Thirst as an ingestive behavior: A brief review on physiology and assessment

Assistant nurses' experiences of thirst and ethical dilemmas in dying patients in specialized palliative care-A qualitative study

AIMS

To describe assistant nurses' experiences of thirst and ethical challenges in relation to thirst in terminally ill patients in specialized palliative care (PC) units.

DESIGN

A qualitative, reflexive thematic design with an inductive analysis was used.

METHODS

Data were collected during November 2021-January 2023. Twelve qualitative interviews with assistant nurses working in five different specialized PC units in different hospitals in Sweden were conducted. The interviews were transcribed verbatim and analysed with a reflexive thematic analysis. The study was guided by the Standards for Reporting Qualitative Research (SRQR).

RESULTS

Two main themes were found in this study. (1) 'A world of practice for thirst relief' where assistant nurses present a task-oriented world where the knowledge of thirst is an experience-based unspoken knowledge where mainly routines rule. (2) Ethical challenges presents different ethical problems that they meet in their practice, such as when patients express thirst towards the end of their life but are too severely ill to drink or when they watch lack of knowledge in the area among other health professionals.

CONCLUSION

Thirst in dying patients is a neglected area that assistant nurses work with, without communicating it. Their knowledge of thirst and thirst relief are not expressed, seldom discussed, there are no policy documents nor is thirst documented in the patient's record. There is a need for nurses to take the lead in changing nursing practice regarding thirst.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

IMPACT

In palliative care, previous studies have shown that dying patients might be thirsty. Assistant nurses recognize thirst in dying patients, but thirst is not discussed in the team. Nurses must consider the patient's fundamental care needs and address thirst, for example in the nursing process to ensure patients quality of life in the last days of life.

REPORTING METHOD

The study was guided by the SRQR. WHAT DOES THIS ARTICLE CONTRIBUTE TO THE WIDER GLOBAL CLINICAL COMMUNITY?: Thirst is a distressing symptom for all humans. However, when a patient is dying, he or she loses several functions and can no longer drink independently. The knowledge from this article contributes to our understanding of current practice and shows an area that requires immediate attention for the improvement of fundamental palliative care delivery.

Water scarcity can be a critical limitation for the poultry industry

Water is essential for various physiological functions and the productive performance of animals. However, with climatic uncertainties exacerbated by climatic changes, water could become a scarce nutrient shortly. This is already the case in one-third of the world's countries, which are under medium to high levels of water stress. Accordingly, with the growth of poultry production, the availability of water at ad libitum level may not be guaranteed, and birds can be under water restriction for variable periods. Thus, this article aims at attracting the attention of animal scientists to the freshwater shortage challenge, as well as shedding light on (1) the effects of climate change on the freshwater resources; (2) the effects of limited access to water, either by water restriction (WR) or water deprivation (WD), on the growth, feed efficiency, and meat quality of broilers; (3) the effects of different levels of WR or WD on egg production and egg quality traits; (4) the effects of limited access to water on the health, behavior, and welfare status of chickens; and (5) suggested solutions to overcome future water shortage challenges. In conclusion, severe water shortage/restriction might negatively influence the productivity, behavior, and welfare status of the chickens. Genetic background and environmental conditions may interact with the WR effects. The tolerance level of indigenous chicken breeds to limited water access could provide the knowhow to potential solutions to overcome water shortage problems. Selection of chicken strains with high tolerance capacity to thirst and limited water access regimens may be a sustainable solution for solving water scarcity problems.

The effectiveness of cold oral stimuli in quenching postoperative thirst: A systematic review and meta-analysis

OBJECTIVE

To examine the effectiveness of cold oral stimuli in quenching postoperative thirst in patients undergoing surgery.

DESIGN

A systematic review and meta-analysis of interventional studies.

SETTING

Postoperative care units.

METHODS

Seven electronic databases (Medline, Scopus, Web of Science, PubMed, CINHAL, PsycInfo, and EMBASE) were systematically searched from their inception to January 12, 2022. The Cochrane Handbook for Systematic Reviews of Interventions was followed. Two researchers examined the study quality using the Cochrane risk of bias tools. A meta-analysis with a subgroup analysis was performed. Sensitivity analysis, funnel plots and Egger's test were used to examine publication bias.

MAIN OUTCOME MEASURE

A thirst intensity score was used to rate postoperative thirst.

RESULTS

Data were collected from 11 interventional studies for this systematic review. Eight studies underwent a meta-analysis with a total of 1504 patients. Our meta-analysis showed that the thirst intensity scores decreased in the experimental groups by 1.42 points (95% confidence interval: -2.162 to -0.684) more than those of the control groups. Subgroup analysis indicated that Asian patients and age were two factors that moderated the thirst intensity score after applying cold oral stimuli.

CONCLUSION

Cold oral stimuli were effective in mitigating postoperative thirst. Ice products such as ice cubes, or ice chips are easily available in postoperative units. When applying cold oral stimuli, health professionals should be aware of that in Asian and older patients. Cultural acceptance and physiological degeneration, respectively, may influence the thirst ratings. Future research should investigate various factors underlying the perioperative period. Network meta-analysis can be used to examine multiple strategies for thirst management.

Comparing thirst and spot urine concentrations in humans of differing body sizes: An observational study

Elevated body mass index (BMI) has been associated with elevated urine osmolality (UOsm), despite having higher total water intake, but it is unclear if overweight/obese individuals have reduced thirst. In this observational study, we found that overweight/obese individuals had higher UOsm compared to normal-weight individuals (749 ± 37 vs. 624 ± 35 mmol•kg^-1; P < 0.01) while possessing similar thirst ratings (56.4 ± 3 vs. 51.6 ± 3 mm; P = 0.3). In this observational study, overweight/obese individuals possessed more concentrated urine in the absence of higher thirst perception.

Thirst in patients admitted to intensive care units: an observational study

Background

Despite various studies reporting a high prevalence, reaching 71%, the sensation of thirst in intensive care unit (ICU) patients, its prevention, detection, and management, is not well known nor considered. Limited research has examined the causes of thirst in ICU patients, while it has been examined in other patient populations.

Aim

To determine the incidence and intensity of thirst in patients admitted to ICU and its association with airway devices (endotracheal tube, tracheostomy, oxygen mask), airway humidification, patients’ characteristics, and therapy (serum sodium concentration, hematocrit, fluid balance, possibility of oral hydration, and dosage of diuretics).

Methods

Patients were interviewed daily to report the presence of thirst and rate its intensity on a Numeric Rating Scale (NRS) from 0 (no thirst) –10 (intolerable thirst). Other data were obtained through direct evaluation or by consulting medical records. Patients admitted to three ICUs from May to August 2014 in a university hospital in Italy were included.

Results

A total of 220 Patients were enrolled. Thirst was found in 76.1% of patients’ observations, with a mean thirst score of 5.37. Thirst intensity was predicted by high doses of diuretics (> 100 mg/die), increasing serum sodium concentration, absence of oral hydration and the presence of xerostomia. Thirst was associated with the use of humidified Venturi mask.

Conclusions

Thirst is highly prevalent among patients in this population of intensive care patients. It would be desirable to evaluate this stressor at least daily, to eliminate or relieve this sensation.