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Fluids given via sponge ‘not wrong’ for end of life care

  • 4 Comments

Nurses have hit back against suggestions in the national media that they were leaving end of life care patients so dehydrated they were resorting to sucking water from sponges.

Members of the nursing profession said there was a “misunderstanding” over the use of sponges as a hydration tool, in the wake of a renewed focus on end of life care this week.

“A lot of nurses say there is a complete misunderstanding about this”

John Humphrys

Earlier this week the National Institute for Health and Care Excellence published draft guidance on end of life care, designed to partially replace the discredited Liverpool Care Pathway.

The draft guidelines highlighted that patients in their last days of life should be encouraged to drink “if they wish to and are able to” and that, if considered beneficial, should receive assisted hydration.

Widespread media coverage of the guidance drew attention to the controversial Liverpool Care Pathway, which was withdrawn last year following an independent review.

The pathway was repeatedly described on BBC Radio 4’s Today programme on Wednesday as having resulted in “some people being deprived of food and water in their last few days”, with patients becoming “so dehydrated they tried to suck water from the sponges used to moisten their mouths”.

Presenter John Humphys subsequently told listeners that the radio station had received “an awful lot of emails from nurses” who were concerned about the description.

“A lot of nurses say there is a complete misunderstanding about this,” he said. In particular, he quoted a message received via email from a sister called Julie Vine.

“Please do not let families think that giving fluids on a sponge is wrong”

Julie Vine

She said her ward was currently providing care to a dying patient whose swallowing was “very poor” and needed thickened fluids as a result.

“I was giving her fluids by teaspoon, but it kept moving round her mouth and coming out,” she said. “She didn’t have the strength to suck up a straw, so I gave her fluid on a mouth care sponge and she could suck the water from that.

“Everyone is an individual, so please, please do not let families think that giving fluids on a sponge is wrong,” she said.

 

John Humphrys describes nurse concerns in full:

“We’ve had an awful lot of emails from nurses who are concerned that people have been complaining about the care of people in their final stages, who were so weak and were not being rehydrated that they were sucking water from the sponge that was being used to moisten their lips.

Well a lot of nurses say there is a complete misunderstanding about this.

Julie Vine says: ‘I’m a sister, and we’ve a patient dying on the ward at the moment. Her swallowing is very poor, she needs thickened fluids. I was giving her fluids by teaspoon, but it kept moving round her mouth and coming out.

She didn’t have the strength to suck up a straw, so I gave her fluid on a mouth care sponge and she could suck the water from that. I asked if that was better, she said “yes”, it gave her great relief – and her eyes smiled.

Everyone is an individual, so please, please do not let families think that giving fluids on a sponge is wrong.’”

 

Earlier in the programme, Mr Humphrys had interviewed Mark Baker, director of NICE’s Centre for Clinical Practice, about the draft guidance.

Making the case for improvement, Mr Baker said: “We take meticulous care in bringing people into life, we need to take as meticulous care in helping them to leave life comfortably.”

“The science of medicine helps us live longer, but the art makes its delivery comfortable”

Mark Baker

He noted that the Liverpool Care Pathway “had a place in improving the experience of dying” when used by specialists and “managed sensitively”. But he acknowledged that its use in non-specialist hands was “too easily abused”.

Asked if this meant there was a need to “end the technology approach of nursing”, Mr Baker highlighted that clinical care involved both art and science. 

“The science of medicine helps us live longer, but the art makes its delivery comfortable,” he said. “Perhaps in some places and at some times we focus too much on the science and have lost the art.”

Pushed by Mr Humphrys on whether nursing had “to change”, he highlighted the need for patient-centred care and good communication from all health professionals, as set out in the draft guidance.

Mark Baker

Mark Baker

“I think all the professions need to be assured that they are always working in the patient’s best interests and that requires them to find out what the patient’s interests are,” said Mr Baker.

Mr Humphrys went on to question the need for guidelines, arguing that decisions on end of life care should be left to nurses to make through “humanity, common sense and decency”.

Mr Baker stated that there were “basic values and philosophical issues which ought to be intrinsic to the ways of working of all the health professions”, but that guidelines brought consistency.

 

 

  • 4 Comments

Readers' comments (4)

  • We as nurses are to blame for some of the back lash. We find it hard to spend 5 minutes with a patients family to explain what care we are providing to their loved one. Why we have stopped giving solid food or reduced their fluid intake, all have a reason behind it but we don't explain it to those who see it. Healthcare professionals have a lot to be desired when it comes to communication skills and that is the basic problem. Its not the pathway it us.

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  • I quite agree, it is the quality of the nurse. I was in charge of a palliative care suite where I was giving frequent small amounts of fluid to a lovely lady who was lucid and talking. Two days later this lady had passed away. As a bank nurse I was not there for two days. I will never know if it was the LCP, the nurse or just a rapid deterioration in the patient. The situation will never leave me. I'm now retired.

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  • one of my colleagues resuscitated a dying patient with beer! mouth care with beer-soaked swabs when she was comatose, teaspoonfuls when she was waking up and able to swallow which gradually increased from sips to glasses full.


    this 85 year old who had received her last rites and had her family travel a great distance to be with her a few days later was rushing down the corridor pursued by the physios who had difficulty keeping up with her! Her complaint - rehab for multiple pelvis and femur fractures following an RTA from which she had been slowly recovering and mobilising before she fell into a coma and was declared dying - and given full palliative care over an entire weekend until it was discovered she had a serious electrolyte Na/K imbalance which had apparently been cured by the beer!

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  • Does anyone feel that we have gone backwards and that frequently we are reinventing the wheel when it comes to nursing care?
    It does take time to give care and that's where we fail.
    Nurse training is at fault really. No Clinical Tutors on the shop floor - they were invaluable! No SEN's - again invaluable. Good clinical leadership - essential.....need I go on?
    Allow Students to be paid and included in the 'numbers' like we used to be. The Art & Science of nursing will then be balanced.

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