The Decision-Making Experiences of Caregivers Regarding Feeding Tube Placement in Community-Dwelling Adults: A Descriptive Phenomenological Study.

Percutaneous endoscopic gastrostomy feeding tube placement is multifactorial and considered a lifesaving mechanism, which leads to a host of thoughts and feelings that affect the decision-making experience. As people live longer and the population ages, these decisions often involve the caregivers who have their own experience and therefore can result in caregiver burden and anxiety. A descriptive phenomenological study was conducted to describe and understand the caregiver's decision-making experience regarding percutaneous endoscopic gastrostomy feeding tube placement in community-dwelling adults. Edmund Husserl's philosophical underpinnings were utilized in conjunction with Colaizzi's (1978) method of data analysis to maintain the rigor of the study. Sixteen adult caregivers of patients from six rehabilitation and skilled nursing facilities were interviewed using a semistructured interview guide. The audio-recorded interviews were transcribed and thematic analysis was conducted. The study results yield four main themes: "Survival ... that was the determining factor"; "The doctor decided"; "More education ... just make sure they understand"; and "It makes me very scared." Implications for practice, policy, and future research are thoroughly discussed.

Decisional Conflict in Percutaneous Gastrostomy Tube Placement in Adults: An Integrative Review of the Literature.

Percutaneous endoscopic gastrostomy tubes are placed when individuals are unable to orally consume adequate nutrition and require an alternative method to meet their daily nutritional needs. This decision is multifactorial and depends on the prognosis of the illness, patients' wishes, and weighing risks versus benefits. The recent movement toward patient-centered care supports open communication and shared decision-making that have the potential to mitigate decisional conflict. The aim of this literature review was to identify factors associated with the decision-making process for gastrostomy tube placement for adults. Three quantitative, 4 qualitative, and 1 Q-methodology study were analyzed. Social life, body image and intimacy, uncertainty and fear, complications, and burden to caregiver were central factors that influenced decision making. Social life and body image associated with intimacy were found to be the most prevalent themes in the review. This review indicates that decision making for gastrostomy tube placement is highly individualized. Patients need adequate information to make informed decisions that are congruent with their healthcare goals. Nurses should act as patient advocates and must have candid discussions to ensure that patients have received thorough and adequate information regarding gastrostomy tube placement and management.

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A guide to the selection and application of concept analysis.

The purpose of this article is to provide practical guidance in the process of choosing a method to use for concept analysis (CA), a commonly used method for defining and exploring concepts in nursing. Best outcomes are achieved when there is close alignment between the concept, the purpose of the analysis, and the CA method utilized. This process has become complicated by the number of approaches developed in recent decades, with varying purposes and theoretical underpinnings. Other variables include the specific type of concept chosen and the purpose of the analysis, which may vary from clinical care to theory development to research design. The net result is a process that can be confusing for experienced and inexperienced scholars alike. An overview of the most common CA methods used in recent years, including theoretical underpinnings, intended uses, steps involved in the process, and recommended applications, is followed by detailed guidance in selecting a method to use for the specific concept to be analyzed. Also provided is a discussion of the factors to consider in choosing a concept for analysis. The desired outcome is the promotion of high-quality CA that advance the scholarship of nursing.