ProNurse

I have recently been reflecting on the following issue and would like others reflections on the issue of diminished capacity in the elderly with dementia. Please comment on the following scenario;

83 year old patient is admitted from psychiatry to an complex care acute setting with renal failure (and low potassium) all attempts by nursing and medical staff to (correct the renal failure) i.e. administer ivi fluids (cannulas constantly pulled out) catheterised (pulled out) doubly incontinent, immobile, refusing to eat or drink despite all attempts, food charts, dietic supplements, feeding and throughout the patients care the patient is frequently distraught and aggressive.   

A psychiatric review badly critises this care as sub-standard and that all reasonable care standards have not been addressed because the patient lacks the capacity to decide whether they want to live or die / eat or drink/ go to the toilet etc therefore in the instance of best interests we as healthcare professionals should be thinking more “out of the box” in meeting the needs of this patient. Documented plan was- enforcing care such as feeding bananas, pineapple to the patient and enforcing fluid replacement and monitoring in the patient ( DEADLY SERIOUS yes I really do mean they said tying the patients arms down!)    

Comments please-

Is this substandard care in the first instance or just a frequent dilemma in caring for patients with this terrible illness?

Secondly is the above suggestion really in the best interest of the patient?

It is a no win scenario, and staff can only document what they do and is refused on an hour by hour basis.