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Understanding how nil by mouth can affect patients' behaviour

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VOL: 100, ISSUE: 48, PAGE NO: 43

Julie Rees, is a second-year nursing student, University College of Medicine, Cardiff

I initially read Best's article (2004) because the topic had recently been debated in our clinical skills lab. We h...

I initially read Best's article (2004) because the topic had recently been debated in our clinical skills lab. We had discussed the problems of preoperative fasting with regard to delayed healing time in acute wounds. We will soon be going on our surgical placements and reading this article has broadened my understanding.

Interestingly, the author used patients undergoing radiological and gastrointestinal endoscopy procedures in her investigations. I reflected upon my own experience not just as a nurse but also as a patient. I too have undergone gastrointestinal endoscopy. My experiences were very similar to the findings highlighted by Best.

I had received written information about preoperative fasting, which detailed the length of time I would have to fast for before surgery. It did not state why this was necessary. Nor did the letter state when I could start eating and drinking again, or how to make my dry mouth feel more comfortable. When I consider my patients who have had to undergo preoperative fasting, I noted that very little information was offered to them about why it was necessary to remain nil by mouth, what they could do to relieve a dry mouth or indeed when they could look forward to their next meal or cup of tea.

This lack of information is an aspect of my nursing that I hadn't previously considered, and I will now give patients as much information as possible, which I hope will increase patient comfort and help allay anxiety.

The article also highlighted that patients tend to fast for longer periods than is necessary. I could relate to this and also identified with the 'symptom list' on the authors' questionnaire. I too had experienced hunger, thirst and headache, which I attributed to a lack of food. However, the tiredness I felt was probably caused by my lack of sleep due to the anxiety of the procedure and test results, rather than a lack of food - although I realise that this could have been a contributing factor.

I appreciate that this is a personal perspective, but when I go on my surgical placement I will look for changes in patient behaviour, mood and body language that indicate their discomfort during the period of fasting. The ideas for relieving a dry mouth were very useful. Simple ideas such as brushing teeth and rinsing the mouth seem obvious to me now and I shall put this information into practice on the wards.

As a novice nurse, understanding the protocols for patients who have diabetes or are on drugs that need to be taken with food and yet have to be nil by mouth remain problematic. The potential for giving misinformation and delaying surgery is a cause of anxiety.

This article has broadened my understanding of the potential problems of preoperative fasting and how to overcome them. I will take the recommendations on board for my practice. The article has helped me to identify my own learning needs and has prompted me to ask further questions about this topic. I now feel the need to go and carry out more research.

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