Nurses' decisions in the care of advanced dementia patients: a survey

Introduction. The aim of treatment for most dementia patients should be comfort, symptoms control and withholding of futile or invasive treatments. Aim. To describe the decision of Nursing Home (NH) nurses towards some critical situations for advanced dementia patients. Methods. A questionnaire with 7 clinical cases was administered to the nurses of 7 Italian NHs. The cases described a common or exemplar situation in an advanced dementia patient (FAST stage >7a) and limited life expectation. For each case the 4 closed ended questions described a behavior oriented to comfort (one answer) or aggressive treatment (3 answers). Results. Sixty-three/92 nurses (68.5%) answered the questionnaire. The majority (39, 61.9%) would feed the patient until death; 53 (84.1%) would favor hospital admission or resuscitation attempts while 55 (87.3%) would administer antibiotics for pneumonia even without distressing symptoms. With an expected survival <15 days 34 (54%) would favor a terminal sedation with refractory symptoms and 35 (55.6%) would stop unnecessary treatments (only 4 would prefer subcutaneous route). Thirty-two nurses (50.8%) would assess pain while 28 (44.4%) would contain an agitated patient. Continuing education is associated to cestrain behaviors, specifically for sedation (p 0.01) and revision of drug regimens (p 0.05). Conclusions. Nurses are not fully competent in providing palliative care. Due to the impact of education, courses should be developed to improve the care of the dying and make nurses aware of the natural course of dementia.