Afzien van kunstmatige toediening van voeding en vocht bij psychogeriatrische patiënten in het verpleeghuis; een kwalitatief onderzoek door participerende observatie

To assess how the decision to start or forego the artificial administration of fluids and food (AAFF) to psychogeriatric patients in nursing homes is made.

Design

Qualitative investigation by participative observation.

Method

The qualitative (ethnographic) study was carried out by two researchers in two phases (October 1998-April 1999 and December 1999-February 2001) on 10 psychogeriatric wards in two nursing homes in the Netherlands, in which 35 patients with dementia, 8 nursing home practitioners, 43 nurses and 32 families were involved.

Results

So-called ‘theoretical saturation’ of the observed patterns was reached after 21 case descriptions; the remaining 14 were used to see whether the patterns found were correct. The process of progressive and total deterioration caused by dementia was considered to be a normal course of events and was scarcely reason to initiate AAFF in the terminal phase. AAFF appeared to occur mainly if there was an acute illness or occurrence that had to be medically treated, which required sufficient hydration. The disease process, current medical status, presumed quality of life of the patient, and wishes of the family were considered to be more important than living wills and policy agreements.