From Means to Ends: Artificial Nutrition and Hydration

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Nursing knowledge

There are ways of “knowing” that underpin how nurses reason and act concerning the use and effectiveness of artificial nutrition and hydration (ANH). Among these reasons are those that nurse theorist Barbara Carper suggested in her seminal work published in 1978 entitled “Fundamental Ways of Knowing in Nursing,” in which she suggests a typology of nursing knowledge using 4 patterns: empirics, ethics, personal, and esthetic.1 Two of these patterns are particularly relevant and support the notion

Reasoning

Reason defined as a “statement offered in explanation or justification” is “the power of comprehending, inferring, or thinking, especially in orderly rational ways.”60 Reasoning may be seen in this context as the exercise of decision making. Up to this point, the nurse has gathered empiric knowledge in the form of scientific evidence and applied moral knowledge from professional codes of ethics, ethical theories, and principles. Dealing with value differences that result in ethical dilemmas

To act

Nurses act in different ways based on their level of experience and variety of clinical exposures. Noting the novice-to-expert theory, Benner68 described nursing as a clinical practice in which theory becomes relevant as nurses progress along the continuum. Assuming this process may be applied to the development of ethical skill and sensitivity, it is plausible to suggest that nurses with basic knowledge of ethical theories and principles are at the beginning of the continuum. This knowledge,

Summary

To achieve meaningful ends to the controversies that arise in the provision of ANH, various measures have been used. Each measure entails requisite skills of knowing, justifying, and acting with empiric and ethical perspectives. Given the preponderance of controversial issues associated with the provision, withholding, and withdrawal of ANH, there is an obligation to strike a balance between those who may benefit and those who do not. This balance should be based on scientific evidence as to

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