Which statement by a graduate nurse in a hospice unit requires intervention by the preceptor?

• A. The patient has eaten only small amounts the past 48 hours; will the physician consider placing a feeding tube?
• B. The family seems comfortable with the long periods of silence.
• C. The physician ordered an increase in the dosage of morphine; I will administer the new dose right away.
• D. The blood pressure is lower this afternoon than it was this morning; I will communicate the changes to the family.

Answer: (A)

In hospice care, the emphasis is on comfort and aligning every intervention with the patient’s goals and the likely benefits vs. burdens. A situation where a patient with advanced illness has had minimal intake for two days and the team is considering placing a feeding tube signals a shift toward aggressive treatment that is often not aligned with palliative goals. The preceptor needs to step in to redirect the plan toward comfort-focused care, clarify the patient’s wishes and prognosis, and ensure decisions reflect goals of care and informed discussions with the family. This is a teaching moment about when artificial nutrition is appropriate in late life versus when it may cause more burden than benefit.

The other statements fit within a care plan that respects orders, family dynamics, and ongoing communication: following a physician’s order to adjust pain medication ensures the patient’s comfort; communicating objective changes like blood pressure shifts to the family supports transparency and shared decision-making; and a family’s comfort with silence reflects adaptability to the patient’s and family’s coping style.

So the statement about considering a feeding tube requires the preceptor’s intervention to reinforce a hospice-appropriate approach and guide goal-concordant care.