Preferences of Registered Dietitians and Nurses Recommending Artificial Nutrition and Hydration for Elderly Patients

Abstract

Objective The study was designed to identify how the beliefs and perceptions of registered dietitians (RDs) affect their decisions to propose artificial nutrition and hydration (ANH) for elderly patients as compared with nurses. Design A questionnaire consisting of demographic information, 13 belief statements, and eight patient scenarios requiring ANH was mailed to RDs (n=1,500) and nurses (n=1,500) throughout Florida. Thirteen statements, rated on a 5-point Likert scale, addressed beliefs that influence ANH decisions. Eight scenarios of patients, without an advance directive or surrogate decision maker, were created with variations in age, cognition, and emotion. For each scenario, participants selected a treatment, ANH or hydration, and responded: recommend; not recommend; undecided; or recommend a trial period; if no improvement, stop treatment. Statistical Analyses Performed To establish reliability and validity, the instruments were pilot-tested with a group of RDs and nurses. Cross tabulations with χ 2 tests compared the distribution of responses to the belief statements and scenarios. Statistical significance was P<0.05. Results Responses to the belief statement, “when in doubt, feed” differed significantly ( P<0.001) between RDs and nurses, all other belief statements were not significantly different. In all eight scenarios, significantly more ( P<0.001) RDs recommended ANH than did nurses. Conclusions RDs clearly endorsed feeding when in doubt; therefore, they recommended ANH more than nurses. Nurses, who hesitated to feed when in doubt, were more diverse with their recommendations, either recommending a trial or not recommending ANH. A philosophical difference related to feeding was apparent between RDs and nurses and may affect consistent and quality care in patients without an advance directive or surrogate decision maker.