Self Directed Learning Package - University of Queensland

143 • Self Directed Learning Package - CareworkerTry and provide as much information as possible when reportingto the nurse. This will allow them to decide how urgently theyneed to review the resident.Thinking pointWhich of the following do you think will get the bestresponse?Careworker to nurse:‘Alfred appears to be having trouble drinking andeating. He has been getting worse over the last fewdays and it seems to be related to him becomingdrowsier’.Is better than:‘Alfred is refusing to eat or drink’.DoManage the problemKey PointDiligent hand feeding and offering drinks frequentlyis important for all residents. 4If Alfred becomes unable to swallow, staff should cease offeringfood and drink, instead focusing on excellent mouth care.When a resident cannot swallow food or fluids by themselves, itis possible to provide these by artificial means such as through atube (PEG tube) or SC (subcutaneous cannula) ‘drip’.Decision makingThere is no simple answer to whether these interventions are rightor wrong. The benefits of artificial nutrition or hydration need tooutweigh the potential burden and side effects for the resident.Residents and family members cannot make the best decisionsif they do not have enough information. Conversations with thenurse and doctor about the positive and negative aspects ofartificially providing food or fluids are very important at this stage.Artificial nutritionKey PointFor residents requiring a palliative approach,there is no evidence that tube feeding prolongslife, improves comfort or quality-of-life, preventsaspiration pneumonia, leads to better nourishmentor decreases the risk of pressure sores. 6Artificial hydrationThinking PointAlfred is unconscious and you would not be surprisedif he dies in the next two to three days. A fellowcareworker is upset that Alfred cannot drink. He says‘How bad must it be for Alfred being so dehydrated,he should have a saline drip’.Do you agree with his comments?