NURS 6052 Patient Preferences and Decision Making Discussion

Sample Answer for NURS 6052 Patient Preferences and Decision Making Discussion Included After Question

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.

A Sample Answer For the Assignment: NURS 6052 Patient Preferences and Decision Making Discussion

Title: NURS 6052 Patient Preferences and Decision Making Discussion

Patient involvement is an important aspect in nursing practice. One of my experiences where I incorporated patient values and preferences into the treatment process was when dealing with African American patient admitted to the medical ward. The patient had been diagnosed with diabetes. According to the patient, spirituality was an important component of the care that he needed. He wanted to be visited by his pastor as a way of ensuring that he recovered fully from his condition. As a nurse working with him, I granted his request to have his pastor allowed to visit the patient. The incorporation of spirituality in the care process was important since the patient developed more trust towards the treatment interventions that were used. The patient was also empowered to explore additional healthy interventions that could be utilized to improve his health and wellbeing (Scheunemann et al., 2019). According to him, living a healthy lifestyle was important because it aligned with his expected behaviors as a Christian. A decision aid was also incorporated into the treatment plan for the patient. A brochure was given that provided the patient with information on the diets and exercises that were essential for the management of his condition.  

The incorporation of patient values and preferences may affect the trajectory of the situation in a number of ways. Firstly, it promotes patient satisfaction with care. The patient is satisfied with the provision of care that respect his or her diverse needs and values as seen in the above scenario. The incorporation also promotes patient empowerment. The patient is empowered to be an active seeker of innovative ways of promoting health. Patients also demonstrate their empowerment by adhering to the prescribed treatment plans or interventions (Bastemeijer et al., 2017). This effect can be seen in the above scenario where the patient was empowered to take responsibility of his health by embracing lifestyle and behavioral interventions that promote health. The use of the decision aid in the above experience was important in improving the knowledge of the patient about the management of diabetes (Milner & O’Connor, 2017). The decision aid also provided the patient with information on the additional sources of information such as websites and journals for diabetes management. Therefore, I will use the decision aid in my professional practice to strengthen the health behavioral messages and effectiveness of health educational interventions in nursing practice. 

NURS 6052 Patient Preferences and Decision Making Discussion
NURS 6052 Patient Preferences and Decision Making Discussion

 

References 

Bastemeijer, C. M., Voogt, L., van Ewijk, J. P., & Hazelzet, J. A. (2017). What do patient values and preferences mean? A taxonomy based on a systematic review of qualitative papers. Patient Education and Counseling, 100(5), 871–881. https://doi.org/10.1016/j.pec.2016.12.019 

Milner, K., & O’Connor, M. (2017). Shared decision making and decision aids: An important part of evidence-based practice. Journal of Nursing Education, 56(11), 702–703. https://doi.org/10.3928/01484834-20171020-14 

Scheunemann, L. P., Ernecoff, N. C., Buddadhumaruk, P., Carson, S. S., Hough, C. L., Curtis, J. R., Anderson, W. G., Steingrub, J., Lo, B., Matthay, M., Arnold, R. M., & White, D. B. (2019). Clinician-family communication about patients’ values and preferences in intensive care units. JAMA Internal Medicine, 179(5), 676–684. https://doi.org/10.1001/jamainternmed.2019.0027 

A Sample Answer 2 For the Assignment: NURS 6052 Patient Preferences and Decision Making Discussion

Title: NURS 6052 Patient Preferences and Decision Making Discussion

The World Health Organization (WHO) began monitoring a type of pneumonia with an unknown cause in Wuhan, China, on December 31, 2019. The WHO declared a public health emergency of international concern in January 2020, recommending measures such as early detection, isolation, contact tracing, and social distancing. In February 2020, the WHO designated the virus COVID-19, activated a Crisis Management Team, distributed the first RT-PCR laboratory diagnostic kits, finalized guidelines for mass gatherings, invited the US to the WHO-China Joint Mission conference, announced guidelines for personal protective equipment in light of global shortages, and published considerations for individual quarantine. In March 2020, a call for a 40% increase in global PPE production confirmed that the number of COVID -19 cases had exceeded 100,000. This was confirmed through continued monitoring guidelines, published laboratory testing strategies, and continued processes for acquiring and distributing health care equipment and PPE. In April 2020, after one million COVID-19 cases were confirmed globally, the WHO issued new guidelines on personal protective equipment (PPE) and testing. Donald Trump announced his intention to withdraw from the WHO in July 2020.

Due to the lack of a treatment for COVID-19, a person who is not feeling well may require testing. Fever, dry cough, fatigue, headache, sore throat, conjunctivitis, loss of taste or smell, and dyspnea are all symptoms of COVID -19. It is recommended to seek immediate medical attention if experiencing severe symptoms and to manage mild symptoms at home for a period of 5-6 days from the time of infection, up to 14 days. A positive viral test indicates that a person is currently infected. Antibody blood tests are used to determine if a person has ever been infected. Nationally, the Centers for Disease Control and Prevention report 3,173,212 cases and 133,666 deaths. (CDC,2020).

According to the CDC, testing guidelines have been revised numerous times. The CDC recommends collecting and testing an upper respiratory specimen for initial diagnostic testing for SARS-CoV-2. Acceptable specimens include a nasopharyngeal (NP) swab, an oropharyngeal (OP) swab, and an anterior nares swab, all of which can be performed at home or at an onsite collection center. The real-time polymerase chain reaction (RT-PCR) is used to diagnose acute infections in patients with severe disease. Serological testing assesses each patient’s antibody response. Along with COVID-19 surveillance, seroepidemiological studies are conducted to ascertain the infection rate in a population of people who did not seek medical care and were missed by current surveillance efforts due to the absence or mildness of symptoms. For each novel virus, such as COVID-19, the initial population seroprevalence is believed to be negligible due to the virus’s novel origin. Thus, monitoring antibody seropositivity in a population can provide insight into the extent of infection and the cumulative incidence of infection in the population. NURS 6052 Discussion of Patient Preferences and Decision Making

There are several reasons why patient preference is decreased with COVID testing. Patients believe the risks, benefits and costs of

testing burden healthcare systems, patients feel they are being profiled and potentially “ostracized” from public, they may fear job loss or additional economic burdens associated with  a quarantine or positive test, and finally there is vast information  from conspirators, hoaxers and even our own government potentially increasing the risks of spread of disease and even mortality . As a healthcare provider who has been tested for COVID four times, I encourage every patient, neighbor, friend and loved one to be tested as well attempt to provide valid medical information to those that doubt science. In West Virginia, I read where the positive cases are the highest in the nation currently. A surge in positive cases in West Virginia can be attributed to patient doubt, insecurity, lack of education and need to rebel.

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References

Timeline of WHO’s response to COVID-19. (n.d.). Www.Who.Int. https://www.who.int/news-room/detail/29-06-2020-covidtimeline

CDC. (2020, February 11). Coronavirus Disease 2019 (COVID-19). Centers for Disease Control and Prevention. https://www.cdc.gov/coronavirus/2019-ncov/symptoms-testing/testing.html

A Sample Answer 3 For the Assignment: NURS 6052 Patient Preferences and Decision Making Discussion

Title: NURS 6052 Patient Preferences and Decision Making Discussion

Shawn you provided much useful information, education, and clarification to the COVID-19 timeline and testing. Many of my colleagues in our home state of Arizona have contracted the virus, some twice, the danger is real. With my education and experience I am able to understand and empathize with patients’ preferences regarding wearing masks, social distancing, testing, and treatment. I also understand that many are sacred due to the endless theories circulating on how this pandemic came to be.

Somewhere along the lines of my nursing education, I was taught about making ethical principles and decision-making. In medicine when making a decision conflicts in obligations/duties and their potential outcomes arise. The utilitarian ethical approach the outcomes determine the means and greatest benefit for the greatest benefit expected for the greatest number of people (Mandal et al., 2016). Mandating quarantines and for people to wear masks in public falls under this ethical theory but may violate personal preferences and some say constitutional rights. An ethical dilemma has ensued around the world in regards to honoring personal [patient] preferences over doing what is necessary to protect the majority of the people in the world and to stop the spread of this ferocious illness. NURS 6052 Patient Preferences and Decision Making Discussion

A few thoughts/questions for further research and contemplation: When do we stop placing the benefits of the few by honoring personal [patient] preferences a priority and start enforcing the interventions that are best for all humankind? How do we make these decisions? To what extent does evidence-based practice and ethics attribute to decision-making in critical situations such as our current pandemic?

Mandal, J., Ponnambath, D., & Parija, S. (2016). Utilitarian and deontological ethics in medicine. Tropical Parasitology, 6(1), 5. https://doi.org/10.4103/2229-5070.175024

A Sample Answer 4 For the Assignment: NURS 6052 Patient Preferences and Decision Making Discussion

Title: NURS 6052 Patient Preferences and Decision Making Discussion

Excluding patients’ preferences in decision-making not only defies the moral ethics of autonomy but also compromise the patient’s well-being and satisfaction with care. Patient-centered care is essential for both safety and satisfaction (Gusmano et al., 2019). According to the Institute of Medicine, patient-centered care is the act of providing care that is responsive to and respectful of patient’s needs, values, preference, and ensuring the client values guide the entire clinical decision.

In August 2019, working as a night nurse at a Florida-based oncology clinic, a male patient was admitted with symptoms of respiratory complication. Upon assessment, the physician discovered signs of lung complication, including coughing up blood, chest pains, hoarseness, shortness of breath, and fatigue (Hirsch et al., 2017). The laboratory’s pathology and biochemical results alongside radiology images confirmed stage 2 lung cancer (malignant cells are found in both the nearby lymph nodes and lungs). The tensed patient recommended chemotherapy as the best procedure since surgery could worsen her condition. As a diabetic patient for the past seven years and staying alone, the patient got worried about the risk of wound infection due to poor hygiene. Also, diabetes mellitus is linked to impaired leukocyte function and metabolic malfunctions. NURS 6052 Patient Preferences and Decision Making Discussion

The physician insisted on surgical removal of the cancerous cells and booked the desperate patient for surgery. After a successful surgery, the patient developed complications, including air leaks in the left lung, damage to the blood vessels and nerves (in the right lung), internal bleeding in the lungs, and severe pain. The patient’s condition deteriorated and later suffered from thromboembolic stroke due to the destruction of blood vessels. The patient was admitted to the hospitals’ Intensive Care Unit (ICU) for specialized care, leading to an extended stay by twelve months with a significant hospital bill to settle (over $30000). The patient was readmitted after two months of discharge, with complaints of severe chest pain and headache. The client gave a negative rating to the facility for creating more harm than good to her condition, indicating dissatisfaction with care.

How Adhering to Patient’s Preference Could Affect the Trajectory and Application in Clinical Practice

Integrating the patient’s ideas and preference in the decision-making process could ensure additional safety by eliminating the occurrence of thromboembolic stroke and surgery-related complications. Also, it could prevent the additional medical cost and possible readmissions alongside reduce the length of hospitalization (David et al., 2018). Patient-centered care could improve the patient’s satisfaction with care, together with the facility’s brand image.

The patient’s decision to undergo chemotherapy could lead to bearable side effects and risks compared to the surgical process. Chemotherapy is painless and involves a combination of drugs, including etoposide and cisplatin, and carboplatin and irinotecan, among others. The symptoms include hair loss, mouth sores, loss of appetite, vomiting and nausea, and diarrhea (Hirsch et al., 2017). Drugs like cisplatin can cause kidney damage. However, doctors give a significant amount of intravenous fluids prior to and after every dose of the drug to prevent such occurrence.

In the healthcare industry, decision-making present challenges to the caregivers due to the unforeseeable repercussions and ethical and medical dilemmas. In future nursing, I will always let the patient’s preference and choice of treatment to reign supreme and guide the entire treatment plan. However, it is important to ensure the patient is capacitated to make sound decisions regarding the preferred line of treatment. For example, despite the clinical expertise, patient-centered care guarantees safety and improve satisfaction with care.

References

David, G., Saynisch, P. A., & Smith-McLallen, A. (2018). The economics of patient-centered care. Journal of health economics, 59, 60-77.

Gusmano, M. K., Maschke, K. J., & Solomon, M. Z. (2019). Patient-centered care, yes; patients as consumers, no. Health Affairs, 38(3), 368-373.

Hirsch, F. R., Scagliotti, G. V., Mulshine, J. L., Kwon, R., Curran Jr, W. J., Wu, Y. L., & Paz-Ares, L. (2017). Lung cancer: current therapies and new targeted treatments. The                                                                     Lancet, 389(10066), 299-311.

A Sample Answer 5 For the Assignment: NURS 6052 Patient Preferences and Decision Making Discussion

Title: NURS 6052 Patient Preferences and Decision Making Discussion

Three months ago, I had an experience with a 30-year-old female patient who reported in the inpatient cancer treatment facility where I was working as a charge nurse. The patient had breast cancer that had become too severe, leading to chronic pain. After the diagnosis, the patient was incorporated into developing the treatment plan. She was presented with two treatment options for her condition, including mastectomy and breast-conserving surgery as provided in the Decision Aid tool for breast cancer (Ottawa Hospital Research Institute, 2019). According to the patient’s preferences, she opted for removing the breast, which the attending doctor had to respect.

However, during the initiation of the treatment plan, the patient preferred that she be assigned a female caregiver due to her Islamic culture, which the medical team gladly accommodated in the plan. This is because respecting her care preference means that she would comply with the treatment plan. Hence, the patient always remained receptive to the treatment she underwent, ensuring that her anxiety about the type she would receive was eliminated because her preferences were well taken care of throughout the treatment (Mathioudakis et a., 2019). As a result, the treatment was carried out smoothly.

In terms of Decision Aid (DA) selection, it is essential to consider other aspects, such as post-surgical treatments and care as the patient wishes, keeping in her preference to have a female caregiver. Therefore, the application of Evidence-based medicine (EBM) and shared decision making (SDM) would be an appropriate Decision Aid for the patient. The importance of using the DA is that it ensures that the treatment begins and ends with the patient while also focusing on other aspects, such as modesty and self-awareness of the care procedures (Simons et al., 2019).

Applying the DA inventory would be appropriate for my professional practice since it offers a wealth of information on all aspects of clinical care to promote the development of more informed interventions to help address patient conditions. Evidence-based medicine would be a critical tool for my practices because it integrates all the care need that a patient may require. This, in turn, can facilitate proper decision-making on what can work best for the patient.

References

Mathioudakis, A. G., Salakari, M., Pylkkanen, L., Saz‐Parkinson, Z., Bramesfeld, A., Deandrea, S., … & Alonso‐Coello, P. (2019). Systematic review on women’s values and preferences concerning breast cancer screening and diagnostic services. Psycho‐Oncology, 28(5), 939-947.

Simons, M. R., Zurynski, Y., Cullis, J., Morgan, M. K., & Davidson, A. S. (2019). Does evidence-based medicine training improve doctors’ knowledge, practice and patient outcomes? A systematic review of the evidence. Medical teacher, 41(5), 532-538.

The Ottawa Hospital Research Institute. (2019). Patient decision aids. Retrieved from https://decisionaid.ohri.ca/

A Sample Answer 6 For the Assignment: NURS 6052 Patient Preferences and Decision Making Discussion

Title: NURS 6052 Patient Preferences and Decision Making Discussion

The National Kidney Foundation (2020) state that, in the United States, 37 million adults are estimated to have chronic kidney disease, and approximately 90 percent don’t know they have it. Risk factors associated with CKD are diabetes, high blood pressure, heart disease, obesity, and family history. According to Hoffman et al. (2014), evidence-based medicine should begin and end with the patient. For example, when a patient transitions from chronic kidney disease (CKD) to end-stage renal disease (ESRD), the patient is faced with several treatment options that are critical to their survival. These treatments are necessary for the rest of their lives, so patients need to choose the most suitable treatment for them. According to Green et al. (2018) many patients are unprepared for kidney failure treatments—even when they have been under nephrology specialty care for years. Nephrologists are often unable to predict the timing of kidney failure.

Sometimes patients with advanced kidney disease experience rapid decline in kidney function, which leaves little time for a nephrologist to help patients prepare in advance (p. 2). With electronic health records (EHR) and analysis, algorithms predict CKD patient characteristics and laboratory measures. The nephrologist can recognize patient needs or prognosis of kidney transition based on age, gender, eGFR, urine albumin, creatine ration, calcium, phosphorus, albumin, and bicarbonate focus, providing patients with the knowledge, skills, and support in shared decision making (p. 5). Kon et. (2016) note three elements of a shared decision-making (SDM) approach include information exchange, deliberation, and making a treatment decision addressing the patient preference, values, and goals of care (p. 1334). The impact in outcomes is that patients and families who are educated, informed, and supported throughout their diagnosis can better participate in SDM, accommodating their medical needs and preferences, leading to more satisfying outcomes and relationships.

Patient preferences and values

Evidence-based practice requires a patient-centered approach when it comes to decision-making. The Institute of Healthcare Improvement (IHI, 2013) describes “patient-centered” as placing an international focus on patients’ cultural traditions, values, personal preferences, family issues, social circumstances, and lifestyle. This approach leads to better patient engagement and outcomes (Melnyk & Fineout-Overholt, 2019, p.227). The evaluation of factors related to home and family life can make or break a successful care plan; for example, a young family of four with two children under the age of four recently found out that the husband/father needed to start dialysis therapy. This family has already been dealing with financial hardship, unstable marital concerns, and the responsibility of raising two small children. The husband reports a lack of support once starting treatment from his wife, who feels burdened and unappreciated.

He is afraid of losing her and his children and feels burdened with guilt and worry. The family needs a transdisciplinary care plan that focuses on the patient’s best options for treatment (given his current circumstances), including transplant and home therapies. This care plan would include counseling support to help save their marriage and adjust to this new chronic health diagnosis, care management to help provide support, financial guidance and options, and dietician to ensure the patient has the knowledge needed to optimize his therapy. William Osle’s quote, “It is much more important to know what sort of a patient has a disease than what sort of disease a patient has (Melnyk & Fineout-Overholt, 2019, p. 229) embodies the reason why patient preferences and values determine clinical decisions and outcomes.

In healthcare today there are issues of adequacy of informed consent. I have worked many hours on a medical/ surgical unit where surgeries have not been explained thoroughly to patients. Yet, they sign the consent form prior to surgery with unanswered questions. Now, there are always exceptions where informed consent is not required such as in life-threatening emergencies, or if the patient is incapacitated (Shah et al., 2022) But, outside these exceptions, patients need to be made entirely aware of all of the risks involved and given the opportunity to have shared decision making which as defined by Hoffmann et al., is the process when both the healthcare professional and the patient cooperatively participate in the informed consent process (2014). One unfortunate event occurred while I was working on the medical surgical unit where a patient underwent gastric bypass surgery, unfortunately, this patient spent nearly a month in the hospital due to developing peritonitis after this surgery. There were moments when this patient would say if I would have known this could happen, I would have never done this.

I am sure the surgeon explained that there could be the possibility of peritonitis, but did the patient really know what that looked like, or what that even meant? If this patient could have seen what real complications look like or had been given true informed consent the decision might have been different. Utilizing the Ottawa Hospital Decision Aid Inventory, I found an aid about weight loss surgery. I think this could have made a difference because it explains things in layman’s terms and allows the reader to self-reflect on the need for more information about the procedure. It gives a clear outline of comparing the two options including what is involved, benefits, risks, and side effects ( Staff, 2022). Utilizing this tool would help the patient make an informed decision and allow them to incorporate their preferences. It has been proven that shared decision-making is essential to obtaining optimal patient care (Hoffmann et al., 2014) Overall, being able to utilize the decision aid as a tool to help explain risk versus benefits, the process, and without the use of medical jargon will allow the patient to feel more confident in their own shared decision making.

References:

Hoffmann, T. C., Montori, V. M., & Del Mar, C. (2014). The connection between evidence-based medicine and shared decision making. JAMA, 312(13), 1295. https://doi.org/10.1001/jama.2014.10186

Shah, P., Thornton, I., Turrin, D., & Hipskind, J. E. (2022, June 11). Informed consent – statpearls – NCBI bookshelf. National Library of Medicine . Retrieved February 8, 2023, from https://www.ncbi.nlm.nih.gov/books/NBK430827/

Links to an external site.

Staff, H. (2022, August). Obesity: Should I Have Weight-Loss Surgery? Patient decision AIDS – ottawa hospital research institute. Retrieved February 7, 2023, from https://www.healthwise.net/ohridecisionaid/Content/StdDocument.aspx?DOCHWID=ug2364