 2008; Mayashita, 2007). Prior to introducing a feasibility study on CAH (Davies, 2018) on one hospice site, an unpublished survey of nursing staff revealed widespread dissatisfaction with the standard practice of not routinely offering CAH. Following completion of the study a staff survey was undertaken to see if attitudes had changed. Aims To determine if nurses feel coerced into accepting the current hospice policy on CAH. To examine how nurses interacted with families when asked about CAH. To explore staff engagement with research on CAH. Method A semi-structured questionnaire sent to all nursing staff including HCA’s, with closed and open-ended questions. The responses were analysed using descriptive statistics and thematic analysis. Results The responses indicated that; The majority accept standard care without feeling coerced (68%). Nurses felt they could challenge accepted practice (62%). An overwhelming majority felt the hospice should be engaged in research on CAH (80%). Nursing staff expressed the following; Nurses wanted to be more involved in decision making around CAH. Many felt that a standard practice should be replaced with individual patient decisions. Staff were frequently asked about CAH and felt able to discuss the risks and benefits with families. Conclusions Overall, nurses accepted hospice standard practice on CAH and did not feel coerced. A few opposed further research, most welcomed it to establish an evidence base.