Patient Preferences and Decision Making Discussion
Discussion – Week 11
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.
To Prepare:
- Review the Resources and reflect on a time when you experienced a patient being brought into (or not being brought into) a decision regarding their treatment plan.
- Review the Ottawa Hospital Research Institute’s Decision Aids Inventory at https://decisionaid.ohri.ca/.
- Choose “For Specific Conditions,” then Browse an alphabetical listing of decision aids by health topic.
NOTE:To ensure compliance with HIPAA rules, please DO NOT use the patient’s real name or any information that might identify the patient or organization/practice.
By Day 3 of Week 11
Post a brief description of the situation you experienced and explain how incorporating or not incorporating patient preferences and values impacted the outcome of their treatment plan. Be specific and provide examples. Then, explain how including patient preferences and values might impact the trajectory of the situation and how these were reflected in the treatment plan. Finally, explain the value of the patient decision aid you selected and how it might contribute to effective decision making, both in general and in the experience you described. Describe how you might use this decision aid inventory in your professional practice or personal life.
By Day 6 of Week 11
Respond to at least two of your colleagues on two different days and offer alternative views on the impact of patient preferences on treatment plans or outcomes, or the potential impact of patient decision aids on situations like the one shared.
Click on the Reply button below to reveal the textbox for entering your message. Then click on the Submit button to post your message.
7 months ago
hope Davis
RE: Discussion – Week 11
Integrating culture and technology in healthcare has resulted in more educated and well-informed patients. Patients are now more involved in making decisions or expressing opinions on the several treatment options, including the sharing of information and being able to accept instructions provided by the healthcare team. While working in my healthcare organization, a patient was diagnosed with type 2 diabetes. Managing diabetes requires outstanding commitment both from the clinician’s side and the patient’s side to reduce the risk of life-threatening complications. The healthcare team decided to involve the patient in his care, and the results were very positive.
The team consisted of the primary care provider, the diabetes care specialist, and the nutritional specialist. The team educated the patient on managing the diabetic condition and made it clear that the more considerable commitment would be from the patient’s side. After receiving the information from the team, the patient also came up with some possible ways that he would apply in the management of his care. For instance, he promised to stop smoking and even suggested that he engage in regular physical exercise[1]. The patient was also able to recommend some of the ways he could use to manage his diet, and all of these proved to be essential as the patient’s quality of life improved within a few months.
Engaging patients in their care is critical and practical as it helps the healthcare team make informed decisions about the healthcare options available for the patients. For diabetic
patients, patient participation in healthcare results in good health outcomes and improves the quality of life for individuals. The patient was also able to receive a more effective, relevant, and cost-effective healthcare service. Therefore, it is essential to engage patients in their healthcare process to improve their healthcare behavior and better monitor their health.
References
Krist, Alex H, Sebastian T Tong, Rebecca A Aycock, and Daniel R Longo. “Engaging Patients in Decision-Making and Behavior Change to Promote Prevention.” Studies in health technology and informatics. U.S. National Library of Medicine, 2017. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6996004/.
Lemmens, Lidwien C, Simone R de Bruin, Jeroen N Struijs, Mieke Rijken, Giel Nijpels, and Caroline A Baan. “Patient Involvement in Diabetes Care: Experiences in Nine Diabetes Care Groups.” International journal of integrated care. Uopen Journals, December 15, 2015. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4843182/.
Vahdat, Shaghayegh, Leila Hamzehgardeshi, Somayeh Hessam, and Zeinab Hamzehgardeshi. “Patient Involvement in Health Care Decision Making: A Review.” Iranian Red Crescent medical journal. Kowsar, January 2014. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3964421/.
7 months ago
Albert Hatcher
RE: Discussion – Week 11
7 months ago
Stacy Hinson
RE: Discussion – Week 11- Reply #2
Hope,
Great plan of action with your patient. Having the patient as part of the interdisciplinary team is key in getting the A1c lowered, especially since diabetes is a hand to mouth disease (Kon et al, 2016). The CDC also
acknowledges the family support as being vital in the disease management by enabling the patient to feel empowered and not overwhelmed (CDC, 2020). There was also a paper done by Teufel-Shone, Drummond, &
Rawiel (2005) that touched on the importance of including family to build family support for patients with diabetes and to teach primary prevention behaviors to family members since diabetes is seen with genetic
components, especially in ethnic communities such as Native Americans and Hispanics.
Reference:
Centers for Disease Control and Prevention. (2020, August 13). Friends, Family & Diabetes. Centers for Disease Control and Prevention. Retrieved May 12, 2022, from https://www.cdc.gov/diabetes/library/features/family-friends-diabetes.html
Kon, A. A., Davidson, J. E., Morrison, W., Danis, M., & White, D. B. (2016). Shared decision making in intensive care units: An American College of Critical Care Medicine and American Thoracic Society policy statement. Critical Care Medicine, 44(1), 188-201. https://www.doi.org/10.1097/CCM.0000000000001396
Teufel-Shone, N. I., Drummond, R., & Rawiel, U. (2005). Developing and adapting a family-based diabetes program at the U.S.-Mexico border. Preventing chronic disease, 2(1), A20.
7 months ago
Mary Bemker-page WALDEN INSTRUCTOR MANAGER
RE: Discussion – Week 11
As you indicate, the buy-in is a big part of compliance. When we share the decision- making process with the patient or client we increase the probability that the individual will follow through. When we do not include the patient in the overall decision process, it is easy to miss key variables that can impact outcome. Int also enhances the overall probability of the patient’s lack of understanding and potential compliance. We can hear the patient/client and properly assess their understanding, environmental supports, etc. Just using a decision tree without truly listening to our partner (patient/client) is great; combining this with the added dynamics you address is spectacular.
Kudos for such!
Dr. B.
7 months ago
Adetokunbo Oluwatuyi
RE: Discussion – Week 11
Hello Hope!,
I do believe that your behavior toward patients will be reflected on they come out, dealing with patients at times is like raising a baby. I am glad you and the healthcare team and the patient all worked together to gain positive results and I am very happy for both sides. Those are the times when being in the healthcare industry gives the best feelings. I am glad you guys followed patient participation which brings involvement of the patient in decision making or expressing opinions about different treatment methods, which includes sharing information, feelings, and signs and accepting health team instructions. (Vahdat et al., 2014) What level do you think that healthcare team was at with patient involvement, I can guess it’s higher due to the results because it is stated in an article that different regulators are at different stages in developing strategies and methods of patient engagement, which are more advanced in some areas (eg, anticancer medicines) than in others. (Campbell & Sedrakyan, 2021)
Campbell, B., & Sedrakyan, A. (2021). Patient involvement in regulation: an unvalued imperative. The Lancet, 397(10290), 2147–2148. https://doi.org/10.1016/s0140-6736(21)00977-6
Vahdat, S., Hamzehgardeshi, L., Hessam, S., & Hamzehgardeshi, Z. (2014). Patient Involvement in Health Care Decision Making: A Review. Iranian Red Crescent Medical Journal, 16(1). https://doi.org/10.5812/ircmj.12454
7 months ago
Mary Bemker-page WALDEN INSTRUCTOR MANAGER
RE: Discussion – Week 11
You offer some great points here. Did you use any decision trees for this consideration?
Dr. B.
7 months ago
Britny Ray
RE: Discussion – Week 11
Hey Hope,
Having culturally knowledge peple in healthcare is very important. Cultural competence in healthcare refers to the “ability of systems to provide care to patients with diverse values, beliefs and behaviors, including the tailoring of healthcare delivery to meet patients’ social, cultural and linguistic needs (ahrq.gov, 2019). Diabetes is a very common disease in African Americans and it is important to understand the culture behind it to have successful patient outcomes. Black adults are nearly twice as likely as white adults to develop type 2 diabetes, this racial disparity has been rising over the last 30 years (nih.gov, 2018).
References
U.S. Department of Health and Human Services. (2018, January 23). Factors contributing to higher incidence of diabetes for Black Americans. National Institutes of Health. Retrieved May 14, 2022, from https://www.nih.gov/news-events/nih-research-matters/factors-contributing-higher-incidence-diabetes-black-americans
Cultural Competence and Patient Safety. Patient Safety Network. (n.d.). Retrieved May 14, 2022, from https://psnet.ahrq.gov/perspective/cultural-competence-and-patient-safety
7 months ago
Crystal Anderson
Response #2
7 months ago
Shirley Harleston
RE: Discussion – Week 11
I believe in listening to my patients. When I do this, it has always resulted in positive outcomes. An example is when I used to work in long-term care, We have so many patients to care for and I always make sure that during the walk-in rounds I assess all my patients as I get reports. I ask them how they are doing. At that time they tell me their issues and I address those issues promptly. For Patients who are not verbal, I do a thorough assessment and if the family is present and they tell me that they are not doing well I make sure I do what I can as a nurse. In some situations, you have to call the physician and describe the situation and get orders to treat the patient. By taking care of patients at the beginning of the shift my day runs smoothly.
Likewise, during an encounter with patients, we get a history of the patient that comprises of previous medical history and family history. Evidence-Based Medicine has shown that Without Shared decision-making (SDM), authentic EBM cannot occur. It is a mechanism by which evidence can be explicitly brought into the consultation and discussed with the patient. (Hoffman, et al., 2014).
According to the literature, clinicians should generally start with a default shared decision-making approach that includes the following three main elements: information exchange, deliberation, and making a treatment decision. the patient or surrogate shares information about the patient’s values, goals, and preferences that are relevant to the decision at hand (Kon, et al 2016).
According to The Ottawa Hospital Patient decision aids, a decision aid summary is a means of making decisions with patient involvement. This tool asks questions about criteria to be defined as patient decisions, and criteria to lower the risk of making Evidenced-biased decisions. People exposed to decision aids feel more knowledgeable, better informed, and clearer about their values and risks. (Stacy, et al., 2017).
Reference:
Hoffmann TC, Montori VM, Del Mar C. The Connection Between Evidence-Based Medicine and Shared Decision Making. JAMA. 2014;312(13):1295–1296. doi:10.1001/jama.2014.10186
Kon, A. A., M.D., Davidson, Judy E,D.N.P., R.N., Morrison, W., M.D., Danis, M., M.D., & White, Douglas B,M.D., M.A.S. (2016). Shared decision-making in intensive care units: Executive summary of the american college of critical care medicine and american thoracic society policy statement. American Journal of Respiratory and Critical Care Medicine, 193(12), 1334-1336. Retrieved from https://www.proquest.com/scholarly-journals/shared-decision-making-intensive-care-units/docview/1797885427/se-2?accountid=14872
Patient decision aids. The Ottawa Hospital Patient decision aids. Decision aid summary.
Stacey D, Légaré F, Lewis KB. Patient Decision Aids to Engage Adults in Treatment or Screening Decisions. JAMA. 2017 Aug 15;318(7):657-658. doi: 10.1001/jama.2017.10289.
7 months ago
hope Davis
RE: Discussion – Week 11
Hi Shirley,
I enjoyed reading your post. The only way to get accurate subjective information is to listen to the patient. Patients know their bodies better than we as healthcare workers know. Off cause we real on objective results we get after assessing a patient and evidence-based information. However, overall a patient leads us as healthcare to that direction by giving us all the personal information necessary to get a diagnosis. According to Wilson, “Subjective data is critical as it allows the physicians to determine what the patient’s official diagnoses are, or help nurses paint a picture of a patient’s condition (findanyanswer.com).”
As nurses, our job is to assess a patient and make the physician aware of the symptoms, so he/she can determine the diagnosis. You sound so thorough, and I wish all nurses would care for their patients as you do. I genuinely enjoy your informative post.
evidence-based is the only way to get positive outcomes from patients and their families after a diagnoses
.
references
Findanyanswer.com. (n.d.). Retrieved May 9, 2022, from https://findanyanswer.com/
What is evidence-based medicine? – informedhealth.org – NCBI bookshelf. (n.d.). Retrieved May 9, 2022, from https://www.ncbi.nlm.nih.gov/books/NBK279348/
7 months ago
Tosin Addeh
RE: Discussion – Week 11
Good day Shirley,
I want you to know that your post was very educative to read and I admire the choice of words you used to educate us. I like that you used the term Shared decison making (SDM). Acoording to Hargraves et al. (2020), SDM allows the patient to have an individualized plan of care where the patient can incorperate with own values and preferences. I strongly agree that all healthcare professionals should try to employ SDM in their daily practices. Doing this will help the patient actualize their healing goals and make them feel acomplished.
I feel like the SDM is like the Ottawa Hospital Patient decision aids; patient are able to make infomred decisons about thier health that is meaninging and with positive outcome instead of making deceision from a place of no hope.
Reference
Hargraves, I. G., Fournier, A. K., Montori, V. M., & Bierman, A. S. (2020, October). Generalized shared decision making approaches and patient problems. adapting AHRQ’S SHARE approach for purposeful SDM. Patient education and counseling. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8142549/
Patient decision aids. The Ottawa Hospital Patient decision aids. Decision aid summary. https://decisionaid.ohri.ca/#:~:text=Patient%20decision%20aids%20are%20tools,counseling%20from%20a%20health%20practitioner.
7 months ago
Shirley Harleston
RE: Discussion – Week 11
Thank you, Tosin.
7 months ago
Claudia Paz
RE: Discussion – Week 11
Hello Shirley,
I think it is important to start the day off on the right foot. A thorough assessment benefits the patient in so many ways and can even save their lives. In nursing homes it can be extremely difficult for the patient and doctor to participate in shared decision making. The majority of the patients are confused and those that are not have might not have a patient advocate that can speak for them. On the other hand,some patients are “active stakeholders” and are very involved in their care (Semenov et al., 2018). Some patients benefit from the Ottawa personal decision guide whether they are faced with a small or big decision and it is helpful in identifying the patients needs (Patient decision aids, 2019).
Reference
Semenov, I., Kopanitsa, G., Denisov, D., Alexandr, Y., Osenev, R., & Andreychuk, Y. (2018). Patients Decision Aid System Based on FHIR Profiles. Journal of Medical Systems, 42(9), 1. https://doi.org/10.1007/s10916-018-1016-4
The Ottawa Hospital Research Institute. (2019). Patient decision aids. Retrieved from https://decisionaid.ohri.ca/
7 months ago
Crystal Anderson
RE: Discussion – Week 11
Shirley,
Good post this week, I enjoyed reading your post. I also believe in listening to my patients. Patient engagement can inform patient and provider education and policies and enhance service delivery (Bombard, et al., 2018). Joint commission mandated that health care organizations encourage patients to be actively involved in their care, helping create a culture of safety (Agency for Healthcare Research and Quality, 2019). Again good post this week.
Reference
Agency for Healthcare Research and Quality. (2019). Patient Engagement and Safety. https://psnet.ahrq.gov/primer/patient-engagement-and-safety
Bombard, Y., Baker, G., Orlando, E., Fancott, C., Bhatia, P., Casalino, S., Onate, K., Denis, J., & Pomey, M. (2018). Engaging patients to improve quality of care: A systematic review. Implantation Science 13,98. https://doi.org/10.1186/s13012-018-0784-z
7 months ago
April Williams
RE: Discussion – Week 11
Hello Shirley,
You had a great perspective in your post, especially mentioning you include the patient and the family when making daily assessments. According to Nsiah et al (2019), nurses view involving the patient in decision making as a form of patient advocacy that promotes patient safety and quality care. At the same time, nurses may be in conflict when the issue include areas that involve tough decision like Goals of Care discussion. Even in these situations, patients need to be in control of lead in their health care decision, and healthcare providers must continue to provide the tools and educations for patients to understand matters involving ethics in order to build confidence when making decisions (Krist et al., 2019). The makes the Ottawa Decision aids a critical part of health solutions (The Ottawa Hospital Research Institute, 2019) .
References
Krist, A. H., Tong, S. T., Aycock, R. A., & Longo, D. R. (2017). Engaging Patients in Decision-
Making and Behavior Change to Promote Prevention. Studies in health technology and
informatics, 240, 284–302.
Nsiah, C., Siakwa, M., & Ninnoni, J. (2019). Registered Nurses’ description of patient advocacy
in the clinical setting. Nursing open, 6(3), 1124–1132. https://doi.org/10.1002/nop2.307
The Ottawa Hospital Research Institute. (2019). Patient decision aids. https://decisionaid.ohri.ca/
7 months ago
Motunrayo Aigbedion
RE: Discussion – Week 11
Main Discussion Post
The description of the situation experienced and an explanation of how incorporating or not incorporating patient preferences and values impacted the outcome of their treatment plan.
I once took care of a Spanish-speaking patient who had newly immigrated to the United States (U.S.). The patient was attacked on the street in broad daylight by a group of men. The men took his wallet, all his money, and personal items, including his cellphone. They also beat him up and bloodied his nose. He had no relatives in the U.S., and he could not locate the friend he had been lodging with. He could not speak English and only spoke Spanish. With this patient, communication was key to knowing his preferences to provide for his care and needs. All communication with this patient was provided in Spanish, with Spanish translators present for healthcare personnel that were not fluent in Spanish. After obtaining approval from management, a nurse was able to find his relative on social media and called his sister through the social media messaging and calling feature. Establishing a trusting relationship with the patient was paramount to providing adequate care. Kon et al. (2016) state that clinicians should be trained to establish a trusting relationship to optimize the patient experience. The hospital provided medical care to the patient and helped him find help through a case manager.
Shared decision-making and evidence-based practice align when “patient preferences and clinician expertise are considered in making clinical decisions that affect the health and well-being of patients and families” (Melnyk & Fineout-Overholt, 2018, p. 231). Incorporating patient preferences and values was necessary with this Spanish-speaking patient. The patient was not used to American food, culture, and customs. Hospital workers could pick food choices that most closely resembled his native food due to effective communication with the patient. Luckily, the patient was also easy-going and grateful to have survived the attack. Locating his sister and helping the patient communicate with her helped him emotionally. Melnyk & Fineout-Overholt (2018) stress that good clinical judgment requires the clinician to discern what is good in a particular situation (p. 226). In this situation, speaking Spanish to the patient and locating the patient’s sister were essential for shared-decision making.
Explain how including patient preferences and values might impact the trajectory of the situation and how these were reflected in the treatment plan.
Hoffman et al. (2014) define shared-decision making as a process where the clinician and patient jointly discuss treatment options, the benefits, and harms and considers the patient’s values, preferences, and circumstance. Patient preferences and values directly impacted the trajectory of this situation, given the language and cultural barrier of this newly immigrated patient. The patient had just experienced the traumatic event of being mugged and assaulted. Therefore, creating a therapeutic environment where the patient felt safe and attended to was essential for establishing a trusting relationship. Once safety and trust were established, hospital personnel could determine and carry out an effective treatment plan that included medical, lodging, and discharge placement needs. Communicating with him in Spanish allowed hospital staff to identify the patient’s needs and allowed the patient to understand his treatment plan and ask questions. Knowing that the patient had nowhere to go and had no support helped staff explore discharge placement options and resources for the patient.
Explain the value of the patient decision aid you selected and how it might contribute to effective decision-making, both in general and in the experience you described.
Patient decision aids are evidence-based tools that allow patients to make informed healthcare decisions that enhance shared-decision making between clinicians, patients, and their families (The Ottawa Hospital Research Institute, 2019). According to Schroy et al. (2014), studies show that decision aids reduce decisional conflict by enhancing patient knowledge about specific aspects of their medical care. Decision aids are also stated to increase patient satisfaction. The decision aid chosen for this patient and general practice is the COVID-19 decision health aid. All patients must be educated about how they should conduct themselves during this pandemic. This decision aid gives guidance on things to consider if people choose to partake in activities outside their homes. Options include guidance on low, medium, and high-risk activities for COVID-19 exposure, physical distancing, use of facemasks, and modes of transportation (The Ottawa Hospital Research Institute, 2019). The decision aid is not intended to replace medical advice (The Gerontological Society of America, 2021). However, it is intended to guide patients in keeping themselves safe and making effective decisions about the COVID-19 pandemic.
Describe how you might use this decision aid inventory in your professional practice or personal life.
Often, people have comorbid health conditions they must consider when making decisions about new healthcare treatment plans and options. The decision aid inventory would allow patients and their families to consider how new healthcare treatment decisions would affect pre-existing health conditions they have. The role of the psychiatric mental health nurse practitioner is to treat the mental and behavioral conditions of patients. The health aid inventory would assist patients in considering medical or non-psych pre-existing conditions when making mental healthcare decisions.
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. https://doi.org/10.1001/jama.2014.10186
Kon, A. A., Davidson, J. E., Morrison, W., Danis, M., & White, D. B. (2016). Shared decision making in intensive care units: An American College of Critical Care Medicine and American Thoracic Society policy statement. Critical Care Medicine, 44(1), 188-201. https://www.doi.org/10.1097/CCM.0000000000001396
Melnyk, B. M., & Fineout-Overholt, E. (2018). Evidence-based practice in nursing & healthcare: A guide to best practice (4th ed.). Philadelphia, PA: Wolters Kluwer.
Schroy, P. C., Mylvaganam, S., & Davidson, P. (2014). Provider perspectives on the utility of a colorectal cancer screening decision aid for facilitating shared decision making. Health Expectations, 17(1), 27-35. https://www.doi.org/10.1111/j.13697625.2011.00730.x
The Ottawa Hospital Research Institute. (2019). Patient decision aids. https://decisionaid.ohri.ca/
The Gerontological Society of America. (2021). A COVID-19 Decision Aid: How Do I Choose When to Interact with People or Take Part in Activities Outside My Home During the Pandemic? https://www.geron.org/images/gsa/documents/GSA_Decision_Aid.pdf
7 months ago
Albert Hatcher
RE: Discussion – Week 11
According to (Stanton et al., 2021), “the number of nonnative English speakers (NNESs) in the United States has more than doubled since 1990 and continues to increase, which means that the likelihood of health care providers encountering and providing patient care in the presence of a language barrier also continues to increase.” Motunrayo, I am happy that you were able to aid your patient. We forget or do not always have the time to provide complete individual care for our patients. You first eliminate the communication issues, which helps better understand your patient’s needs and create a trustful relationship. Nurses must be able to connect with our patients, if possible so that the patient will be more open to treatment. Everyone who communicates with your patient will know that a translation will be needed for effective communication because his treatment plan reflects the need. The case manager will help the patient with discharge needs and hopefully follow the patient in the community. The patient aid that you use of listening and communicating your patient’s needs was the best way to assist your patient. The patient probably felt hopeless since all his belongings were stolen from him, but you gave him hope to get over that bad moment in his life. (Eriksson et al., 2017) states, “the individual and holistic approach that characterizes the health care provided is a key aspect in the prevailing change of health care practice.”
References
Eriksson, I., Lindblad, M., Möller, U., & Gillsjö, C. (2017). Holistic health care: Patients’ experiences of health care provided by an advanced practice nurse. International Journal of Nursing Practice, 24(1), e12603. Retrieved May 9, 2022, from https://doi.org/10.1111/ijn.12603
Stanton, B. M., Rivera, M. J., Winkelmann, Z. K., & Eberman, L. E. (2021). Support systems and patient care delivery for nonnative English-speaking patients: A study of secondary school athletic trainers. Journal of Athletic Training, 57(2), 148–157. Retrieved May 9, 2022, from https://doi.org/10.4085/1062-6050-0181.21
7 months ago
Motunrayo Aigbedion
RE: Discussion – Week 11
Thank you for the positive and encouraging response post. Cultural competence and sensitivity is a must in healthcare.
7 months ago
Mary Bemker-page WALDEN INSTRUCTOR MANAGER
RE: Discussion – Week 11
This appears to be a very interesting point, and the dynamics are ones that need to be considered. As you indicate, if the patient is able to make decisions for herself or himself, then the main partner in the decision-making process is the patient. Sometimes this point is overlooked or bypassed. When they are unable to do so, then other means need to be taken (e.g., speak to the individual with medical power of attorney, address the family, work with the patient advocate). As nurses, we have an ethical responsibility to ensure the patient’s voice is heard through the appropriate means. First, the patient if he or she is able to make a lucid decision; if not, then we move to the other appropriate individuals for guidance.
There are various ethical examples that are impacted by this dynamic. Sometimes individuals who do not have the capacity to choose due to pain, medication, etc. are said to choose. When this occurs, it is typically the person making this decision “passing the buck”, putting their values on the decision chosen, etc. As you note, using decision tree can assist us in assessing capacity to choose when that ability is in question. In other instances, some just try to push their beliefs onto others.
My father was hospitalized and on a vent a few years ago. He was conscious, lucid and making sense based on the comments he wrote on his whiteboard. One of the nurses actually called me at home and asked me to sign a DNR. In fact, she would have been pleased if he had been removed from the ventilator.
I explained to her my decision would not be a legal or ethical one as my father was conscious and able to make decisions for himself. The nurse started arguing with me about this. I finally told her my decision was that my father made his own decisions. I was aghast that this happened, and I wonder how many others this nurse had attempted to influence.
Dr. B.
7 months ago
April Williams
RE: Discussion – Week 11
7 months ago
Adetokunbo Oluwatuyi
RE: Discussion – Week 11
Hello Motunrayo,
I am deeply sorry about what happened to your patient and I hope the men who beat him were caught and dealt with. I am glad your patient has gotten help and has recovered from the tragedy, and I hope he has gotten the best care plan as it is important to document the patient’s needs and wants, as well as the nursing interventions (or implementations) planned to meet these needs. (The Nurse’s Guide to Writing a Care Plan | USAHS, 2021) With the best care treatment, the patient can recover well in a short amount of time, depending on the experience that the patient has it can also build even better relationships and trust. Hoping the patient decision aids were well executed because they are tools that help people become involved in decision making by making explicit decision that needs to be made, providing information about the options and outcomes, and by clarifying personal values. They are designed to complement, rather than replace, counseling from a health practitioner. (Patient Decision Aids – Ottawa Hospital Research Institute, 2020)
The Nurse’s Guide to Writing a Care Plan | USAHS. (2021, July 12). The University of St. Augustine for Health Sciences. https://www.usa.edu/blog/how-to-write-a-care-plan/
Patient Decision Aids – Ottawa Hospital Research Institute. (2020). Ohri.ca. https://decisionaid.ohri.ca/
7 months ago
Albert Hatcher
RE: Discussion – Week 11
Informed Decisions
The nurse called a behavioral code for an agitated patient because she did not want a staff member sitting in her room. I explained to the patient that staff must always remain with her because her doctor placed her on one to one due to her attempted suicide. The patient stated that she was leaving because that would not happen, and I explained that I could not allow her to leave AMA because she was involuntarily committed. The patient became very upset and crying; she stated that she felt like she was losing control of everything in her life, and that’s why she decided to end her life. I asked the sitter to leave so I could sit down and talk to the patient.
Patient Preferences
(Bradshaw et al., 2022) says, “emotional support composes 3 components, including: a cognitive understanding of patient needs; an affective imagination of what the patient values; and an altruistic action to alleviate the patient’s pain.” She told me that her life was perfect and that she lost her job due to Covid and that when it took a change for the bad. She had to move in with a friend, and everything went well for a month. She was saving up for a down payment on an apartment. She stated that her friend’s boyfriend abused her while she was there and was afraid to report it. She became overwhelmed and attempted to end her life. She says that the male sitter in the room made her feel uncomfortable because he sat there and stared at her, and she became upset. I explained that he was watching because you had cut your wrists before arrival, and he was making sure you were not cutting under the covers.
Value of the Patient Decision and Professional Practice
According to (Melnyk & Fineout-Overholt, 2019), “patient-centered care has been defined as providing care that is respectful of and responsive to individual patient preferences, needs and values, and ensuring that patient values guide all clinical decisions.” The patient permitted me to report what she told me to her primary nurse so that we could put in her treatment plan no male sitter, female only. I could also have the nurse put consult with a social worker so that we could help with her living situation. I asked the patient if she wanted to speak with a chaplain, and she agreed. I called the doctor and got an order for Atarax 25mg because she said that she had anxiety when she thought about what had happened. According to (McKenna et al., 2020), “effective listening, as a quality of effective communication, has been promoted by the nursing profession as a way of demonstrating care to patients and their families.” The patient thanked me for taking the time to listen to her and I thanked her for allowing me to help her be more comfortable. I will continue to stop to listen to my patients so that I can provide the best care possible.
References
Bradshaw, J., Siddiqui, N., Greenfield, D., & Sharma, A. (2022). Kindness, listening, and connection: Patient and clinician key requirements for emotional support in chronic and complex care. Journal of Patient Experience, 9, 237437352210926. Retrieved May 9, 2022, from https://doi.org/10.1177/23743735221092627
McKenna, L., Brown, T., Williams, B., & Lau, R. (2020). Empathic and listening styles of first year undergraduate nursing students: A cross-sectional study. Journal of Professional Nursing, 36(6), 611–615. Retrieved May 9, 2022, from https://doi.org/10.1016/j.profnurs.2020.08.013
Melnyk, B., & Fineout-Overholt, E. (2019). Evidence-based Practice in Nursing & Healthcare (4th ed.). Wolters Kluwer.
7 months ago
Motunrayo Aigbedion
RE: Discussion – Week 11
Discussion Response Post
Thank you for your post, Albert.
Trauma Informed Care (TIC) is a new concept that acknowledges the lasting effect of trauma (Stokes et al., 2017). Stokes et al. (2017) define trauma as exposure to actual or threatened death, serious injury, or sexual violence. Beckett et al. (2017) report trauma as the “single most significant predictor of an individual needing mental health services” (p. 34). Though this patient presents as agitated, her underlying trauma is job loss due to Covid-19 and being sexually violated by her friend’s boyfriend. Communication with patients to understand the root cause of their behavior is essential in trauma-informed care (TIC) and is needed in mental health care. The decision to designate a nurse with whom the patient felt safe was an excellent clinical decision. Indicating that female-only nurses attend to this patient was also beneficial in providing a safe and therapeutic environment for this patient. Patient preferences and clinical expertise are essential to making beneficial healthcare decisions (Melnyk & Fineout-Overholt, 2018).
Reference
Beckett, P., Holmes, D., Phipps, M., Patton, D., & Molloy, L. (2017). Trauma-Informed Care and Practice: Practice Improvement Strategies in an Inpatient Mental Health Ward. Journal of Psychological Nursing 55(10), 34-38.
Melnyk, B. M., & Fineout-Overholt, E. (2018). Evidence-based practice in nursing & healthcare: A guide to best practice (4th ed.). Philadelphia, PA: Wolters Kluwer.
Stokes, Y., Jacob, J.D., Gifford, W., Squires, J., Vandyk, A. (2017). Exploring nurses’ knowledge and experiences related to Trauma-Informed Care. Global Qualitative Nursing Research 4, 1-10. https://doi.org/10.1177/2333393617734510
7 months ago
Mary Bemker-page WALDEN INSTRUCTOR MANAGER
RE: Discussion – Week 11
You did an outstanding job listening to the patient. Often this piece can be missed, and the consequence is often noncompliance. As a patient advocate, it is our responsibility to foster communication, and for both the heath care professional and patient need to be able to understand what is being stated. Kudos for following through with best practices!
Dr. B.
7 months ago
Christina Fisher
RE: Discussion – Week 11
Albert,
I too work in mental health and have a profound understanding of this situation as I have been in it many times. I admire you for taking the time to provide your patient with what they needed in a time of crisis. Roberts (2022) states“Learning to care for patients with many complex medical and psychosocial issues takes even more: more thoroughness, more time, more work, more compassion” (p. 619). As healthcare providers, we are committed to doing whatever possible to provide patients with positive outcomes. According to Kon et al., (2016) “Clinicians should generally start with a default shared decision-making approach that includes the following three main elements: information exchange, deliberation, and making a treatment decision” (p. 1334). I encourage my patients to take the time to inform their treatment team of their needs as soon as they can.
References:
Kon, A. A., M.D., Davidson, Judy E,D.N.P., R.N., Morrison, W., M.D., Danis, M., M.D., & White, Douglas B,M.D., M.A.S. (2016). Shared decision-making in intensive care units: Executive summary of the american college of critical care medicine and american thoracic society policy statement. American Journal of Respiratory and Critical Care Medicine, 193(12), 1334-1336. Retrieved from https://www.proquest.com/scholarly-journals/shared-decision-making-intensive-care-units/docview/1797885427/se-2?accountid=14872
Roberts, L. W. (2022). Learning to Care for Patients: A Comment on “Blind Spots.” Academic Medicine: Journal of the Association of American Medical Colleges, 97(5), 619. https://doi.org10.1097/ACM.000000000004637
7 months ago
Sarah Lockwood
RE: Discussion – Week 11
Hello Albert,
thank you for your informative post. You seem like a caring healthcare professional, and I am sure your patient appreciated your time and understanding. It was kind of you to notice her frustrations and attend to her concerns. According to Melnyk & Fineout-Overholt (2018), patient-centeredness allows patients to engage in their own care, helping make decisions about plan of care. You did just that when you advocated for your patient, obtaining a female sitter. An interesting theory made by Berwick in 2009 discusses a radical change in healthcare delivery with a shift of power. Moving control and power out of caregiver hands and into the patients’ hands so they may be sole decision maker in their plan of care (Melnyk & Fineout-Overholt, 2018). Although there must be policies and regulation in attempted suicide cases, perhaps allowing more engagement in their plan of care choices would allow for improved outcomes within that patient population.
Additionally, being empathetic towards a patient is considered patient-centeredness. According to Bradshaw et al. (2022), emotional support is critical in patient-centered care. Deep listening and social connection promote a shared understanding, enhancing a healthcare professional’s ability to support and facilitate appropriate treatment (Bradshaw et al., 2022).
Bradshaw, J., Siddiqui, N., Greenfield, D., & Sharma, A. (2022). Kindness, listening, and
connection: Patient and clinician key requirements for emotional support in chronic and
complex care. Journal of Patient Experience, 9, 237437352210926. Retrieved May 9,
2022, from https://doi.org/10.1177/23743735221092627
Melnyk, B. M., & Fineout-Overholt, E. (2018). Evidence-based practice in nursing & healthcare:
A guide to best practice (4th ed.). Philadelphia, PA: Wolters Kluwer.
7 months ago
Claudia Paz
RE: Discussion – Week 11
Hello Albert,
I am so sorry that this happened to your patient. Building patient rapport is crucial in such disturbing circumstances. I am glad that you were able to connect with the patient and that she had the confidence in you to tell you what happened to her. patient centered care includes making our patients feel safe and building an environemnt around them that promotes compassion and positivity (Bradshaw et al., 2022). Facilities need to have resources available for nurses to provide emotional support (Bradshaw et al., 20220. Sometimes patients just need someone to sit and talk with them. They want to talk about their life and what they used to enjoy doing but since they are sick they can not do those things anymore. Active listening shows our patients that care about them and have time for them.
Reference
Bradshaw, J., Siddiqui, N., Greenfield, D., & Sharma, A. (2022). Kindness, Listening, and Connection: Patient and Clinician Key Requirements for Emotional Support in Chronic and Complex Care. Journal of Patient Experience, 9, 23743735221092628. https://doi.org/10.1177/23743735221092627
7 months ago
Tosin Addeh
RE: Discussion – Week 11
7 months ago
Stacy Hinson
RE: Discussion – Week 11- Main Post
7 months ago
Motunrayo Aigbedion
RE: Discussion – Week 11- Main Post
7 months ago
hope Davis
RE: Discussion – Week 11- Main Post
I enjoyed reading your discussion. It is amazing how taking a few steps and giving a patient a little more time to find out the real reason why they are refusing treatments and procedures that could potentially save their lives. The patient had limited fear because one of his family members had died going through the same procedure. It takes an actual nurse like you to have a one-on-one conversation with a patient, explaining the benefits of having the procedure done and directing him to the right people so he may get more help. “Nurses should take advantage of any appropriate opportunity throughout a patient’s stay to teach the patient about self-care. The self-care instruction may include teaching patients how to inject insulin, bathe an infant or change a pouching colostomy system (the nurse’s role in patient education).”
It is part of our job responsibility as nurses to take our time to assess, listen and advocate for our patients. Nursing is such a demanding career, and I feel that we have enough time to sit with a patient, listen to their real issues, and provide them with the appropriate help they need due to the nurse-patient ratio.
According to the article The Importance of a Nurse patient relationship, ” it is vital that they know how to establish healthy relationships with the patients they interact with day in and day out. Not only is it suitable for the patient, but it can also benefit the mental health of the nurse as well. For nurses, finding a balance between compassionate care and professionalism is vital to connect with the individuals they are treating.” Establishing a healthy relationship with a patient makes it easy for patients to open up about their health and fears. In turn, patients will get appropriate care or be directed to the appropriate providers.
references
The Nurse’s Role in patient education. Arkansas State University Online. (2018, March 22). Retrieved May 11, 2022
Importance of a nurse-patient relationship. Host Healthcare. (2022, April 19). Retrieved May 11, 2022
7 months ago
Memory Rinomhota
RE: Discussion – Week 11- Main Post
Hi, Hope
Thank you for the post.
I agree patients are now taking charge of healthcare. When patients are educated about their illness, they become compliant. Patients are sometimes non-compliant with treatment because they do not understand the disease process. When dealing with diabetic patients, some may not afford the recommended diet. The patient needs to provide the diet he can afford and modify it accordingly. Patients are more involved when they understand what is going on and are well informed (Campbell & Sedrakyan, 2021). The patient has the final decision on how he wants the treatment to proceed. As healthcare workers, it is our responsibility to communicate with patients and build trust, advocate, educate and provide holistic care (Bradshaw et al., 2022).
Reference
Bradshaw, J., Siddiqui, N., Greenfield, D., & Sharma, A. (2022). Kindness, Listening, and Connection: Patient and Clinician Key Requirements for Emotional Support in Chronic and Complex Care. Journal of Patient Experience, 9, 23743735221092628. https://doi.org/10.1177/23743735221092627
Campbell, B., & Sedrakyan, A. (2021). Patient involvement in regulation: an unvalued imperative. The Lancet, 397(10290), 2147–2148. https://doi.org/10.1016/s0140-6736(21)00977-6
7 months ago
Mary Bemker-page WALDEN INSTRUCTOR MANAGER
RE: Discussion – Week 11- Main Post
Education is the cornerstone of proactive communication. Offering the patient, patient’s family and/or colleague key information needed to make an informed decision is the foundation for acceptance and compliance. Having positive support for the decision-making process is also a key variable for success. I appreciate how these dynamics are applied in your posting. Knowing both our stakeholders and the appropriate process in supporting proactive decision making can be a real plus for promoting evidence-based intervention and compliance.
Dr. B.
7 months ago
Cory Legan
Response 1 – Week 11
Hi Stacy,
Sometimes, our patient’s desires differ from our plan of care. As healthcare providers, we should honor our patient’s wishes. I believe that patients should have a say in their healthcare. However, patients should be properly educated, to make an informed decision. A patient’s health literacy greatly impacts healthcare outcomes (Centers for Disease Control and Prevention, 2021). If a patient’s preference is not in their benefit, we should ask questions. Healthcare providers should educate patients and offer them choices based off evidence-based practice (Bailo & et al., 2019). However, it is the patient’s responsibility to make their own healthcare choices.
References:
Bailo, L., Vergani, L., & Pravettoni, G. (2019). Patient Preferences as Guidance for Information
Framing in a Medical Shared Decision-Making Approach: The Bridge Between Nudging and Patient Preferences. Patient preference and adherence, 13, 2225–2231. https://doi.org/10.2147/PPA.S205819
Centers for Disease Control and Prevention. (2021). Understanding Health Literacy. Retrieved
from https://www.cdc.gov/healthliteracy/learn/Understanding.html
7 months ago
Sharon Muchina
RE: Discussion – Week 11- Main Post
7 months ago
Kehinde Tade
RE: Discussion – Week 11 Discussion :Response 1
7 months ago
Kehinde Tade
RE: Discussion – Week 11- Response 1
Hi Stacy, I enjoyed reading your post,
Patients play a vital role in deciding what medicines should be accessible to them, and administrative organizations should consider their inclinations when deciding on treatment endorsement. Implementing an evidence-based practice should begin with shared practitioner and patient-centered outcomes. Hoffman suggested that 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. Evidence-based decisions are the course of clinicians also, patients together taking an interest in a well-being choice. Patients utilizing their role in deciding what treatments or medication is acceptable will increase patient adherence and satisfaction (Ho et al., 2015). Being Value and Implementing Patient Preference Kon et al. (2016) exclaimed that shared decision-making is a collaborative process that allows patients and clinicians to make the best scientific evidence available with patients’ values, goals, and preferences.
References
Ho, M. P., Gonzalez, J. M., Lerner, H. P., Neuland, C. Y., Whang, J. M., McMurry-Heath, M., Hauber, A. B., & Irony, T. (2015). Incorporating patient-preference evidence into regulatory decision-making. Surgical Endoscopy, 29(10), 2984–2993. https://doi-org.ezp.waldenulibrary.org/10.1007/s00464-014-4044-2
Kon, A. A., M.D., Davidson, Judy E, D.N.P., R.N., Morrison, W., M.D., Danis, M., M.D., & White, Douglas B, M.D., M.A.S. (2016). Shared decision-making in intensive care units: Executive summary of the American college of critical care medicine and American thoracic society policy statement. American Journal of Respiratory and Critical Care Medicine, 193(12), 1334-1336. Retrieved from https://ezp.waldenulibrary.org/login?qurl=https%3A%2F%2Fwww.proquest.com%2Fscholarlyjournals%2Fshared-decision-making-intensive-care-units%2Fdocview%2F1797885427%2Fse2%3Faccountid%3D14872
7 months ago
Mary Bemker-page WALDEN INSTRUCTOR MANAGER
RE: Discussion – Week 11
Week 11
This is the last week of the course. Can you believe it? Look back at what you wrote for Week 1 and compare that to your discussion post for Week 11. How is it different? What have you learned since your first post. What have you learned that enhances current practice?
The week’s efforts are as follows:
|
Week 11, Days 1-2 |
Read the Learning Resources. Compose your initial Discussion post. |
|
Week 11, Day 3 |
Post your initial Discussion post. |
|
Week 11, Days 4-5 |
Review your Discussion posts. Compose your peer Discussion responses. |
|
Week 11, Day 6 |
Post two peer Discussion responses. |
|
Week 11, Day 7 |
Wrap up Discussion |
Learning Objectives
Students will:
- Analyze opportunities for change within healthcare organizations
- Recommend evidence-based organizational changes using an evidence-based practice approach to decision making
- Identify measurable outcomes addressed by evidence-based changes
- Justify dissemination strategies
- Analyze the impact of patient preferences on clinical decision making
- Analyze decision aids
Remember the discussion posts are due on Saturday and the course ends on Sunday.
Dr. B.
7 months ago
Stacy Hinson
RE: Discussion – Week 11-Reply
Dr. Bemker_Page
Looking back over the first week till now I find a easier flow of concept in my discussion posts, with a better analysis of the material addressed and integrated into the discussion post. Sometimes it does not feel like you have made any improvements or changes till you look back at where you started from.
7 months ago
Chaquita Nichols
RE: Discussion – Week 11
Melnyk and Fineout-Overholt (2018) noted “Evidence-based practice is the integration of patient preferences and values, clinical expertise, and rigorous research to make decisions that lead to improved outcomes for patients and families (pg. 2019). When it comes to educating patients, it is particularly important to include them in their care. We also like to include family members especially if they are caretakers. “Programs to accelerate the implementation of healthcare teams supported by information and communication technologies are needed to deliver patient centered care, particularly for individuals living with chronic conditions” (Gogovor et al. 2019). That way patients are able to keep a track of their healthcare information. Patients should be involved in their care because they know what they can do, and we do not want to have any negative outcomes. Shared decision making is when the clinician involves the patient in their healthcare decision in which they go over patient values and preferences and if it is combined with Evidenced-based medicine, it can provide good patient outcomes (Hoffman, Montori, & Del Mar, 2014).
Some patients that we see as being noncompliant are not noncompliant, but not properly educated. I hear my diabetic patients say all the time that they do not eat a lot of sweets, so that is when we bring in a diabetic educator or dietician in to talk to the patient because some people are not aware that certain foods turn in to sugar once they break down in your body. My dad thought he was about to become a diabetic because when he went to one of his appointments his blood sugar was high. I asked him what he had eaten before his appointment and he told me 4 oranges, so I quickly educated him on that. I also tell my patients not to eat a bag of fruit in one sitting. I also let my patients do a teach back moment in which they repeat what they heard. They are also given an opportunity to add things they think might help them. “Patient decision aids are tools that help people become involved in decision making by making explicit decisions that need to be made, providing information about the options and outcomes, and by clarifying personal values. They are designed to complement, rather than replace, counseling from a health practitioner “(Ottawa, n.d.).
Gogovor, A., Valois, M.-F., Bartlett, G., & Ahmed, S. (2019). Support for teams, technology and patient involvement in decision-making associated with support for patient-centred care. International Journal for Quality in Health Care, 31(8), 590–597. https://doi.org/10.1093/intqhc/mzy224
Hoffman, T. C., Montori, V. M., & Del Mar. (2014). The connection between evidence-based medicine and shared decision making. Journal of the American Medical Association, 312(13), 1295-1296. https://doi.org/10.1001/jama.2014.10186
Melnyk, B., & Fineout-Overholt, E. (2018). Evidence-Based Practice in Nursing Practice and Healthcare (4th ed.). Wolters Kluwer.
7 months ago
Stacy Hinson
RE: Discussion – Week 11
Chaquita,
Your example reminded me of a recent patient I have been working with. He had been in and out of the hospital for BG greater than 500. I talked to our endocrinology department and got him approved for the new Libre 2 monitor believing this would help with better glucose control. Pt. came into the office and after having a discussion about daily diet the etiology was found for the continued highs and lows in his BG. The patient was under the impression that he should not eat sugar, because that is what caused his BG to be high, but everything else was ok. Pt was eating sandwiches and toast multiple times a day, but only white bread with peanut butter so his sugar would not be high. At 85 he is on a tight budget. After a discussion on how the body processes his foods, and education on amount of carbs that should be consumed as well as protein foods and fresh fruits and vegetables the patient had a better grasp on his disease management. I was also able to get him enrolled in meals on wheels for better nutrition control. Along with the Libre 2, which I have gone to switching sensors for him every two weeks to keep in contact his blood glucose readings have leveled out without extreme highs and lows and is now 120-135. So Melnyk & Fineout-Overholt (2018) were right ” Evidence practice that involves the patient along with the research informed decisions does improve outcomes when the nurse can provide correct information to the patient (pg. 2019). As defined by one study conducted by Trikkalinou, Papzafiropoulou, & Melidois (2017) that looked at the quality of life in diabetics “diabetes is a strong and cunning enemy demanding all of our resources,” and evidence-based research is part of that resource to arm our patients with for a brighter future.
Reference:
Melnyk, B., & Fineout-Overholt, E. (2018). Evidence-Based Practice in Nursing Practice and Healthcare (4th ed.). Wolters Kluwer.
Trikkalinou, A., Papazafiropoulou, A. K., & Melidonis, A. (2017). Type 2 diabetes and quality of life. World journal of diabetes, 8(4), 120–129. https://doi.org/10.4239/wjd.v8.i4.120
7 months ago
Stacy Hinson
RE: Discussion – Week 11 –Reply #1
7 months ago
Mary Bemker-page WALDEN INSTRUCTOR MANAGER
RE: Discussion – Week 11
You make some key points here, and your application to process is on point. We tend to be more successful when process is included in the decision along with outcome. Thank you for these insights.
Dr. B.
7 months ago
Rona Adams
RE: Discussion – Week 11
Discussion Response 2
Chaquita,
Great post; I agree that healthcare providers should include patients and families in decision-making. Sometimes when a patient receives information from providers about their health care needs, they become overwhelmed and don’t make the best decisions for themselves. An example, if a patient is diagnosed with prostate cancer, the Oncologist might want them to have surgery, chemotherapy, radiation, or watch and wait. It is essential that the patient is well informed and make informed decisions about their care. According to Melnyk and Fineout-Overholt (2019), patients’ involvement in the decision-making process will help achieve a positive outcome in managing their care, especially if there is a collaboration with the clinician. Health literacy is an issue that affects patients creating barriers to managing their care. The individuals with low health literacy are elderly, from low socioeconomic status/education, non-English speaking, etc. (CDC.gov, 2021). It is the clinician’s responsibility to identify if there is a health literacy problem. Clinicians or other health care professionals must ensure the patient understands the clinical information to make appropriate decisions regarding their health.
References
Centers for Disease Control and Prevention. (2022, March 31). The what, why, and how of health literacy. https://www.cdc.gov/healthliteracy/learn/understanding.html
Melnyk, B., & Fineout-Overholt, E. (2019). Evidence-based practice in nursing & healthcare: A guide to best practice (Fourth, International ed.). Lippincott Williams and Wilkins.
7 months ago
Matthew Cluderay
RE: Discussion – Week 11
Learning about your patients includes their background, culture, and preferences. Incorporating patients’ preferences and values lead to better outcomes as they are included and educated about their care (Melnyk & Fineout-Overholt 2018). There was one instance that I recall that taking patients’ values into account would have helped ease some tensions. He was a Muslim patient who wouldn’t eat pork products in accordance with his religion. I didn’t know at the time, but many of the medications that are made with gelatin come from pork byproducts that he wouldn’t take. Some communication with the treatment team solved the problem by finding medications that he would tolerate. This happened early in my nursing career, and I did not know that some medications were made from pork but it’s something that I have remembered since.
The decision-making aid is something that I’ve used in my practice on a few occasions. The mentally ill population is typically underserved in the medical community and despite the COVID vaccine being free and available, I have many patients who have not taken it as they either don’t know how to set up appointments, don’t understand the vaccine generally, or are afraid of side effects. I’ve found that time spent educating receptive patients is usually time well spent and the decision-making aids can help answer questions they may have. I’ve found that using a handout from a credible source also helps ease any apprehensions my patients may have.
Thanks to everyone for making this class fun. I enjoyed posting the discussions with everyone and learning from each other. Hope you all enjoy the summer and good luck with future courses!
Melnyk, B. M., & Fineout-Overholt, E. (2018). Evidence-based practice in nursing & healthcare: A guide to best practice (4th ed.). Philadelphia, PA: Wolters Kluwer.
The Ottawa Hospital Research Institute. (2019). Patient decision aids. Retrieved from https://decisionaid.ohri.ca/
7 months ago
Kehinde Tade
RE: Discussion – response 2 Week 11
Hi Matthew,
Thanks for your post,
I think that is one of the hardest parts of being a nurse is that although we push education, awareness, and encouragement for our patients to make educated decisions, it can be upsetting to witness patients making decisions out of their own perceptions without the proper information from evidence-based research and healthcare providers. We, as healthcare providers, greatly influence the decision-making process for our patients to attain the best decision regarding their health. Although the patients make the ultimate decision but considering shared decision-making can be beneficial for all. For example, including diabetic patients in managing their plan of care provides the patient control of their health, and in turn, results in better patient outcomes. The advantage of implementing a patient-centered approach includes improved patient compliance, trust, patient safety, satisfaction with their care, and acknowledgment of their healthcare needs (Butterworth et al., 2020). It is essential to not only take into consideration the patients’ rights in their decisions but to also provide evidence-based research that acknowledges the social and cultural factors that may affect their care (Siminoff, 2017). I enjoyed reading your discussion post.
References
Butterworth, J. E., Hays, R., McDonagh, S. T. J., Bower, P., Pitchforth, E., Richards, S. H., & Campbell, J. L. (2020). Involving older people with multimorbidity in decision-making about their primary healthcare: A Cochrane systematic review of interventions (abridged). Patient Education and Counseling, 103(10), 2078–2094. https://doiorg.ezp.waldenulibrary.org/10.1016/j.pec.2020.04.008
Siminoff, L. A. (2017). Incorporating patient and family preferences into evidence-based medicine. BMC Medical Informatics & Decision Making, 13, 1–7. https://doiorg.ezp.waldenulibrary.org/10.1186/1472-6947-13-S3-S6
7 months ago
Mary Bemker-page WALDEN INSTRUCTOR MANAGER
RE: Discussion – Week 11
7 months ago
Marissa Ludwig
RE: Discussion – Week 11
7 months ago
Mary Bemker-page WALDEN INSTRUCTOR MANAGER
RE: Discussion – Week 11
You have made. solid points related to making positive health decisions. Having a clear means of assessing a situation. Having clear direction promoes positive choices. Knowing a means to find such promotes positive outcomes. Thanks for your insights.
Dr. B.
7 months ago
Sarah Lockwood
RE: Discussion – Week 11
Oftentimes, healthcare professionals forget to consider patients’ values and preferences because physicians and nurses are taught textbook scenarios and healthcare organizations have set rules and policies that must be followed. According to Hoffamn, Montori, & Del Mar (2014), shared decision making is essential to quality healthcare however, medical professionals give least attention to patient values, preferences, and circumstances, making it difficult to have the shared decision making. Combining evidence-based practice (EBP) and patient preferences lead to improved outcomes for patients (Melnyk & Fineout-Overholt, 2018).
Unfortunately, I have witnessed situations where cardiovascular physicians did not incorporate patient preferences or values and the outcomes were negative. Practicing on a telemetry unit, I worked alongside talented and intelligent cardiovascular physicians. However, occasionally a physician would not incorporate patient’s preferences or value their primary healthcare complaints. Unstable angina, or continuous chest pain, would be a chief complaint and patients would go undergo a series of tests and medications. Sometimes, the tests, such as EKG or stress test would have negative results, but patients would continue with angina. According to Mayo Clinic (2021), patients suffering from angina can undergo an angioplasty with possible stent placement to widen a blocked artery and increase blow flow to the heart. If pharmaceutical intervention did not alleviate the pain, the physician would order an angioplasty.
However, in this situation, a patient was experiencing angina with a past medical history of unstable angina and stent placement. The physician followed protocol and ordered an EKG, stress test, and nitrates for pain. The nitrates did alleviate pain, a good indication of artery blockage but the stress test was normal. The physician increased the patient’s anti-angina medications and prescribed nitrates as needed and wrote a discharge order. The patient had stable vital signs, normal heart rhythm, and negative tests but continued of complain of chest pain. The nurses continued to make the physician aware, but he did not come back to talk to the patient and insisted patient be discharged. The patient ended up in the emergency department that night and received three drug-eluding stents and was readmitted.
The patient’s values and preferences were not heard by the physician, and she had a negative outcome. According to Bryant McGill, a sincere form of respect is listening to what another has to say (Melnyk & Fineout-Overholt, 2018). If the physician has genuinely listened to this patient, her outcome could have been avoided. Medical decisions are best achieved with context of caring and patient-centeredness (Melnyk & Fineout-Overholt, 2018).
According to the patient decision aid of angina treatment, angioplasty is a treatment option (Mayo Clinic, 2021). This intervention was not discussed with the patient, and she was not given options to decide. The physician decided without her. The physician did followed the patient decision aid for primary testing and medications but did not go further into the treatment options.
As a nurse practitioner student, I have an interest in cardiovascular patients and I know I will be caring for them throughout clinicals with a preceptor. I am going to refer to the patient decision aid to make unbiased decisions for my patients. Additionally, I will value their preferences and listen to their wants and needs.
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
Mayo Clinic. (2021). Angina treatment: Stents, drugs, lifestyle changes — What’s best?
Retrieved on May 10, 2022, from https://www.mayoclinic.org/diseases-
conditions/coronary-artery-disease/in-depth/angina-treatment/art-20046240
Melnyk, B. M., & Fineout-Overholt, E. (2018). Evidence-based practice in nursing & healthcare:
A guide to best practice (4th ed.). Philadelphia, PA: Wolters Kluwer.
7 months ago
Mary Bemker-page WALDEN INSTRUCTOR MANAGER
RE: Discussion – Week 11
7 months ago
Cory Legan
Response 2 – Week 11
7 months ago
Kehinde Tade
RE: Discussion – Week 11
The medical care sector introduces us to persons from various walks of life, including different cultures, religious systems, and treatment options, whether in clinics or hospitals—medical care. The opportunity to care for patients who belonged to the Islamic faith while working as a nurse practitioner at an inpatient cancer treatment center presented itself. My female patient was clinically diagnosed with breast cancer. She decided to undergo a mastectomy with surgical reconstruction of the breast using a flap created from abdominal tissues as a donor site. She also received a Foley catheter to siphon urine and regular supervising of the flap and surgery site to rule out any health problems. Several therapy options are available to a woman with breast cancer, many of which are listed in the patient decisions help tool (mastectomy). Conducting breast-conserving surgery to eliminate the malignancy and then receive radiation treatment.” (The Ottawa Hospital Research Institute, 2019).
It was vital for me to pick a clinical patient decision assistance that would be relevant to my patient’s religious and cultural affiliations while bearing in thought the requirement to acknowledge her needs and desires regarding post-surgical care and therapeutic interventions choices to incorporate relevant factors for the patient propriety and patient self-awareness and reflection following her breast surgery. The decision aid I used for a breast cancer patient outlined things to keep in mind when providing care to patients in this situation. Excellent medical treatment requires both evidence-based medicine (EBM) and shared decision making (SDM), yet the two methods’ interdependence is often underappreciated. It’s important to remember that the patient is at the heart of evidence-based medicine; after obtaining and evaluating evidence, practitioners must seek to make a choice that is in line with their patient’s beliefs and situations” In 2020 (Healthwise.org, (2020).
Regarding my individual life and professional practice, the decision aid inventory provides various resources of knowledge about different medical scenarios and cautiously reasoned treatments that patients might be motivated to utilize provided the system, the expert analysis, and other substantial alternatives that the patient could select to improve their primary medication processes that in turn would then positively impact their general diagnosis with the therapies. “Evidence-based practice is the merging of patient choices and beliefs, ethical knowledge, and comprehensive investigation in making decisions that led to better results for patients and families” (Melnyk, 2018, p219)
References
Healthwise.org. (2020). Advance Care Planning: Should I Receive CPR and Life Support? Retrieved from Healthwise.org: https://www.healthwise.net/ohridecisionaid/Content/StdDocument.aspx?DOCHWID=tu2951
Melnyk, B. M., & Fineout-Overholt, E. (2018). Evidence-based practice in nursing & healthcare: A guide to best practice (4th Ed.). Philadelphia, PA: Wolters Kluwer.
The Ottawa Hospital Research Institute. (2019). Patient decision aids.
