Long-term care nurses' ethical convictions about tube feeding

Area of Science:

• Nursing Ethics
• End-of-Life Care
• Bioethics

Background:

• Ethical decisions for nurses are influenced by moral certainty and uncertainty.
• Nurses in long-term care face complex ethical dilemmas, particularly concerning artificial nutrition and hydration (ANH) for elderly patients in end-stage life.

Purpose of the Study:

• To explore the moral certainty and uncertainty experienced by long-term care nurses regarding withholding or withdrawing ANH in elderly patients.
• To analyze moral certainty and uncertainty as universal concepts within the context of end-of-life care decisions.

Main Methods:

• Qualitative study design.
• Analysis of moral certainty and uncertainty using participant narratives.
• Focus on experiences of long-term care nurses.

Main Results:

• Morally certain nurses perceived tube feeding negatively and were inclined to act, often by educating families.
• Morally uncertain nurses viewed tube feeding neutrally or benignly, tending towards inaction while prioritizing patient comfort and preventing suffering.
• Distinct patterns of action and perception were identified based on the level of moral certainty.

Conclusions:

• Moral certainty and uncertainty significantly shape nurses' responses to ANH decisions in end-of-life care.
• Understanding these concepts is crucial for supporting nurses and improving ethical decision-making in long-term care settings.
• The findings highlight the need for ethical support and clear guidelines for nurses managing ANH dilemmas.