Sample Answer for NURS 6052 DISCUSSION PATIENT PREFERENCES AND DECISION MAKING 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.
RESOURCES
Be sure to review the Learning Resources before completing this activity.
Click the weekly resources link to access the resources.
WEEKLY RESOURCES
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.
A Sample Answer For the Assignment: NURS 6052 DISCUSSION PATIENT PREFERENCES AND DECISION MAKING
Title: NURS 6052 DISCUSSION PATIENT PREFERENCES AND DECISION MAKING
Patient engagement is an essential part of healthcare and a crucial component of safe and high-quality patient-centered care (World Health Organization, 2016). As nurses, we have to engage our patients in the decision-making processes. It allows us to make better-informed decisions about their care options. To facilitate patient engagement in their care, we have to understand their personal preferences and values. Patient preferences can be spiritual or religious values, cultural and social values, personal priorities, beliefs about health, and thoughts about what is important for their quality of life (Ginex, 2018). Since the patient population is diverse and everyone is different, it is significant for us to always assess our patients’ preferences and values before providing healthcare services.
My Experience
I am currently working part-time in the aesthetic field and incorporating patients’ preferences and values are the key to successful results. Patient satisfaction with the result tends to be low when patients’ preferences and values are not considered during the procedures. When I first started to work in this field, I performed the procedures as I got trained. For instance, we have a non-invasive radiofrequency (RF) therapy called Thermage. When I got training on the Thermage procedure, the trainer only covered the patient’s face. After the training, I did several Thermage procedures, and I only covered the face. However, one of the patients said that she also did it on the neck in the previous Thermage procedure. I already used all the shots from the Thermage tip at the time she talked about it. As a result, I had to open up another Thermage tip and use some shots on her neck. From this experience, I learned that it is crucial to communicate with patients throughout the procedures.
After I learned about the importance of incorporating patients’ preferences and values, I always communicate with the patients all the time. For example, if the patient asks, I let patients put the numbing cream on for a longer period of time or use ice to ease the pain. For injection procedures, such as fillers and Sculptra, I always ask if they have specific concerns about their faces and bodies before starting the procedures. After assessing what they want, I help fix those concerns. Most patients are satisfied with the result when their preferences and values are incorporated into the procedures.
Decision Aid Inventory
Patient decision aids are tools that assist health practitioners to involve patients in decision-making by providing patients necessary information about the care options and possible outcomes, clarifying personal preferences and values, and making clear decisions that need to be made (The Ottawa Hospital, n.d.). For example, I selected “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?” among the patient decision aids. It consists of a series of questions that are based on one’s interest and level of risk. Answering those questions step-by-step helps clarify the reasons for interacting or not interacting with other people or taking or doing or not doing activities outside. There are many patient decision aids that can be useful in my practice. I can provide patients with these patient decision aids so they can effectively make their decisions.
References
Ginex, P. (2018, March 22). Integrate evidence with clinical expertise and patient preferences and values. https://voice.ons.org/news-and-views/integrate-evidence-with-clinical-expertise-and-patient-preferences-and-values
The Ottawa Hospital. (n.d.). Patient decision aids. https://decisionaid.ohri.ca/index.html
World Health Organization. (2016). Patient engagement. https://apps.who.int/iris/bitstream/handle/10665/252269/9789241511629-eng.pdf
A Sample Answer 2 For the Assignment: NURS 6052 DISCUSSION PATIENT PREFERENCES AND DECISION MAKING
Title: NURS 6052 DISCUSSION PATIENT PREFERENCES AND DECISION MAKING
As a nurse that works in critical care, I have seen nurses that become patients, or family with a relative that is a nurse or health care worker. I had the pleasure of working with a patient that her husband was a paramedic. That patient came to the ER after experiencing large amounts of urine, dizziness, and feeling off. The patient has been receiving large amounts of steroids due to inflammation to her back. According to her husband which was a paramedic, she has been taking prednisone 80mg daily for the last 3 weeks. Which is a high dose for a young woman. upon checking her blood sugar, it was measured at 880. Immediately we speak to them about starting insulin drip and fluids to bring her blood sugar down slowly. Her husband refused, and stated if we give her insulin she will be always dependent on insulin. The patient agrees with her husband due to his background.
The patient preference impaction on treatment
As the patient is a certified nurse aid, and her husband is a paramedic they have been refusing insulin to lower her blood sugar and only allowed fluids, multiple doctors and nurses attempted to educate the patinet and her husband and gave the patient 3 hours of fluids to attempt to bring her sugar down, but it failed. her sugar only dropped few points and she became acidotic. In that emergency situation, insulin drip was started and blood sugar started to come down.
Patient decision may impact positively and negatively on their plan of care, proper education and research is needed before weighing in heavily on your plan of care.
References
- Fineout-Overholt, L. E. Long, & L. Gallagher-Ford. (2018). Making the case for evidence-based practice and cultivating a spirit of inquiry. In Melnyk, B. M., & Fineout-Overholt (Eds.), Evidence-based practice in nursing & healthcare: A guide to best practice (4th ed., pp. 7–32). Wolters Kluwer.
The Ottawa Hospital Research Institute. (2019). Patient decision aids. https://decisionaid.ohri.ca/
A Sample Answer 3 For the Assignment: NURS 6052 DISCUSSION PATIENT PREFERENCES AND DECISION MAKING
Title: NURS 6052 DISCUSSION PATIENT PREFERENCES AND DECISION MAKING
Introduction
This paper will provide examples of how incorporating or not incorporating patient preferences and values impact their outcomes. Then, we will explain how including patient preferences and values influence their health situation and are reflected in their plan of care. Finally, we will discuss decision aid support and its impact on patient decision-making and use in professional practice.
The situation related to patient preference and value impacts outcomes in the plan of care.
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.
Decision-Aid Support and Impact on Decision-Making
Decision aids are a valuable tool in helping patients make the right decisions based on their values and needs. The Ottawa Hospital Research Institute (2019) provides an A-Z inventory of decision aids. For example, when searching the term, “Kidney”: multiple decision aid tools populate to relating to chronic kidney disease, end of life issues, and kidney failure to include dialysis choice, dialysis; doing the right choice, My life, My dialysis choice, advanced care planning: should I stop kidney dialysis, Kidney Failure: Should I start dialysis? This tool provides patients with treatment options, pathways, and outcomes. Clinicians use it to support patient preference and guide patient and provider decision-making (Melnyk & Fineout-Overholt, 2019, p. 228). In the example of the kidney patient who has multiple barriers to achieving optimal care, this information would have provided him with the options needed before starting dialysis. It would give a platform of shared decision between himself, his wife, and his provider. Clinicians should use decision aids in their daily practice with patients newly diagnosed or with patients who are not managing their diagnosis well. These aids will support active engagement by the patient and lead to both an improved patient and provider experience and outcomes.
References
Green, J. A., Ephraim, P. L., Hill-Briggs, F. F., Browne, T., Strigo, T. S., Hauer, C. L., Stametz,
- A., Darer, J. D., Patel, U. D., Lang-Lindsey, K., Bankes, B. L., Bolden, S. A., Danielson, P., Ruff, S., Schmidt, L., Swoboda, A., Woods, P., Vinson, B., Littlewood, D., Jackson, G., … Boulware, L. E. (2018). Putting patients at the center of kidney care transitions: PREPARE NOW, a cluster randomized controlled trial. Contemporary clinical trials, 73, 98–110. https://doi.org/10.1016/j.cct.2018.09.004
Hoffmann, 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
Kon, A.A., Davidson, J.E., Morrison, W., Danis, M., & White, D.B. (2016). Shared decision-
making in intensive care units: Executive summary of the American College of Critical Care Medicine and American Thoracic Society policy statement. Critical Care Medicine, 44(1), 188-201. Doi:10.1097/NND.0000000000000483
National Kidney Foundation. (2020) NKF statement on the ESRD treatment choices model
(ETC) and policies to improve kidney patient choice: Kidney disease facts. https://www.kidney.org/news/nkf-statement-esrd-treatment-choices-model-etc-and-policies-to-improve-kidney-patient-choice
The Ottawa Hospital Research Institute. (2019). Patient decision aids. Retrieved from
Rubric
| NURS_6052_Module06_Week11_Discussion_Rubric | ||||||
| Criteria | Ratings | Pts | ||||
| This criterion is linked to a Learning OutcomeMain Posting |
|
50 pts | ||||
| This criterion is linked to a Learning OutcomeMain Post: Timeliness |
|
10 pts | ||||
| This criterion is linked to a Learning OutcomeFirst Response |
|
18 pts | ||||
| This criterion is linked to a Learning OutcomeSecond Response |
|
17 pts | ||||