1. Navanna Pelletier Renee Sanford Rebecca Croft Nicole Eddy

2. Objectives Following the presentation our fellow colleges will be able to: Illustrate artificial hydration Explain benefits of artificial hydration Explain disadvantages of artificial hydration Describe how artificial hydration relates to nursing Integrate ethical views involving artificial hydration and its impact on nursing practice

3. Relevant Terms Artificial Hydration Hydration Dehydration End of life

4. Historical Influences Common since the 1970s (Bryd, 2004) Historically seen as a medical treatment (Owen, 2007) 1997  US Supreme court decision (Hospice and Palliative Care, Charlotte Region)

5. Current Influences Clinic decisions regarding artificial hydration currently are based on the pros and cons (Owens, 2007). Many times the offering and not offering of artificial hydration is depends on many factors (Schmidlin, 2008). Continues to be a highly debated topic (Owens, 2007) More research needed

6. Benefits of Artificial Hydration Decrease dehydration Decrease sedation Decrease myoclonus Improve electrolyte imbalances Van der Riet et. al. 2008

7. Potential benefits Prolong length of life Improve thirst and dry mouth, delirium and cognition Improves bedsores improves agitation improve communication and capacity Improve fatigue Improve hallucinations Van der Reit et. al. 2008

8. Risks of Artificial Hydration Increase pleural effusion Increase peripheral edema and ascities Increase pain, discomfort of procedure and ongoing interventions Increase chances of infection Van der Reit et. al. 2008

9. Benefits of Dehydration Decrease pain Anaesthetic effect of electrolyte imbalance Decreased pharyngeal secretions Reduced choking sensations Reduced peripheral edema Reduced urine output Be cared for at home Fewer physical barriers for relatives Fox as cited in Blakely & Milword 2007

10. Ethical Challenges

11. Ethical challenges Ethical dilemmas: a situation which has equally compelling ethical reasons both for and against a particular course of action are acknowledged and a decision must be made (CNA, 2008).

12. The Right to be Informed A competent patient must be informed about artificial hydration. - Delivered by a competent person - Provide sufficient amount of information - Must be voluntary McIntyre & McDonald, 2010

13. Client`s Wishes If the Client is in opposition of the treatment, it is ethically acceptable to withhold or withdraw artificial hydration (Maxwell, 2005). It is ethically acceptable to administer artificial hydration to client that is in favour of the treatment (Maxwell, 2005).

14. What if the Client`s Wishes are Unknown? An ethical dilemma may occur if a patient can not express their wishes and is without an advance directive.

15. The Family They may support or oppose artificial hydration. May want to initiate or continue artificial hydration despite advice from health care professionals.

16. Facilitating a Therapeutic Relationship Recognize & respond to families needs. Focus on the reason for dying rather than dehydration. Encourage alternative nurturing activities such as touching, talking, oral care, & personal hygiene. Support decisions based on the best interest of the client rather than their own personal beliefs.

17. Role of the Nurse Education Advocate for your patients best interest Family support Comfort measures

18. Nurses Responsibility Evaluate patients needs & preferences. Promote choices which benefit the patient and respect their autonomy. Provide counselling, education and explanations. Empower patient & family to make informed choices.

19. Questions