NURS 6052 Discussion: Patient Preferences and Decision Making

NURS 6052 Discussion: Patient Preferences and Decision Making

NURS 6052 Discussion: Patient Preferences and Decision Making

Discussion: Patient Preferences and Decision Making

As a labor and delivery (L&D) nurse you are involved in and witness a lot of patients and their families making tough decisions. One situation that comes to mind is a 22-year-old female, pregnant with her first child and the fetus was diagnosed with a neural tube defect. She did not have prenatal testing during her pregnancy. This defect caused her baby’s brain not to fully develop. The parents did not understand the diagnosis and wanted more information about the defect.

They were provided the information but were also told that the baby would not survive long after delivery and other options were discussed. Ultimately, the team and the family were all on the same page, and made the best decision for the patient and her wishes. It was a beautiful process.

As her nurse, it was my responsibility to get in touch with the genetic counselor to make sure the parents were provided the information and the support needed to make an informed decision. Since I have been a nurse, it is imperative for me to involve the patients and their families. Autonomy or self-determination is at the core of all medical decision-making in the United States. (Congress.gov, 1990).  It means that patients have the right and ability to make their own choices and decisions about medical care and treatment they receive.

When we include the patient’s preferences and values, the trajectory of the situation might change in a way that the medical providers do not anticipate. Sometimes the outcomes are surprising, but often, it is what the physicians said it would be.  As caregivers, we must respect the patients wants and needs, and if that means going in another direction because that is what the patients want, then that is what we are going to do. (Davoodvand, et al, 2016). The physicians do get upset, but we as nurses must speak up for and at times speak for the patient. I know some nurse’s personalities are stronger than others, but we must advocate for our patients.

The patient decision aid I selected was “Pregnancy: Should I Have Screening Tests for Birth Defects?” According to the Ottawa Hospital’s Research Institute, (2022) Testing for birth defects means that you may find out that your baby has a serious problem Would this information about that your baby having a birth defect change your plans? What I have seen in my practice as an L&D nurse is, we can never tell who will and will not continue with the pregnancy.

We need to make sure that the proper information is given and that the parents understand what is being told to them.  Often, they do not comprehend and we as providers do not see that they don’t. it is important to use tools that the patients and their families understand and use to better understand their situation and or diagnosis.

I would use this visual aid; it is very clear and straight to the point about what the screening is. It goes through six steps in detail. Get the facts, compare options, your feelings, your decision, quiz yourself, and your summary. This aid helps your say in this decision, this information will help you understand what your choices are so that you can talk to your doctor about them.

References

Congress.Gov.(1990). H.R.4449 – Patient Self Determination Act of 1990.

https://www.congress.gov/bill/101st-congress/house-bill/4449Links to an external site.

Davoodvand S, Abbaszadeh A, Ahmadi F. (2016). Patient advocacy from the clinical nurses’ viewpoint: a qualitative study. J Med Ethics Hist Med. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4958925/

The Ottawa Hospital’s Research Institute. (2022) Decision Aids Inventory. “Pregnancy: Should I Have Screening Tests for Birth Defects?” https://decisionaid.ohri.ca/Azsumm.php?ID=1179

NURS6052 Discussion Week 8 Module 5

Patient Preferences and Making Decisions

There have been many instances in my ten years as a nurse where I felt that the patient’s personal preferences and experiences could be beneficial to their treatment.  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 ( Hoffman, Montori, & Del Mar, 2014). I have had many providers listen to the patient’s input. I have also had many providers ignore the patient and do what they felt was best. One such case was a young lady with severe anxiety and panic attacks.

The patient had tried many different medications through-out the years and felt as if she knew what was completely ineffective.

She also had not been able to find a coping skill that was enough to prevent a panic attack. The provider in this case ordered sedating medication, which the patient had expressed made her “a zombie” as well as coping skill education. The patient was unable to participate in coping skills education as she quickly became so somnolent that all she did was sleep. She was not having panic attacks however sleeping all day is not helpful. I believe that had the provider listened to the patient in the first place, valuable time would not have been loss on ineffective treatment. Utilizing coping skills was eventual removed from her plan of care as it did not work for her. A focus that incorporates all three facets of evidence based practice helps ensure solid footing for effective decisions (Laureate Education, 2018). Patient preferences were not taken in to account in this instance. I chose the decision aid, panic disorder: Should I take medicine? The patient decision aid would be useful in the particular situation as well as similar situation because it allows the patient to make decisions in a step by step matter. First with education regarding the diagnosis, what to expect, and why your provider may order what they do. I feel that a start to finish visual guide such as this would ease the patients stress regarding treatment and improve their experience. I would definitely use these aids as a provider for the before mentioned reasons.

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. doi:10.1001/jama.2014.10186

Laureate Education (Producer). (2018). Evidence-based Decision Making [Video file]. Baltimore, MD: Author.

The Ottawa Research Hospital Institute. (2019). Patient decision aids. Retrieved from https://decisionaid.ohri.ca/Azsumm.php?ID=1060 https://decisionaid.ohri.ca/Azsumm.php?ID=1060

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Discussion: 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.

Shared decision-making and evidence-based practice (EBP) play significant roles in patient care quality and patient outcomes (Hoffman et al., 2014). They can be used together to improve patient outcomes. Shared decision-making allows the patient to feel like they have some control over their treatment and the decisions being made. EBP allows the best practices to be used in care.

            Incorporating patient preferences, social determinants, and values can significantly improve the care provided to patients (Gurmu, 2022). I work with patients with mental health and behavioral disorders. In this specialty, I have worked with a variety of patients with depression. For instance, there was an adolescent patient admitted to the unit where I worked who was very depressed and expressed suicidal ideation. His parents were perfectionists and pushed him very hard. They allowed him no freedom and controlled every aspect of his life. He expressed the desire to take his life because he felt it was the one thing he could control. During the initial assessment, I used his preferences, values, and social determinants to create a care plan. During his hospital stay, I allowed him to make some decisions regarding his care and treatment follow-ups when discharged. Using his preferences, values, and social determinants to guide his care gave him a sense of control over his life. His parents became a part of his treatment, and their roles in his life were altered for the better. He no longer voiced any depression or suicidal ideation.

            The patient decision aid I selected was “taking antidepressants for depression”. Antidepressants with counseling can be more effective in treating depression than counseling alone (The Ottawa Hospital Research Institute, 2019). Antidepressants help those with depression to manage their condition better and have an improved quality of life. In the experience posted, the patient decision aid helped me treat the patient’s condition. The patient decision aid is effective in practice, and I will continue to use it to treat others suffering from depression.

References

Gurmu Y. (2022). Patient Preferences in Shared Decision Making During Healthcare and Associated Factors Among Adult Admitted Patients at Public Hospitals of West Shoa Oromia, Ethiopia. Patient preference and adherence, 16, 1781–1786. https://doi.org/10.2147/PPA.S376600Links to an external site.

Hoffman, T. C., Montori, V. M., & Del Mar, C. (2014). The connection between evidence-based medicine and shared decision makingLinks to an external site.. Journal of the American Medical Association, 312(13), 1295–1296. doi:10.1001/jama.2014.10186

The Ottawa Hospital Research Institute. (2019). Patient Decision Aids. Retrieved November 6, 2023, from https://decisionaid.ohri.ca/Azsumm.php?ID=1058

 

A profound situation that sticks out to me was when I was a surgical nurse. We had an oncology patient come in for tumor excision. Prior to the surgery I ran her urine POCT, and she was pregnant. She refused the surgery, understandably. The doctors discussed with her that chemo and radiation were her best option, however ultrasound had showed the baby was just into the second trimester. This was an impossible situation for me to imagine and still is. The mom decided to decline all treatments until after the baby was born. Just under a year later she was back, with the baby! We did the treatments as we originally planned, but the cancer had progressed and she did end up leaving on Hospice with CMO orders. Even so, she was absolutely at peace with this decision and thrilled that she had a healthy baby.

It is always important to consider patient preferences. The patient retains the right to choose. It is important that the patient can provide sound informed consent and agree to proceed with the procedure (Olejarczyk, 2022). The best way to approach situations like these is with shared decision making. Shared decision making includes establishing a trusting relationship with the patient; providing emotional support; assessing patients’ understanding of the situation; explaining the patient’s condition and prognosis; highlighting that there are options to choose from; explaining principles of surrogate decision-making; explaining treatment options; eliciting patient’s values, goals, and preferences; deliberating together; and making a decision (Kon et al., 2016).

There are decision aids for cancer. There are decision aids for each type of cancer. There are decision aids for pregnancy. Decision aids are a useful tool that help to easily organize the treatment options (McAlpine at al., 2018). It may be helpful to utilize decision aids in my future practice when patients need them. Ultimately, however this woman made her choice from love for her child, which no aid can help navigate.

 

Patient Preferences and Decision Making

            It is the role of the clinician to assist patients and their support system to provide guidance in regards to the patient specific treatment plan. Using Evidence-Based Practice (EBP), which is the integration of patient preferences, their values, clinical expertise, and thorough research will assist in the collaboration to make treatment decisions that result in improved outcomes (Melnyk & Fineout-Overholt, 2018). When patients and families are faced with difficult choices regarding the treatment of their medical problem, many times emotions and logic may skew decision making capacity.  Therefore, it is crucial that the treatment team to use EBP integrate patient preferences with the treatment plan.  Utilizing decision making tools is helpful for those involved to weigh the facts and feelings in order to do what is best for the patient.

Patient Scenario

            In my work as a member of the Behavior Response Team at my hospital, I am often called to assist staff in managing patients with dementia who are experiencing behavioral disturbances, aggression, and agitation.  The case of Bob (alternative name) is an example of a family making an incredibly difficult decision to transition to palliative care. 

            Bob was approximately 90 years old and diagnosed with Advanced Dementia and recurring Urinary Tract Infections (UTI). Sudden behavioral changes such as confusion, aggression, hallucinations, delusions, and paranoia are common symptoms of a UTI (Alzheimer’s Association, 2020). This was the experience for Bob over the course of several months.  His care facility would bring him the Emergency Department due to aggressive behaviors towards staff and he would subsequently be diagnosed with a UTI and admitted for treatment. For the first several days of admission, Bob would exhibit ongoing aggression, paranoia, and confusion which required administration of chemical restraints with physical hold. After the first few days of antibiotic dosing his behavior would return to baseline; a pleasantly confused man who enjoyed listening to country music and talking about farm life.

            Bob’s wife was his medical Power of Attorney, which had been activated several years ago.  In conjunction with the recommendations of the medical ethics team, Bob’s wife chose to honor his dignity and transition to palliative care.  There would be no more administration of antibiotics for his recurring UTI’s and his care would be comfort focused.  The palliative care team worked closely with Bob, his wife, and the hospital staff to outline a plan to relieve Bob’s distress and provide him with peace in his final days.

Impact of Patient Preferences

            Shared decision making is the intersection of patient-centered communication and EBP in which the patient and clinician work together to make a health care decision after reviewing the options for care, benefits and consequences of treatment, patient values, preferences and circumstances (Hoffman et al., 2014). This process was evident in the scenario of Bob and his wife. After failed ability to decrease UTI, behavioral disturbances and hospitalizations, the palliative team worked closely with Bob and his wife to determine the most appropriate treatment plan. Bob had made his end of life wishes known to his wife prior to his cognitive decline, and through the shared decision-making process with the clinicians involved, she was able to honor his wishes and dignity and decrease his emotional and physical distress through provision of comfort cares.

Value of Patient Decision Aid

            There is a wide variety of tools available to assist patients, their families, and clinicians to work through ethical obligations and realistic treatment options when facing challenging decisions.  I’m unsure if any particular decision-making model was utilized in the case of Bob, however, the University of North Carolina (UNC) Palliative Care Program does have a tool specifically designed for guiding patients and families in making decision about end of life care.  A Decision Aid About Goals of Care for Patients with Dementia (UNC School of Medicine, 2020) was created by UNC Palliative Care Program to assist families to make difficult choices for their family member with dementia.  The tool is a simple to follow video, which guides families through common treatment decisions that they will encounter such as life-sustaining treatment, tube feeding, treatment of infections, and hospital transfer for acute illness.  There is proven relevancy to the impact using this tool has on the care of the patient.  In a goals of care study, researchers found that a decision aid for surrogate decision makers of patients with advanced dementia was effective in improving the quality of end-of-life communication and enhanced palliative care (Hanson et al., 2017).

            The patient decision aid for patients with dementia may have contributed to the decisions Bob’s wife had to make on his behalf. It may have provided additional education from an independent source to help guide her decisions about goals of care to be informed and also educate on how to communicate with the treatment team about the decisions to be made. 

Application of Decision Aid in Personal Practice

            The Ottawa Hospital Research Institute’s Decision Aids Inventory (The Ottawa Hospital Research Institute, 2019) provides a wealth of resources for patients and clinicians to encourage people to become more engaged in decision making about health care treatments by providing options, outcomes while integrating personal values.  I will utilize this inventory in my own practice.  By choosing a specific condition, I can utilize the tool to provide condition specific education and deconstruct complicated treatment scenarios into discrete items to be viewed through the scope of patient preferences and values.  It will be valuable to use for patients and families who may be overwhelmed with the emotions associated with end-of-life care planning or other diagnosis and situations which require a methodical approach.

            Bob’s life ended during that final hospitalization. His wife had to make a difficult decision which required separating her personal need for Bob to remain alive and the harsh reality of his disease state and poor outcomes.  Integrating a decision making tool into scenarios like this would be helpful for the patient and family members to be knowledgeable about their personal beliefs and values, disease processes and outcomes and ability to communicate preferences to the treatment team.

 

 

Initial Discussion – Week 8  

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NURS 6052 Discussion Week 8 Module 5 Patient Preferences and Making Decisions 

There have been many instances in my ten years as a nurse where I felt that the patient’s personal preferences and experiences 

could be beneficial to their treatment.  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 ( Hoffman, Montori, & Del Mar, 2014). I have had many providers listen to the patient’s input. I have also had many  

providers ignore the patient and do what they felt was best. One such case was a young lady with severe anxiety and panic attacks.  

The patient had tried many different medications through-out the years and felt as if she knew what was completely ineffective.  

She also had not been able to find a coping skill that was enough to prevent a panic attack. The provider in this case ordered  

sedating medication, which the patient had expressed made her “a zombie” as well as coping skill education. The patient was  

unable to participate in coping skills education as she quickly became so somnolent that all she did was sleep. She was not having  

panic attacks however sleeping all day is not helpful. I believe that had the provider listened to the patient in the first place,  

valuable time would not have been loss on ineffective treatment. Utilizing coping skills was eventual removed from her plan of  

care as it did not work for her. A focus that incorporates all three facets of evidence based practice helps ensure solid footing for  

effective decisions (Laureate Education, 2018). Patient preferences were not taken in to account in this instance. I chose the  

decision aid, panic disorder: Should I take medicine? The patient decision aid would be useful in the particular situation as well as  

similar situation because it allows the patient to make decisions in a step by step matter. First with education regarding the  

diagnosis, what to expect, and why your provider may order what they do. I feel that a start to finish visual guide such as this  

would ease the patients stress regarding treatment and improve their experience. I would definitely use these aids as a provider for  

the before mentioned reasons.   

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. doi:10.1001/jama.2014.10186  

Laureate Education (Producer). (2018). Evidence-based Decision Making [Video file]. Baltimore, MD: Author.  

The Ottawa Research Hospital Institute. (2019). Patient decision aids. Retrieved from https://decisionaid.ohri.ca/Azsumm.php?ID=1060 https://decisionaid.ohri.ca/Azsumm.php?ID=1060 

 

DISCUSSION: 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.

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.

 

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,

R. 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

https://decisionaid.ohri.ca/

 

 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

Discussion: Patient Preferences and Decision Making

Applying the best evidence to patients requires attention to their treatment preferences and specific values. Patient preferences can be influenced by social and cultural values, religious or spiritual values, personal thoughts about what entails the quality of life, personal priorities, and beliefs about health (Chang et al., 2021). Healthcare providers can incorporate patient preferences into their plans of care by obtaining their perspectives.

In my former organization, a diabetic patient came to his regular diabetes clinic with uncontrolled hyperglycemia. The patient’s glycemic levels had been uncontrolled for the past three months, becoming a major concern. The patient was on Metformin 500 mg per oral twice daily. I enquired from the patient about his lifestyle modification practices and medication adherence. I learned that the client had challenges remembering to take the evening dose because he was working in the evening.

As a result, he requested that a once-daily dose be prescribed so that he could consistently take the drug in the morning. I informed the clinician about the case, and the dose was changed to 850 mg once daily. In the next clinic visit, the patient blood glucose level had reduced, and he had achieved glycemic control with a HbA1C below 7%. Failing to consider the client’s treatment preferences may have worsened glycemic control due to ineffective medication adherence putting the patient at risk of chronic hyperglycemia complications (Chung et al., 2021).

Type 2 diabetes decision aid in adults was developed for adults taking a single medicine to control blood glucose. The options include DPP-4 inhibitors, Metformin, Pioglitazone, SGLT-2 inhibitors, and Sulfonylureas (NICE, 2015). The decision aid can be used in my professional practice to make decisions regarding treatment for patients with type 2 diabetes.

References

Chang, D. H., Wang, Y. H., Hsieh, C. Y., Chang, C. W., Chang, K. C., & Chen, Y. S. (2021). Incorporating Patient Preferences into a Decision-Making Model of Hand Trauma Reconstruction. International Journal of Environmental Research and Public Health, 18(21), 11081. https://doi.org/10.3390/ijerph182111081

Chung, F. F., Wang, P. Y., Lin, S. C., Lee, Y. H., Wu, H. Y., & Lin, M. H. (2021). Shared clinical decision-making experiences in nursing: a qualitative study. BMC Nursing, 20(1), 85. https://doi.org/10.1186/s12912-021-00597-0

NICE. (2015, December 2). Type 2 diabetes in adults: Management. NICE | The National Institute for Health and Care Excellence. https://www.nice.org.uk/guidance/ng28/resources/patient-decision-aid-2187281197

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NURS 6052 Discussion Week 8 Module 5 Patient Preferences and Making Decisions

There have been many instances in my ten years as a nurse where I felt that the patient’s personal preferences and experiences could be beneficial to their treatment. 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 ( Hoffman, Montori, & Del Mar, 2014). I have had many providers listen to the patient’s input. I have also had many providers ignore the patient and do what they felt was best. One such case was a young lady with severe anxiety and panic attacks. The patient had tried many different medications through-out the years and felt as if she knew what was completely ineffective. She also had not been able to find a coping skill that was enough to prevent a panic attack. The provider in this case ordered

sedating medication, which the patient had expressed made her “a zombie” as well as coping skill education. The patient was unable to participate in coping skills education as she quickly became so somnolent that all she did was sleep. She was not having panic attacks however sleeping all day is not helpful. I believe that had the provider listened to the patient in the first place, valuable time would not have been loss on ineffective treatment. Utilizing coping skills was eventual removed from her plan of care as it did not work for her. A focus that incorporates all three facets of evidence based practice helps ensure solid footing for effective decisions (Laureate Education, 2018).

Patient preferences were not taken in to account in this instance. I chose the decision aid, panic disorder: Should I take medicine? The patient decision aid would be useful in the particular situation as well as similar situation because it allows the patient to make decisions in a step by step matter. First with education regarding the diagnosis, what to expect, and why your provider may order what they do. I feel that a start to finish visual guide such as this would ease the patients stress regarding treatment and improve their experience. I would definitely use these aids as a provider for the before mentioned reasons.

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. doi:10.1001/jama.2014.10186

Laureate Education (Producer). (2018). Evidence-based Decision Making [Video file]. Baltimore, MD: Author.

The Ottawa Research Hospital Institute. (2019). Patient decision aids. Retrieved from https://decisionaid.ohri.ca/Azsumm.php?ID=1060 https://decisionaid.ohri.ca/Azsumm.php?ID=1060

 

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A nurse who has experience in long-term care must at some time talk to close family members about various palliative care alternatives. Sometimes the patient lacks the mental capacity to make decisions, thus the family makes all the decisions. Sometimes the inhabitant is still there, but the body may not give up (Etkind et al., 2020). It’s crucial to remember that the dialogue is challenging each time. In spite of the many advantages hospice care can offer, just a small percentage of patients receive it. 

A liver transplant is the sole therapy option for a person with end-stage liver failure. However, the patient was apprehensive about getting a liver transplant. Due to elevated lactic acid levels, a condition that made the patient feel ill, she had been in and out of hospitals. She was discharged from the hospital with the diagnosis that she would require a new liver to recuperate and that they would not be considering performing the surgery on her. Staff members received the information, but the client was kept in the dark. It so occurred that I was required to assume responsibility for discussing the client’s prognosis and treatment choices with her. I was open and honest with the patient, and at the end of our discussion, she had decided that hospice care was the best course of action. The patient spends most of her time with close friends and family. She also goes to social events, and what matters most is that she is joyful and energetic. 

We arrived at a conclusion about the patient’s requirement for hospice care by taking into account her preferences. It is significant to notice that she was not frequently visiting medical facilities. She did not express any pain, and she is also content and not on a restricted hydration or dietary intake. The client was aware of her treatment strategy and what to expect given the established diagnosis. 

The client is more likely to adhere to the prescribed treatment plan if patient preferences and values are taken into account. Increased compliance frequently results in patients who can be cured recovering more quickly. Patients who are unable to be treated in accordance with their treatment plan experience greater happiness, as do their immediate family members, and their relationships with medical staff advance. Additionally, the patient enjoyed drinking coffee, which she is not allowed to drink due to certain medications. Stronger painkillers may also be considered as the patient suffered from daily severe pain and the hospice was also involved (Younis et al., 2021). When a diabetic patient enters hospice care after being on a strict diet, they are suddenly permitted to eat a variety of foods. Pain is a common diagnosis among diabetic patients. She is happier as a result, and her interactions with staff members are generally better. 

Looking Ahead is a common name for a decision-making tool used by people diagnosed with a terminal illness. Therefore, the choice is applied to patients who are receiving care in inpatient facilities. As a result, the assistance concentrates on choices related to artificial nutrition, mechanical breathing, CPR, and hydration. Therefore, the decision tool was deemed acceptable and helpful. It is critical to note that several participants expressed a wish that this had been incorporated into their overall treatment plan earlier because they had already made some of the decisions (Grant et al., 2021). Through the use of the tool, the clients also felt like they had more control and frequently took an active part in the treatment strategy. 

The decision assistance may also help people with terminal illnesses construct a treatment plan with the help of the medical staff at the appropriate time to address all potential outcomes during their sickness. It is significant to note that patients are better equipped to make informed decisions when they are aware of what to expect from their treatment and what options are accessible to them. This patient might have avoided the anxiety, dread, and uncertainty she experienced during various stages of her illness if she had the choice to develop a plan like this in advance. 

We frequently utilize an advanced directive questionnaire that includes several generic inquiries about specific preferences. It would be beneficial for a nurse working in long-term care to have a more developed and thorough decision aid. Additionally, we may inform the residents of their unique diagnoses and prognoses and tailor the responses to the information and the residents’ individual needs. Additionally, the tool can assist those who have dementia, particularly when utilized in the early stages of the condition (Radbruch et al., 2020). Throughout every stage of the disease and treatment process, the patients’ wishes can be respected. Although it might take a long time to complete these for every patient, doing so could be quite beneficial and helpful in the long run. 

References

Etkind, S. N., Bone, A. E., Lovell, N., Cripps, R. L., Harding, R., Higginson, I. J., & Sleeman, K. E. (2020). The role and response of palliative care and hospice services in epidemics and pandemics: a rapid review to inform practice during the COVID-19 pandemic. Journal of pain and symptom management, 60(1), e31-e40.

Grant, M. S., Back, A. L., & Dettmar, N. S. (2021). Public perceptions of advance care planning, palliative care, and hospice: a scoping review. Journal of palliative medicine, 24(1), 46-52.

Radbruch, L., De Lima, L., Knaul, F., Wenk, R., Ali, Z., Bhatnaghar, S., … & Pastrana, T. (2020). Redefining palliative care—a new consensus-based definition. Journal of pain and symptom management, 60(4), 754-764.

Younis, N. M., Ahmed, M. M., & Abdulsalam, R. R. (2021). Assessing quality of life in palliative care. International Journal of Medical Toxicology & Legal Medicine, 24(3and4), 115-118.

 

     Dissemination of evidence-based practice allows for the spread of education and the better adaptation of up to date practices for a higher quality of care to be delivered to patients. Information is constantly evolving and changing the things that we do in healthcare. For example, it used to to be that physicians would order antibiotics for a wide spectrum of things, even if antibiotics would not necessarily treat the patients infection. Due to this, research has found that there are patients that have become resistant to certain antibiotics due to the over prescribing of these medications. Education has yielded cultures and sensitivities to be completed to ensure patients are receiving the right treatment for them. 

Dissemination Methods 

     The first method I would use is the use of meetings and presenting the information via PowerPoint. We live in a very technological world that uses many different things to convey information. PowerPoints are used throughout the informational and educational scenes and offer information in a concise and professional way. According to Kusuma and Utomo (2022), PowerPoint presentations work so well in meetings because the information is condensed on a memorable (sometimes colorful) slide, they tend to take less time to convey information in comparison to other delivery methods, and it gets more people involved in active listening. 

       The second method that I would use is the use of social media. Social media covers a wide variety of resources (such has facebook, instagram, medical blogs, etc.).  It is estimated that 4.9 billion people use a source of social media (Ruby, 2023). Although I know that blogs and everything you see on social media aren’t always true, it is the quickest way to get news and other updates spread throughout a large population quick. For example, during the outbreak of COVID-19 the CDC was posting updates on their social medias about the new guidelines and the appropriate PPE and transmission rates.  

     Both options have proven to be cost effective and a good way to spread education and awareness of information that may be changing. No matter what method one may choose, the goal of sharing good quality information and providing better care for communities and patients persist.

Barriers to the Methods

      During presentations, unless it is recorded only a specific audience has access to the information and the way the presenter is making their points. In my opinion, it is easy to read information that is outlined in a PowerPoint, but until one can listen to the presenter it is hard to get the whole picture of the information that may not be listed and loose sight of some of the most important parts. To combat this, all presentations could be recorded and shared in a secured page that is accredited to allow for a wide spread sharing of knowledge. In the PowerPoint, there is also a place for the presenters notes that.do not get displayed on the main screen. However, if one was to print out a copy of the PowerPoint for all the attendees, the notes would be displayed on the paper to help to reinforce the main points. 

     Social media, although easy and a very effective way of communication, sometimes does not offer all of the correct information. A article that I read during my research estimated that roughly 5% of hashtags about a certain topic were actually from a credible source (Katz & Nandi, 2021).  Also, although many people to have some sort of social media, not everyone does which results is a limited audience being able to access the information without having another from (like news coverage to posters around the community). To combat the misinterpretation of false data, for each social media platform that is being used, the account must be verified and accountable. 

Least Likely to be Used Dissemination Strategies 

      I am less likely to use methods that do not involve stakeholders and force change. Although changes are necessary to be able to provide the best and most modernized standard of care, it is unfair to not get perspectives of the individuals that are involved the most. Those that are experts in their fields have a opinion that may be different than those who are proposing the change. By allowing all parties to be involved, it allows for a smoother transition, better education opportunities, and employees that are genuinely happier and have positive performance rates (Asbari, Hidayat, &Purwanto, 2021).

Asbari, M., Hidayat, D. D., & Purwanto, A. (2021). Managing employee performance: From leadership to readiness for change. International Journal of Social and Management Studies, 2(1), 74-85.

Katz, M., & Nandi, N. (2021). Social media and medical education in the context of the COVID-19 pandemic: scoping review. JMIR Medical Education, 7(2), e25892.

Kusuma, D., & Utomo, S. (2022). The Effectiveness of Blended Learning Assisted by Interactive PowerPoint on Student Achievement of Elementary School Students in Bintarum Group, Demak District. ANP Journal of Social Science and Humanities, 3, 47-53.

Ruby, D. (2023). Social Media Users-How Many People Use Social Media in 2023. https://www.demandsage.com/social-media-users/