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NURS 6052 Discussion Patient Preferences and Decision Making 

NURS 6052 Discussion Patient Preferences and Decision Making

RE: Discussion – Week 8

NURS 6052

Module 5 Week 8-9

Discussion Patient Preferences and Decision Making

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.

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

RE: Discussion – Week 8 Response
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Response to Sh…

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

NURS 6052 Discussion Patient Preferences and Decision Making 

NURS 6052 Discussion Patient Preferences and Decision Making

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RE: Discussion – Week 8

Patient preferences and Making Decisions

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 economics59, 60-77.

Gusmano, M. K., Maschke, K. J., & Solomon, M. Z. (2019). Patient-centered care, yes; patients as consumers, no. Health Affairs38(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                                                                     Lancet389(10066), 299-311.

Name:  Discussion Rubric

  Excellent

90–100

Good

80–89

Fair

70–79

Poor

0–69

Main Posting:

Response to the Discussion question is reflective with critical analysis and synthesis representative of knowledge gained from the course readings for the module and current credible sources.

40 (40%) – 44 (44%)

Thoroughly responds to the Discussion question(s).

Is reflective with critical analysis and synthesis representative of knowledge gained from the course readings for the module and current credible sources.

No less than 75% of post has exceptional depth and breadth.

Supported by at least three current credible sources.

35 (35%) – 39 (39%)

Responds to most of the Discussion question(s).

Is somewhat reflective with critical analysis and synthesis representative of knowledge gained from the course readings for the module.

50% of the post has exceptional depth and breadth.

Supported by at least three credible references.

31 (31%) – 34 (34%)

Responds to some of the Discussion question(s).

One to two criteria are not addressed or are superficially addressed.

Is somewhat lacking reflection and critical analysis and synthesis.

Somewhat represents knowledge gained from the course readings for the module.

Cited with fewer than two credible references.

0 (0%) – 30 (30%)

Does not respond to the Discussion question(s).

Lacks depth or superficially addresses criteria.

Lacks reflection and critical analysis and synthesis.

Does not represent knowledge gained from the course readings for the module.

Contains only one or no credible references.

Main Posting:

Writing

6 (6%) – 6 (6%)

Written clearly and concisely.

Contains no grammatical or spelling errors.

Adheres to current APA manual writing rules and style.

5 (5%) – 5 (5%)

Written concisely.

May contain one to two grammatical or spelling errors.

Adheres to current APA manual writing rules and style.

4 (4%) – 4 (4%)

Written somewhat concisely.

May contain more than two spelling or grammatical errors.

Contains some APA formatting errors.

0 (0%) – 3 (3%)

Not written clearly or concisely.

Contains more than two spelling or grammatical errors.

Does not adhere to current APA manual writing rules and style.

Main Posting:

Timely and full participation

9 (9%) – 10 (10%)

Meets requirements for timely, full, and active participation.

Posts main Discussion by due date.

8 (8%) – 8 (8%)

Meets requirements for full participation.

Posts main Discussion by due date.

7 (7%) – 7 (7%)

Posts main Discussion by due date.

0 (0%) – 6 (6%)

Does not meet requirements for full participation.

Does not post main Discussion by due date.

First Response:

Post to colleague’s main post that is reflective and justified with credible sources.

9 (9%) – 9 (9%)

Response exhibits critical thinking and application to practice settings.

Responds to questions posed by faculty.

The use of scholarly sources to support ideas demonstrates synthesis and understanding of learning objectives.

8 (8%) – 8 (8%)

Response has some depth and may exhibit critical thinking or application to practice setting.

7 (7%) – 7 (7%)

Response is on topic and may have some depth.

0 (0%) – 6 (6%)

Response may not be on topic and lacks depth.

First Response:

Writing

6 (6%) – 6 (6%)

Communication is professional and respectful to colleagues.

Response to faculty questions are fully answered, if posed.

Provides clear, concise opinions and ideas that are supported by two or more credible sources.

Response is effectively written in standard, edited English.

5 (5%) – 5 (5%)

Communication is mostly professional and respectful to colleagues.

Response to faculty questions are mostly answered, if posed.

Provides opinions and ideas that are supported by few credible sources.

Response is written in standard, edited English.

4 (4%) – 4 (4%)

Response posed in the Discussion may lack effective professional communication.

Response to faculty questions are somewhat answered, if posed.

Few or no credible sources are cited.

0 (0%) – 3 (3%)

Responses posted in the Discussion lack effective communication.

Response to faculty questions are missing.

No credible sources are cited.

First Response:

Timely and full participation

5 (5%) – 5 (5%)

Meets requirements for timely, full, and active participation.

Posts by due date.

4 (4%) – 4 (4%)

Meets requirements for full participation.

Posts by due date.

3 (3%) – 3 (3%)

Posts by due date.

0 (0%) – 2 (2%)

Does not meet requirements for full participation.

Does not post by due date.

Second Response:
Post to colleague’s main post that is reflective and justified with credible sources.
9 (9%) – 9 (9%)

Response exhibits critical thinking and application to practice settings.

Responds to questions posed by faculty.

The use of scholarly sources to support ideas demonstrates synthesis and understanding of learning objectives.

8 (8%) – 8 (8%)

Response has some depth and may exhibit critical thinking or application to practice setting.

7 (7%) – 7 (7%)

Response is on topic and may have some depth.

0 (0%) – 6 (6%)

Response may not be on topic and lacks depth.

Second Response:
Writing
6 (6%) – 6 (6%)

Communication is professional and respectful to colleagues.

Response to faculty questions are fully answered, if posed.

Provides clear, concise opinions and ideas that are supported by two or more credible sources.

Response is effectively written in standard, edited English.

5 (5%) – 5 (5%)

Communication is mostly professional and respectful to colleagues.

Response to faculty questions are mostly answered, if posed.

Provides opinions and ideas that are supported by few credible sources.

Response is written in standard, edited English.

4 (4%) – 4 (4%)

Response posed in the Discussion may lack effective professional communication.

Response to faculty questions are somewhat answered, if posed.

Few or no credible sources are cited.

0 (0%) – 3 (3%)

Responses posted in the Discussion lack effective communication.

Response to faculty questions are missing.

No credible sources are cited.

Second Response:
Timely and full participation
5 (5%) – 5 (5%)

Meets requirements for timely, full, and active participation.

Posts by due date.

4 (4%) – 4 (4%)

Meets requirements for full participation.

Posts by due date.

3 (3%) – 3 (3%)

Posts by due date.

0 (0%) – 2 (2%)

Does not meet requirements for full participation.

Does not post by due date.

Total Points: 100

Name:  Discussion Rubric

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