Nurse–physician communication concerning artificial nutrition or hydration (ANH) in patients with dementia: a qualitative study

Aims and objectives. To explore nurses’ experiences with nurse–physician communication during artificial nutrition or hydration (ANH) decision‐making in hospitalised patients with dementia. Background. Artificial nutrition or hydration decision‐making often occurs in patients with dementia. Effective communication between professionals is extremely challenging in this population, because these patients are unable to communicate their treatment wishes. Design. Qualitative interview design. Methods. Between April 2008 and June 2009, we conducted 21 interviews with nurses from nine different hospitals geographically spread throughout Flanders (Belgium). Interviews were audiotaped and later transcribed. Data processing involved (1) simultaneous and systematic data collection and analysis, (2) constant forwards–backwards wave, (3) continuous dialogue with the data and (4) interactive team processes. Results. The interviews showed that communication with physicians is the central instrument the nurses used in their attempts to realise their perception of ‘the best possible care’. From the nurses’ perspective, we distinguished three mutually connected factors that affected the effectiveness of nurse–physician communication during artificial nutrition or hydration decision‐making: the physicians’ attitude towards the nurses, the nurses’ attitude towards the physicians and the forms of communication used by the nurses. The complex interaction between these three factors resulted in a range of nurses’ perceptions, varying from positive to negative. The direction of their perceptions depended on the extent to which they succeeded or failed to use nurse–physician communication as an instrument to realise the ‘best care’. Conclusion. Nurse–physician communication was the most important instrument determining whether nurses succeeded or failed to actively act as a patient’s representative and whether nurses achieved the best possible care in co‐operation with physicians. Relevance to clinical practice. To reach optimal care and nurse job satisfaction, nurse–physician communication during artificial nutrition or hydration decision‐making should be an open dialogue characterised by mutual respect and understanding.