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The Influence of Nursing Home Culture on the Use of Feeding Tubes

The Influence of Nursing Home Culture on the Use of Feeding Tubes ORIGINAL INVESTIGATION The Influence of Nursing Home Culture on the Use of Feeding Tubes Ruth Palan Lopez, PhD, GNP-BC; Elaine J. Amella, PhD, GNP-BC, FAAN; Neville E. Strumpf, PhD, RN, FAAN; Joan M. Teno, MD, MSc; Susan L. Mitchell, MD, MPH Background: Nationwide, many nursing home (NH) resi- ment centered on food as an important component of daily dents with advanced cognitive impairment are tube fed, de- life, mealtimes staffed with knowledgeable nursing as- spite no demonstrable benefits of this intervention in this sistants who valued hand feeding, and advance care plan- population. Studies suggest that organizational features of ning that included family and palliative care options. In NHs are associated with this practice, but underlying rea- contrast, the high-use NH had an institutionlike envi- sons for these associations are poorly understood. ronment, poorly staffed mealtimes, and staff attitudes fa- voring feeding tubes to avoid aspiration and to meet per- Methods: We conducted a focused ethnographic study ceived regulatory compliance. of 2 NHs in South Carolina, 1 with a high tube-feeding rate (41.8%) in patients with advanced dementia, and Conclusions: The NH culture influences the approach 1 with a low rate (10.7%). Data were collected about physi- to feeding http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png JAMA Internal Medicine American Medical Association

The Influence of Nursing Home Culture on the Use of Feeding Tubes

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Publisher
American Medical Association
Copyright
Copyright 2010 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.
ISSN
2168-6106
eISSN
2168-6114
DOI
10.1001/archinternmed.2009.467
pmid
20065203
Publisher site
See Article on Publisher Site

Abstract

ORIGINAL INVESTIGATION The Influence of Nursing Home Culture on the Use of Feeding Tubes Ruth Palan Lopez, PhD, GNP-BC; Elaine J. Amella, PhD, GNP-BC, FAAN; Neville E. Strumpf, PhD, RN, FAAN; Joan M. Teno, MD, MSc; Susan L. Mitchell, MD, MPH Background: Nationwide, many nursing home (NH) resi- ment centered on food as an important component of daily dents with advanced cognitive impairment are tube fed, de- life, mealtimes staffed with knowledgeable nursing as- spite no demonstrable benefits of this intervention in this sistants who valued hand feeding, and advance care plan- population. Studies suggest that organizational features of ning that included family and palliative care options. In NHs are associated with this practice, but underlying rea- contrast, the high-use NH had an institutionlike envi- sons for these associations are poorly understood. ronment, poorly staffed mealtimes, and staff attitudes fa- voring feeding tubes to avoid aspiration and to meet per- Methods: We conducted a focused ethnographic study ceived regulatory compliance. of 2 NHs in South Carolina, 1 with a high tube-feeding rate (41.8%) in patients with advanced dementia, and Conclusions: The NH culture influences the approach 1 with a low rate (10.7%). Data were collected about physi- to feeding

Journal

JAMA Internal MedicineAmerican Medical Association

Published: Jan 11, 2010

References