Sample Answer for NURS 6052 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.
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
Title: NURS 6052 Patient Preferences and Decision Making
The evolution of technology allows patients to have more access to information resulting in well-informed, educated patients. While it is great that patients are taking the initiative to play active roles in their healthcare, it comes with challenges. Working in labor and delivery, I have had many experiences with patient involvement in treatment and healthcare decisions. One reoccurring experience that patient involvement helps aid in best practice and incorporates them in healthcare decision-making is birth plans.
Birthing plans set expectations and standards of care couples expect during the laboring process (Hidalgo-Lopezosa et al., 2021). According to a study by Hidalgo-Lopezosa et al. (2021), birth plans in southern Spain resulted in fewer interventions and more natural birthing processes. While the utilization of birth plans creates a clear picture of how the patient wants their delivery to go, they can be challenging, especially when they are unwilling to deviate from the plan. When I first started working labor and delivery, the first bout of knowledge my preceptor shared with me is never to trust a pregnant woman. While she did not mean this figuratively, the patient’s status can rapidly progress or decline. This instability can create a need for evidence-based innovations the couple is unwilling to try or had not discussed when developing their plan.
De Campos Silva and Lopes (2020) concluded the need for couples to discuss their birth plans with their physician or midwife to ensure all possibilities are deliberated, and each party has a clear understanding of desires and possible outcomes. Initiating these conversations before delivery would help reduce the challenges healthcare providers at my organization face when handed a birth plan, especially when the plan does not align with unit policies and the American College of Obstetricians and Gynecologist recommendations. The biggest challenge I have faced is a delivery that resulted in a limp unresponsive newborn. The mother’s demand for the newborn to be placed in kangaroo care impeded proper intervention outlined by the Neonatal Newborn Resuscitation Program. After much explanation, the mother allowed the newborn to be placed in the warmer, where the newborn was intubated and flown to a tertiary hospital. The newborn was diagnosed with a diaphragmatic hernia which prevented proper lung growth. The diaphragmatic hernia could have been diagnosed with ultrasound; however, the mother refused. While the patient had the right to create a birth plan, I feel frequent in-depth conversations with a physician or midwife could have helped this situation.
Patients have the right and should want to be active participates in their healthcare decisions. They should research and become educated but also value the expertise of their physician and other healthcare providers. Without the collaboration of patients and healthcare providers, evidence-based practice is nonexistent (Melnyk and Fineout-Overholt, 2019). Both must work together and use best practices to aid their decisions to improve health.
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References
de Campos Silva, T. M., & Lopes, M. I. (2020). The couple’s expectations for the birth
plan. Revista de Enfermagem Referência, 2, 1–7. https://doi-org.ezp.waldenulibrary.org/10.12707/RIV19095
Hidalgo-Lopezosa, P., Cubero-Luna, A. M., Jiménez-Ruz, A., Hidalgo-Maestre, M., Rodríguez-
Borrego, M. A., & López-Soto, P. J. (2021). Association between Birth Plan Use and Maternal and Neonatal Outcomes in Southern Spain: A Case-Control Study. International Journal of Environmental Research and Public Health, 18(2). https://doi-org.ezp.waldenulibrary.org/10.3390/ijerph18020456
Melnyk, B. M., & Fineout-Overholt, E. (2018). Evidence-based practice in nursing &
healthcare: A guide to best practice (4th ed.). Philadelphia, PA: Wolters Kluwer.
A Sample Answer 2 For the Assignment: NURS 6052 Patient Preferences and Decision Making
Title: NURS 6052 Patient Preferences and Decision Making
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
A Sample Answer 3 For the Assignment: NURS 6052 Patient Preferences and Decision Making
Title: NURS 6052 Patient Preferences and Decision Making
Social determinants of health (SDH) refer to the circumstances/condition in which a person lives, such as where a person was born, where a person lives, the education one receives, religion/worship, play, and age that affects an individual’s quality of life, function, and health (Melnyk & Fineout-Overholt, 2018). For example, a person from Africa who needs more education in the English language can experience difficulties when making healthcare decisions. This can be due to limited knowledge of the disease process or a lack of understanding of the treatment method. Also, lack of income, lack of social support, and lack of necessities such as food, housing, and transportation can impact a person’s health and the decision-making process, as in the case of the patient described below. When patients’ preferences, their social determinants, and their values are considered when making healthcare decisions, it can lead to better patient outcomes and health improvement overall.
As an ED nurse, most of the patients I care for are incredibly sick, and for many of them, their time in my care is the end of their lives. While nurses try their hardest to save every patient and nurse everyone back to health, they also have learned how to be realistic and know when to expect that the patient has reached the end. Sometimes, the patient’s prior condition is considered in decision-making, however. Clinicians must act in the patient’s best interests and use evidence-based decision-making, which includes using their judgment to help patients make decisions (Melynk & Fineout-Overholt, 2018). Just recently, I had a 92-year-old patient who, up until nine months ago, was walking several miles a day. He developed an aneurysm. The surgeon used his judgment in that this was an exceptional 92-year-old who was very active and could benefit from surgery. He went in for a stent placement through his left femoral artery. The nursing and medical staff were completely transparent with the family throughout the entire process and after several days of the most intense measures to save his life, including but not limited to CRRT, maxed-out vent settings, and the use of several pressors. Palliative care was consulted, and several discussions between the medical staff and family were made to determine the course of action.
Furthermore, despite the grim prognosis with almost no hope, the family kept pressing. Some family members stated they believed it was not right and that the patient was being “tortured.” When they finally decided to withdraw care, the patient died within minutes. Had a shared decision-making patient (surrogate) decision aid been used earlier in the process, the outcome may have differed.
Decisions on the continuation of life are ultimately the decision of the patient and surrogates. Nobody is comfortable making these decisions, and clinicians should be trained in communication to facilitate treatment decisions (Kon et al.,2016). Our job as healthcare professionals in shared decision-making is to offer the best scientific evidence available while considering the patient’s values, goals, and preferences (Kon et al., 2016). A decision-aid inventory may complement the clinician’s approach by increasing surrogate knowledge.
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. doi: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
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
A Sample Answer 4 For the Assignment: NURS 6052 Patient Preferences and Decision Making
Title: NURS 6052 Patient Preferences and Decision Making
According to existing research, healthcare professionals make most healthcare decisions with little insight from clients (Melnyk & Fineout-Overholt, 2021; Walden University, 2018). Even so, the collective decision to deliver high-quality care acknowledges that treatment options, processes, and test results should be medically beneficial and be favored by clients (Kon et al., 2020). Moreover, determinations should be informed by accessible medical evidence. Nurses are called to account for their clinical decision-making process’s quality, safety, and efficacy and their patients, clients, and any other service user to whom they owe a duty of care. For instance, I had an engagement with a 43-year-old male with Type 2 diabetes and high cholesterol levels during my shift in the inpatient care unit. During this encounter, I provided patient-centered care in which the patient actively participated in the assessment. We exchanged information during the assessment process, which helped build a trusting relationship. During patient-centered care, communication and relationship building are the first steps toward shared decision-making about the patient’s treatment (Kon et al., 2020).
In this particular instance, the patient expressed a desire to lower the levels of bad cholesterol associated with Type 2 diabetes and, as a result, inhibit heart conditions. The need of this patient impacted his search for answers. When there is a collaborative effort and shared decision-making, both the client and the nurse share information that improves the client’s health (Karlsen et al., 2020). Noticeably, the connection I built with my client grew greater and greater, culminating in trust and understanding- he would now express his concerns with ease
The patient decision aid that I selected was to take insulin to keep blood sugar levels under control (The Ottawa Hospital Research Institute, 2019). The patient decision aid improved practice since it informs nurses with the decisions to take suppose they have a patient suffering from Type 2 Diabetes. In the experience that I encountered, the patient decision-making aid could have helped me lower the patient’s sugar levels and have them control the condition. In my practice, I will use this decision aid inventory to understand the clinical decisions that I need to take whenever I have assessed a patient and learned what they are suffering from.
References
Karlsen, M. M., Happ, M. B., Finset, A., Heggdal, K., & Heyna, L. G. (2020). Patient involvement in micro-decisions in intensive care. Patient Education and Counseling, 1-8. https://www-sciencedirectcom.ezp.waldenulibrary.org/science/article/pii/S073839912030207X?via%3DihubLinks to an external site.
Kon, A. A., Davidson, J. E., Morrison, W., Danis, M., & White, D. B. (2020). 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. https://search-proquestcom.ezp.waldenulibrary.org/docview/1797885427?accountid=14872Links to an external site..
Walden University (Producer). (2018). Evidence-based Decision Making [Video file]. Baltimore, MD: Author.
Melnyk, B. M., & Fineout-Overholt, E. (2021). 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/Azsumm.php?ID=1504Links to an external site.