Feb 23, 2024 NURS 6052 Discussion: Patient Preferences and Decision Making
NURS 6052 Discussion: Patient Preferences and Decision Making
NURS 6052 Discussion: Patient Preferences and Decision Making
The evolution of technology allows patients to have more access to information resulting in well-informed, educated patients. While it is great that patients are taking the initiative to play active roles in their healthcare, it comes with challenges. Working in labor and delivery, I have had many experiences with patient involvement in treatment and healthcare decisions. One reoccurring experience that patient involvement helps aid in best practice and incorporates them in healthcare decision-making is birth plans.
Birthing plans set expectations and standards of care couples expect during the laboring process (Hidalgo-Lopezosa et al., 2021). According to a study by Hidalgo-Lopezosa et al. (2021), birth plans in southern Spain resulted in fewer interventions and more natural birthing processes. While the utilization of birth plans creates a clear picture of how the patient wants their delivery to go, they can be challenging, especially when they are unwilling to deviate from the plan. When I first started working labor and delivery, the first bout of knowledge my preceptor shared with me is never to trust a pregnant woman. While she did not mean this figuratively, the patient’s status can rapidly progress or decline. This instability can create a need for evidence-based innovations the couple is unwilling to try or had not discussed when developing their plan.
De Campos Silva and Lopes (2020) concluded the need for couples to discuss their birth plans with their physician or midwife to ensure all possibilities are deliberated, and each party has a clear understanding of desires and possible outcomes. Initiating these conversations before delivery would help reduce the challenges healthcare providers at my organization face when handed a birth plan, especially when the plan does not align with unit policies and the American College of Obstetricians and Gynecologist recommendations. The biggest challenge I have faced is a delivery that resulted in a limp unresponsive newborn. The mother’s demand for the newborn to be placed in kangaroo care impeded proper intervention outlined by the Neonatal Newborn Resuscitation Program. After much explanation, the mother allowed the newborn to be placed in the warmer, where the newborn was intubated and flown to a tertiary hospital. The newborn was diagnosed with a diaphragmatic hernia which prevented proper lung growth. The diaphragmatic hernia could have been diagnosed with ultrasound; however, the mother refused. While the patient had the right to create a birth plan, I feel frequent in-depth conversations with a physician or midwife could have helped this situation.
Struggling to Meet Your Deadline?
Get your assignment on NURS 6052 Discussion: Patient Preferences and Decision Making done on time by medical experts. Don’t wait – ORDER NOW!
Meet my deadline
Patients have the right and should want to be active participates in their healthcare decisions. They should research and become educated but also value the expertise of their physician and other healthcare providers. Without the collaboration of patients and healthcare providers, evidence-based practice is nonexistent (Melnyk and Fineout-Overholt, 2019). Both must work together and use best practices to aid their decisions to improve health.
References
de Campos Silva, T. M., & Lopes, M. I. (2020). The couple’s expectations for the birth
plan. Revista de Enfermagem Referência, 2, 1–7. https://doi-org.ezp.waldenulibrary.org/10.12707/RIV19095
Hidalgo-Lopezosa, P., Cubero-Luna, A. M., Jiménez-Ruz, A., Hidalgo-Maestre, M., Rodríguez-
Borrego, M. A., & López-Soto, P. J. (2021). Association between Birth Plan Use and Maternal and Neonatal Outcomes in Southern Spain: A Case-Control Study. International Journal of Environmental Research and Public Health, 18(2). https://doi-org.ezp.waldenulibrary.org/10.3390/ijerph18020456
Melnyk, B. M., & Fineout-Overholt, E. (2018). Evidence-based practice in nursing &
healthcare: A guide to best practice (4th ed.). Philadelphia, PA: Wolters Kluwer.
As a labor and delivery (L&D) nurse you are involved in and witness a lot of patients and their families making tough decisions. One situation that comes to mind is a 22-year-old female, pregnant with her first child and the fetus was diagnosed with a neural tube defect. She did not have prenatal testing during her pregnancy. This defect caused her baby’s brain not to fully develop. The parents did not understand the diagnosis and wanted more information about the defect.
They were provided the information but were also told that the baby would not survive long after delivery and other options were discussed. Ultimately, the team and the family were all on the same page, and made the best decision for the patient and her wishes. It was a beautiful process.
As her nurse, it was my responsibility to get in touch with the genetic counselor to make sure the parents were provided the information and the support needed to make an informed decision. Since I have been a nurse, it is imperative for me to involve the patients and their families. Autonomy or self-determination is at the core of all medical decision-making in the United States. (Congress.gov, 1990). It means that patients have the right and ability to make their own choices and decisions about medical care and treatment they receive.
When we include the patient’s preferences and values, the trajectory of the situation might change in a way that the medical providers do not anticipate. Sometimes the outcomes are surprising, but often, it is what the physicians said it would be. As caregivers, we must respect the patients wants and needs, and if that means going in another direction because that is what the patients want, then that is what we are going to do. (Davoodvand, et al, 2016). The physicians do get upset, but we as nurses must speak up for and at times speak for the patient. I know some nurse’s personalities are stronger than others, but we must advocate for our patients.
The patient decision aid I selected was “Pregnancy: Should I Have Screening Tests for Birth Defects?” According to the Ottawa Hospital’s Research Institute, (2022) Testing for birth defects means that you may find out that your baby has a serious problem Would this information about that your baby having a birth defect change your plans? What I have seen in my practice as an L&D nurse is, we can never tell who will and will not continue with the pregnancy.
We need to make sure that the proper information is given and that the parents understand what is being told to them. Often, they do not comprehend and we as providers do not see that they don’t. it is important to use tools that the patients and their families understand and use to better understand their situation and or diagnosis.
I would use this visual aid; it is very clear and straight to the point about what the screening is. It goes through six steps in detail. Get the facts, compare options, your feelings, your decision, quiz yourself, and your summary. This aid helps your say in this decision, this information will help you understand what your choices are so that you can talk to your doctor about them.
References
Congress.Gov.(1990). H.R.4449 – Patient Self Determination Act of 1990.
https://www.congress.gov/bill/101st-congress/house-bill/4449Links to an external site.
Davoodvand S, Abbaszadeh A, Ahmadi F. (2016). Patient advocacy from the clinical nurses’ viewpoint: a qualitative study. J Med Ethics Hist Med. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4958925/
The Ottawa Hospital’s Research Institute. (2022) Decision Aids Inventory. “Pregnancy: Should I Have Screening Tests for Birth Defects?” https://decisionaid.ohri.ca/Azsumm.php?ID=1179
NURS6052 Discussion Week 8 Module 5
Patient Preferences and Making Decisions
There have been many instances in my ten years as a nurse where I felt that the patient’s personal preferences and experiences could be beneficial to their treatment. Shared decision making is the process of clinician and patient jointly participating in a health decision after discussing the options, the benefits and harms, and considering the patient’s values, preferences, and circumstances ( Hoffman, Montori, & Del Mar, 2014). I have had many providers listen to the patient’s input. I have also had many providers ignore the patient and do what they felt was best. One such case was a young lady with severe anxiety and panic attacks.
The patient had tried many different medications through-out the years and felt as if she knew what was completely ineffective.
She also had not been able to find a coping skill that was enough to prevent a panic attack. The provider in this case ordered sedating medication, which the patient had expressed made her “a zombie” as well as coping skill education. The patient was unable to participate in coping skills education as she quickly became so somnolent that all she did was sleep. She was not having panic attacks however sleeping all day is not helpful. I believe that had the provider listened to the patient in the first place, valuable time would not have been loss on ineffective treatment. Utilizing coping skills was eventual removed from her plan of care as it did not work for her.
A focus that incorporates all three facets of evidence based practice helps ensure solid footing for effective decisions (Laureate Education, 2018). Patient preferences were not taken in to account in this instance. I chose the decision aid, panic disorder: Should I take medicine? The patient decision aid would be useful in the particular situation as well as similar situation because it allows the patient to make decisions in a step by step matter. First with education regarding the diagnosis, what to expect, and why your provider may order what they do. I feel that a start to finish visual guide such as this would ease the patients stress regarding treatment and improve their experience. I would definitely use these aids as a provider for the before mentioned reasons.
References
Hoffman, T. C., Montori, V. M., & Del Mar, C. (2014). The connection between evidence-based medicine and shared decision making. Journal of the American Medical Association, 312(13), 1295–1296. doi:10.1001/jama.2014.10186
Laureate Education (Producer). (2018). Evidence-based Decision Making [Video file]. Baltimore, MD: Author.
The Ottawa Research Hospital Institute. (2019). Patient decision aids. Retrieved from https://decisionaid.ohri.ca/Azsumm.php?ID=1060 https://decisionaid.ohri.ca/Azsumm.php?ID=1060
ORDER NOW FOR AN ORIGINAL PAPER ASSIGNMENT: Discussion: Patient Preferences and Decision Making
Question Description
I’m working on a Nursing question and need guidance to help me study.
Discussion: Patient Preferences and Decision Making
Changes in culture and technology have resulted in patient populations that are often well informed and educated, even before consulting or considering a healthcare need delivered by a health professional. Fueled by this, health professionals are increasingly involving patients in treatment decisions. However, this often comes with challenges, as illnesses and treatments can become complex.
What has your experience been with patient involvement in treatment or healthcare decisions?
In this Discussion, you will share your experiences and consider the impact of patient involvement (or lack of involvement). You will also consider the use of a patient decision aid to inform best practices for patient care and healthcare decision making.
Shared decision-making and evidence-based practice (EBP) play significant roles in patient care quality and patient outcomes (Hoffman et al., 2014). They can be used together to improve patient outcomes. Shared decision-making allows the patient to feel like they have some control over their treatment and the decisions being made. EBP allows the best practices to be used in care.
Incorporating patient preferences, social determinants, and values can significantly improve the care provided to patients (Gurmu, 2022). I work with patients with mental health and behavioral disorders. In this specialty, I have worked with a variety of patients with depression. For instance, there was an adolescent patient admitted to the unit where I worked who was very depressed and expressed suicidal ideation. His parents were perfectionists and pushed him very hard. They allowed him no freedom and controlled every aspect of his life. He expressed the desire to take his life because he felt it was the one thing he could control. During the initial assessment, I used his preferences, values, and social determinants to create a care plan. During his hospital stay, I allowed him to make some decisions regarding his care and treatment follow-ups when discharged. Using his preferences, values, and social determinants to guide his care gave him a sense of control over his life. His parents became a part of his treatment, and their roles in his life were altered for the better. He no longer voiced any depression or suicidal ideation.
The patient decision aid I selected was “taking antidepressants for depression”. Antidepressants with counseling can be more effective in treating depression than counseling alone (The Ottawa Hospital Research Institute, 2019). Antidepressants help those with depression to manage their condition better and have an improved quality of life. In the experience posted, the patient decision aid helped me treat the patient’s condition. The patient decision aid is effective in practice, and I will continue to use it to treat others suffering from depression.
References
Gurmu Y. (2022). Patient Preferences in Shared Decision Making During Healthcare and Associated Factors Among Adult Admitted Patients at Public Hospitals of West Shoa Oromia, Ethiopia. Patient preference and adherence, 16, 1781–1786. https://doi.org/10.2147/PPA.S376600Links to an external site.
Hoffman, T. C., Montori, V. M., & Del Mar, C. (2014). The connection between evidence-based medicine and shared decision makingLinks to an external site.. Journal of the American Medical Association, 312(13), 1295–1296. doi:10.1001/jama.2014.10186
The Ottawa Hospital Research Institute. (2019). Patient Decision Aids. Retrieved November 6, 2023, from https://decisionaid.ohri.ca/Azsumm.php?ID=1058
A profound situation that sticks out to me was when I was a surgical nurse. We had an oncology patient come in for tumor excision. Prior to the surgery I ran her urine POCT, and she was pregnant. She refused the surgery, understandably. The doctors discussed with her that chemo and radiation were her best option, however ultrasound had showed the baby was just into the second trimester. This was an impossible situation for me to imagine and still is. The mom decided to decline all treatments until after the baby was born. Just under a year later she was back, with the baby! We did the treatments as we originally planned, but the cancer had progressed and she did end up leaving on Hospice with CMO orders. Even so, she was absolutely at peace with this decision and thrilled that she had a healthy baby.
It is always important to consider patient preferences. The patient retains the right to choose. It is important that the patient can provide sound informed consent and agree to proceed with the procedure (Olejarczyk, 2022). The best way to approach situations like these is with shared decision making. Shared decision making includes establishing a trusting relationship with the patient; providing emotional support; assessing patients’ understanding of the situation; explaining the patient’s condition and prognosis; highlighting that there are options to choose from; explaining principles of surrogate decision-making; explaining treatment options; eliciting patient’s values, goals, and preferences; deliberating together; and making a decision (Kon et al., 2016).
There are decision aids for cancer. There are decision aids for each type of cancer. There are decision aids for pregnancy. Decision aids are a useful tool that help to easily organize the treatment options (McAlpine at al., 2018). It may be helpful to utilize decision aids in my future practice when patients need them. Ultimately, however this woman made her choice from love for her child, which no aid can help navigate.
Patient Preferences and Decision Making
It is the role of the clinician to assist patients and their support system to provide guidance in regards to the patient specific treatment plan. Using Evidence-Based Practice (EBP), which is the integration of patient preferences, their values, clinical expertise, and thorough research will assist in the collaboration to make treatment decisions that result in improved outcomes (Melnyk & Fineout-Overholt, 2018). When patients and families are faced with difficult choices regarding the treatment of their medical problem, many times emotions and logic may skew decision making capacity. Therefore, it is crucial that the treatment team to use EBP integrate patient preferences with the treatment plan. Utilizing decision making tools is helpful for those involved to weigh the facts and feelings in order to do what is best for the patient.
Patient Scenario
In my work as a member of the Behavior Response Team at my hospital, I am often called to assist staff in managing patients with dementia who are experiencing behavioral disturbances, aggression, and agitation. The case of Bob (alternative name) is an example of a family making an incredibly difficult decision to transition to palliative care.
Bob was approximately 90 years old and diagnosed with Advanced Dementia and recurring Urinary Tract Infections (UTI). Sudden behavioral changes such as confusion, aggression, hallucinations, delusions, and paranoia are common symptoms of a UTI (Alzheimer’s Association, 2020). This was the experience for Bob over the course of several months. His care facility would bring him the Emergency Department due to aggressive behaviors towards staff and he would subsequently be diagnosed with a UTI and admitted for treatment. For the first several days of admission, Bob would exhibit ongoing aggression, paranoia, and confusion which required administration of chemical restraints with physical hold. After the first few days of antibiotic dosing his behavior would return to baseline; a pleasantly confused man who enjoyed listening to country music and talking about farm life.
Bob’s wife was his medical Power of Attorney, which had been activated several years ago. In conjunction with the recommendations of the medical ethics team, Bob’s wife chose to honor his dignity and transition to palliative care. There would be no more administration of antibiotics for his recurring UTI’s and his care would be comfort focused. The palliative care team worked closely with Bob, his wife, and the hospital staff to outline a plan to relieve Bob’s distress and provide him with peace in his final days.
Impact of Patient Preferences
Shared decision making is the intersection of patient-centered communication and EBP in which the patient and clinician work together to make a health care decision after reviewing the options for care, benefits and consequences of treatment, patient values, preferences and circumstances (Hoffman et al., 2014). This process was evident in the scenario of Bob and his wife. After failed ability to decrease UTI, behavioral disturbances and hospitalizations, the palliative team worked closely with Bob and his wife to determine the most appropriate treatment plan. Bob had made his end of life wishes known to his wife prior to his cognitive decline, and through the shared decision-making process with the clinicians involved, she was able to honor his wishes and dignity and decrease his emotional and physical distress through provision of comfort cares.
Value of Patient Decision Aid
There is a wide variety of tools available to assist patients, their families, and clinicians to work through ethical obligations and realistic treatment options when facing challenging decisions. I’m unsure if any particular decision-making model was utilized in the case of Bob, however, the University of North Carolina (UNC) Palliative Care Program does have a tool specifically designed for guiding patients and families in making decision about end of life care. A Decision Aid About Goals of Care for Patients with Dementia (UNC School of Medicine, 2020) was created by UNC Palliative Care Program to assist families to make difficult choices for their family member with dementia. The tool is a simple to follow video, which guides families through common treatment decisions that they will encounter such as life-sustaining treatment, tube feeding, treatment of infections, and hospital transfer for acute illness. There is proven relevancy to the impact using this tool has on the care of the patient. In a goals of care study, researchers found that a decision aid for surrogate decision makers of patients with advanced dementia was effective in improving the quality of end-of-life communication and enhanced palliative care (Hanson et al., 2017).
The patient decision aid for patients with dementia may have contributed to the decisions Bob’s wife had to make on his behalf. It may have provided additional education from an independent source to help guide her decisions about goals of care to be informed and also educate on how to communicate with the treatment team about the decisions to be made.
Application of Decision Aid in Personal Practice
The Ottawa Hospital Research Institute’s Decision Aids Inventory (The Ottawa Hospital Research Institute, 2019) provides a wealth of resources for patients and clinicians to encourage people to become more engaged in decision making about health care treatments by providing options, outcomes while integrating personal values. I will utilize this inventory in my own practice. By choosing a specific condition, I can utilize the tool to provide condition specific education and deconstruct complicated treatment scenarios into discrete items to be viewed through the scope of patient preferences and values. It will be valuable to use for patients and families who may be overwhelmed with the emotions associated with end-of-life care planning or other diagnosis and situations which require a methodical approach.
Bob’s life ended during that final hospitalization. His wife had to make a difficult decision which required separating her personal need for Bob to remain alive and the harsh reality of his disease state and poor outcomes. Integrating a decision making tool into scenarios like this would be helpful for the patient and family members to be knowledgeable about their personal beliefs and values, disease processes and outcomes and ability to communicate preferences to the treatment team.
Initial Discussion – Week 8
There have been many instances in my ten years as a nurse where I felt that the patient’s personal preferences and experiences
could be beneficial to their treatment. Shared decision making is the process of clinician and patient jointly participating in a
health decision after discussing the options, the benefits and harms, and considering the patient’s values, preferences, and
circumstances ( Hoffman, Montori, & Del Mar, 2014). I have had many providers listen to the patient’s input. I have also had many
providers ignore the patient and do what they felt was best. One such case was a young lady with severe anxiety and panic attacks.
The patient had tried many different medications through-out the years and felt as if she knew what was completely ineffective.
She also had not been able to find a coping skill that was enough to prevent a panic attack. The provider in this case ordered
sedating medication, which the patient had expressed made her “a zombie” as well as coping skill education. The patient was
unable to participate in coping skills education as she quickly became so somnolent that all she did was sleep. She was not having
panic attacks however sleeping all day is not helpful. I believe that had the provider listened to the patient in the first place,
valuable time would not have been loss on ineffective treatment. Utilizing coping skills was eventual removed from her plan of
care as it did not work for her. A focus that incorporates all three facets of evidence based practice helps ensure solid footing for
effective decisions (Laureate Education, 2018). Patient preferences were not taken in to account in this instance. I chose the
decision aid, panic disorder: Should I take medicine? The patient decision aid would be useful in the particular situation as well as
similar situation because it allows the patient to make de
Order a similar assignment, and have writers from our team of experts write it for you, guaranteeing you an A
