NURS 6052 Discussion Week 11 Patient Preferences and Making Decisions

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Title: NURS 6052 Discussion Week 11 Patient Preferences and Making Decisions

NURS 6052 Discussion Week 11 Patient Preferences and Making Decisions

NURS 6052 Discussion Week 11 Patient Preferences and Making Decisions

Thank you for sharing about your experience as a nurse and how you protected your patients values and preferences throughout their care. This is so important in nursing and should always be considered when caring for patients. I have experienced situations even seeing my primary care doctor where it didn’t feel as though my values and preferences were being respected, which is never a good feeling as a patient. 

One of the best ways that we can ensure that our patients values and preferences are being met is by educating patients before they have to make any decisions about their medical care. This can sometimes be difficult in time sensitive situations, but I believe as nurses it is always our responsibility to ensure that our patients are educated and that their voice is heard and respected in care decisions. Even something as simple as ensuring that care is clustered can allow a patient to feel respected and valued when receiving care. 

This technique is called shared decision making and it is when a clinician provides their patient with information about diagnostic or treatment options including all of the benefits and risks (Supporting Patients’ Roles in Their Healthcare Decisions, 2022). From here the patient is prompted to explain their preferences about the potential outcomes, any concerns they may have, and any other issues of importance to them (Supporting Patients’ Roles in Their Healthcare Decisions, 2022). After this the clinician and patient discuss which treatment option makes the most sense given the patient’s preferences (Supporting Patients’ Roles in Their Healthcare Decisions, 2022). Unfortunately, it seems that clinicians do not always have the time to do this but I am sure that patients would feel much more heard and confident in their care if this could be done in every situation. Patient centered care revolves around the patient and involves ensuring that the way of caring for patients is meaningful and valuable to the patient (O’Neill, 2022). 

References 

O’Neill, N. (2022, April 18). The Eight Principles of Patient-Centered Care. Oneview Healthcare. https://www.oneviewhealthcare.com/blog/the-eight-principles-of-patient-centered-care/

Supporting Patients’ Roles in Their Healthcare Decisions. (2022, July 11). Supporting Patients’ Roles in Their Healthcare Decisions | PCORI. https://www.pcori.org/blog/supporting-patients-roles-their-healthcare-decisions

 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.

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NURS 6052 Discussion Week 11 Patient Preferences and Making Decisions

NURS 6052 Discussion Week 11 Patient Preferences and Making Decisions

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.

NURS 6052 Discussion Week 11 Patient Preferences and Making Decisions

By Day 3 of Week 8

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.

Evidence-based practices (EBP) have become essential to providing care that results in more efficient and effective patient outcomes and encourages stewardship by employees for the organization. Although the benefits of EBP are widely known among healthcare workers, it is still noted to take several years to translate research into clinical practices. Due to this, there have been several ways clinicians have looked at disseminating information gathered to help encourage changes in clinical practice using EBP (Melnyk, 2012). There are various ways noted to disseminate information; however, there are two ways I have and will continue to use in my practice.

            Disseminating information through an active, multifaceted approach has been seen to be the most effective way. This is because dissemination alone doesn’t normally drive clinical change, meaning just giving out the information doesn’t always push people to employ such things in their practice. Using active dissemination involves using more than one way of engaging with personnel to help them implement new clinical practices to achieve improved patient outcomes. One of the best ways to help disseminate information is through using subject matter experts as mentors.

Having personnel to help support units with the new roll-out has improved motivation and acceptance of new practices and lower stressors associated with new clinical pathways. In addition, subject expert mentors are utilized to get information inputted into the facility’s policies and procedures (Melnyk, 2011). With new policies would come new training. This would ensure that everyone would be trained on the new policy to help implement such.

            Information can also be disseminated through a more passive approach. This would not be a method I would use solely on its own. Passive information would be done through posters, flyers, announcements, etc. Using items like these would be seen as more beneficial for personnel in a multifaceted approach instead of on its own. Visual aids could help reinforce the other dissemination methods to continue encouraging new clinical practices (Melnyk, 2011).

            There are many barriers to consider when getting information about EBP changes. These barriers could lie in the need for more knowledge about the evidence, the perceived lack of time to implement such changes, building education programs focusing on improved practice using evidence, and the need for available mentors (Melnyk, 2017). Due to the already noted barriers healthcare providers must work through to perform EBP, there must be leadership and administrative support. Having support from the leadership has been noted to be extremely important when implementing new practices and overcoming noted barriers. This means having leadership support on training and getting any extra personnel needed during training to ensure a smooth transition through changes being made.

Agency for Healthcare Research and Quality. (July 31, 2012). Communication and Dissemination Strategies to Facilitate the Use of Health-Related Evidence. Retrieved on January 24, 2022, from https://effectivehealthcare.ahrq.gov/products/medical-evidence-communication/research-protocolLinks to an external site.

Melnyk, B. M. (2012). Achieving a high-reliability organization through implementation of the ARCC model for systemwide sustainability of evidence-based practice. Links to an external site. Links to an external site.Nursing Administration Quarterly, 36(2), 127–135. doi:10.1097/NAQ.0b013e318249fb6a

Melnyk, B. M., Fineout-Overholt, E., Gallagher-Ford, L., & Stillwell, S. B. (2011). Evidence-based practice, step by step: Sustaining evidence-based practice through organizational policies and an innovative model. Links to an external site. Links to an external site.American Journal of Nursing, 111(9), 57–60. doi:10.1097/01.NAJ.0000405063.97774.0e

Melnyk, B. M., Fineout-Overholt, E., Giggleman, M., & Choy, K. (2017). A test of the ARCC© model improves implementation of evidence-based practice, healthcare culture, and patient outcomes Links to an external site. Links to an external site.. Worldviews on Evidence-Based Nursing, 14(1), 5–9. doi:10.1111/wvn.12188

Patient preferences should always be discussed and considered before any type of treatment is initiated. This can include a do not resuscitate order, refusal of blood products, certain medications or procedures, and more. When discussing evidence-based practice it “is the integration of patient preferences, values, clinical expertise, and rigorous research to make decisions that lead to improved outcomes for patients and families” (Melnyk &Fineout, 2018). Another aspect to consider when making decisions is shared decision making (SDM) paired with evidence-based medicine. Shared decision making is the process in which a clinician and patient work together to make a health decision after weighing the benefits and the harms, patient’s values, preferences, and circumstances (Hoffman et al., 2014).  

Looking at a few of the different decision aids I liked the more general Ottawa Hospital Research Institute’s Decision Aids Inventory. I chose this aid because of the lay out, I like all of the different options that are presented in a table form for easy use and understanding. As I work in surgery, we see many different values and preferences come through. I have encountered a few Jehovah Witnesses and as we know, because of their religious values they do not accept blood products. This specific patient was a Jehovah Witness that was about to undergo a total hysterectomy. Whenever we have a patient that is going to have a hysterectomy, they automatically get a type and screen. Since this patient refuses blood  such as red blood cells, white blood cells, plasma, and platelets (Garoufalia et al., 2022). The patient did not want the type and screen done either.   

With JWs refusal of blood products other options are often discussed such as the use of a cell saver that collects the patient’s own blood. The machine will spin the blood, separate the red blood cells, and then the blood is able to be infused again. We also take precautions for any hysterectomy by starting a second large bore IV. By taking these extra precautions, having cautery on hand, and the whole surgical team aware of the risks there was no need for interventions. The patient’s surgery was very successful with the normal amount of blood loss.  

 

Garoufalia, Z., Aggelis, A., Antoniou, E. A., Kouraklis, G., & Vagianos, C. (2022). Operating on Jehovah’s Witnesses: A Challenging Surgical Issue. Journal of Religion & Health, 61(3), 2447–2457. https://doi.org/10.1007/s10943-020-01175-5 

Hoffman, T. C., Montori, V. M., & Del Mar, C. (2014). The connection between evidence-based medicine and shared decision making

Links to an external site.Links to an external site.

Links to an external site.. Journal of the American Medical Association, 312(13), 1295–1296. doi:10.1001/jama.2014.10186 

Melnyk, B. M., & Fineout-Overholt, E. (2018). Evidence-based practice in nursing & healthcare: A guide to best practice (4th ed.). Philadelphia, PA: Wolters Kluwer. 

Patient Decision Aids Research Group – Ottawa Hospital Research Institute. (2015). Ottawa Personal Decision Guide. https://decisionaid.ohri.ca/docs/das/OPDG.pdf

Links to an external site. 

By Day 6 of Week 8

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.

    Patients must be involved with their care, it is essential to improving their overall outcomes and satisfaction with the care experience, reduces costs, and, benefits the clinician experience. (Krist et al, 2017). Patient’s are not wrong about their decisions, it’s their choice. Ignorance hinders their choice, that is why decision aids are so resourceful and effective. Patients learn on many different levels and are all different types of learners. MD or DO behind a name does not mean they are right, or in some instances have the patients best interest at heart. I have witnessed the lack of respect between a patient and their provider and I encouraged them to seek a second opinion. 

            Respect goes both ways, professionals should not talk at or talk down to patient’s, but they do because some providers think it is okay. The culture of the patient might not know it is okay to voice their concerns and ask questions. Reading your patients body language and facial expression is key to making sure their needs are met, questions are answered and their voices heard. There is no trust if there is no respect, and all discussions are stopped and communication is lost. According to James, 2018, one of the most widely cited elements of disrespect mentioned by patients is simply failing to pay attention to their needs, by leaving them unattended or ignored. 

References 

Ted A. James, MD, MHCM, 2018. Setting the Stage: Why Health Care Needs a Culture of Respect. Harvard Medical School; Trends in Medicine.  https://postgraduateeducation.hms.harvard.edu/trends-medicine/setting-stage-why-health-care-needs-culture-respect

Links to an external site.

Krist, R, Tong S, Aycock, R, Longo, D. (2017). Engaging Patients in Decision-Making and Behavior Change to Promote Prevention. Stud Health Technol Inform. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6996004/

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Click here to ORDER an A++ paper from our Verified MASTERS and DOCTORATE WRITERS: NURS 6052 Discussion Week 11 Patient Preferences and Making Decisions

10 months ago

Jessica Whitlow

Initial Discussion – Week 8

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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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10 months ago

Constance Cooper Walden Instructor Manager

RE: Initial Discussion – Week 8

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Jessica, I agree we need to listen to the patient’s experiences and what the outcomes have been with various treatments. Today with the Internet there is quite a bit of information that is helpful and some that are harmful or inaccurate. It is important as a provider to converse with the patient to see what their knowledge base is.

NURS 6052 Discussion Patient Preferences and Decision Making Walden

RE: Discussion – Week 11

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My work as a home hospice case manager has taught me a great deal about respecting patient preferences, even when it’s difficult as a clinician. I oriented to hospice many years ago and was shocked that my first hospice patient was also a full code. I was baffled how a patient could be both admitted into hospice yet still have active orders that ‘everything’ was to be done to save her life, which would inevitably lead to the hospital. It was incongruent. My preceptor whole-heartedly agreed.

We attempted to clarify what she wanted during our first several visits since the two facts were contradictory. However, we quickly learned that this patient was utterly unwilling to have any conversation that broached her coming death, either with her family or us. My preceptor attempted, several times and in the most skillful ways I’ve ever seen, to start difficult conversations, which included: the patient’s code status; a request from the patient’s daughter for a care conference to address family questions and concerns; and the hospice team’s strong expectation for how this particular patient might die (we anticipated a sudden bleed-out due to her sarcoma rapidly growing near her carotid).

We also wanted to provide support, education, and preparation to the family to help answer their questions; support their anticipatory grief, and help prepare them for their loved one’s potentially dramatic death. However, the patient adamantly refused to allow us to discuss anything with them. She was also unwilling to speak about any of these concerns herself with any hospice team member. She would say things like ‘I just want to enjoy the day,’ and ‘You make me sad when you bring these things up.’ After several team members’ attempts, we had to acknowledge and accept that this patient was not ready (and never was prepared) to discuss or prepare for her death with her family or us.

Our facility had a belief in the shared-decision making model, described by Melnyk & Fineout-Overholt (2019), in which research, clinician knowledge, and patient preferences are equally considered. In this situation, the patient’s preferences overrode the other two. So, we changed our approach at visits, and instead of focusing conversation on her code status or concerns from her family, we instead honored her desire to have pleasant talks, complete wound care, and manage her pain. Her treatment plan encompassed what she wanted, and these goals became what we wanted on her behalf.

Ultimately, she entered the actively dying phase very quickly (no bleed out), and her husband was able to call us to the home when she became unresponsive. He signed off on the DNR 45 minutes before she died. In the end, as frustrated as her family was that she had refused to allow them to communicate with hospice, they also stated this was precisely her personality in life. They appreciated that we had respected her ‘feisty and independent’ nature (their words), even though it had been difficult for all involved.

By including her preferences and values in a shared-decision making approach, this scenario’s trajectory held risk for a potentially traumatic experience for her family had she bled out. It also created the possibility that she wouldn’t die at home, which had been her initial expressed desire on admission to hospice. However, in the end, her wishes for ‘pleasant’ visits from hospice were met by the team, and we also managed her wound care and pain quite well. It was a successful patient care experience that taught me a great deal about respecting patients’ rights and desires.

The patient decision aid that I found through the Ottawa Hospital Research Institute (2019) is called the Plan Well Guide. It helps guide difficult conversations related to planning for severe illness and medical treatment options (Heyland, 2019). I don’t believe that this patient decision aid would have made a difference for the scenario I described above – she knew what she wanted and had no problem relaying that to us. Still, I think this tool could be an excellent option for future patients and even friends and family. The site has short videos showing actual patients and their loved ones discussing their experiences with having hard conversations about care, but realizing that they felt better afterward, having made their wants known to their family.

The critical point for clinicians to understand when considering patient preferences in the shared decision-making model is that patients may make decisions that we disagree with or that we feel are ill-informed, as in the example I describe. Our team never had a chance to discuss with our patient what our concerns were or explain how we wanted to support her family; she refused it all. Clinicians have to be prepared to present information in several ways (direct conversations, written materials, websites, videos) and then be ready for the patient to reject this information or not use it in the way we expect. We may have strong feelings about how the patient should decide their treatment plan and who they should include in that decision. In the end, it is what the patient decides that guides the treatment plan. It is the most ‘challenging’ patients that can teach providers the most because if they are indeed in control of their treatment, then we must be ready and willing to accept what they decide…even when we disagree.

Discussion: 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.

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.

Submission and Grading Information

Grading Criteria

To access your rubric:

Week 11 Discussion Rubric

Post by Day 3 and Respond by Day 6 of Week 11

To participate in this Discussion:

Week 11 Discussion

Congratulations! After you have finished all of the assignments for this Module, you have completed the course. Please submit your Course Evaluation by Day 7.

Module 6: Changing the World Through Evidence-Based Practice (Weeks 10-11)

Laureate Education (Producer). (2018). Evidence-based Practice and Outcomes [Video file]. Baltimore, MD: Author.

Due By	Assignment
Week 10, Days 1-3	Read the Learning Resources. Begin to compose your assignment.
Week 10, Days 4-6	Continue to compose your Assignment.
Week 10, Day 7	Deadline to submit your Assignment.
Week 11, Days 1-2	Read the Learning Resources. Compose your initial Discussion post.
Week 11, Day 3	Post your initial Discussion post.
Week 11, Days 4-5	Review your Discussion posts. Compose your peer Discussion responses.
Week 11, Day 6	Post two peer Discussion responses.
Week 11, Day 7	Wrap up Discussion

Learning Objectives

Students will:

• Analyze opportunities for change within healthcare organizations
• Recommend evidence-based organizational changes using an evidence-based practice approach to decision making
• Identify measurable outcomes addressed by evidence-based changes
• Justify dissemination strategies
• Analyze the impact of patient preferences on clinical decision making
• Analyze decision aids

Learning Resources

Note: To access this module’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.

Required Readings

Melnyk, B. M., & Fineout-Overholt, E. (2018). Evidence-based practice in nursing & healthcare: A guide to best practice (4th ed.). Philadelphia, PA: Wolters Kluwer.

• Chapter 7, “Patient Concerns, Choices and Clinical Judgement in Evidence-Based Practice” (pp. 219–232)

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

Note: You will access this article from the Walden Library databases.

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

Note: You will access this article from the Walden Library databases.

Opperman, C., Liebig, D., Bowling, J., & Johnson, C. S., & Harper, M. (2016). Measuring return on investment for professional development activities: Implications for practice. Journal for Nurses in Professional Development, 32(4), 176–184. doi:10.1097/NND.0000000000000483

Note: You will access this article from the Walden Library databases.

Schroy, P. C., Mylvaganam, S., & Davidson, P. (2014). Provider perspectives on the utility of a colorectal cancer screening decision aid for facilitating shared decision making. Health Expectations, 17(1), 27–35. doi:10.1111/j.1369-7625.2011.00730.x

Note: You will access this article from the Walden Library databases.

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

Healthcare professionals work in different settings, and their experiences with patients vary contextually. Despite encountering different patients, healthcare professionals are advised to promote patient-centeredness and ensure that patient values and preferences are incorporated into the treatment plan. Such considerations help to minimize health-related issues hence improving patient care outcomes. Decision aids are among the tools recommended for health professionals to improve decision-making.

I have experienced many situations in practice; some require incorporating patient preferences and values, while others do not need it. I once experienced a case where a patient had challenges choosing between medicines for high blood pressure and trying lifestyle changes first. She was unsure which method was the most effective in terms of recovery time and lasting effects. Incorporating patient preferences and values impacted the treatment plan positively since it was patient-centered, and the patient understood all the components. As González-Bueno et al. (2018) pointed out, patient-centeredness improves medication adherence. Similarly, the patient was more comfortable with the final decisions after evaluating the options.

Including patient preferences and values promotes patient engagement and improves patient care outcomes. Besides scientific evidence and clinical expertise, patient preferences and values are vital to evidence-based practice (Melnyk & Fineout-Overholt, 2018). It is the foundation of patient-centered care where patients play an active role in formulating treatment plans. The same was reflected in the treatment plan since the patient actively participated in decision-making. As Bombard et al. (2018) noted, patient engagement improves the patient-provider relationship and care quality. Similarly, engaging the patient in decision-making improved my relationship with her since she opened up about her everyday activities, fears, and cultural barriers affecting her choices.

The patient decision aid relevant to this situation is the “High Blood Pressure: Should I Take Medicine” option. It has various components to guide decision-making; facts, options comparison, patient’s feelings, decision, self-assessment, and summary (Healthwise Staff, 2022). The options comparison part is the most critical since it compares the effectiveness and setbacks of taking medications versus lifestyle changes. The decision aid contributes to informed decision-making since it analyzes the pros and cons of medications and lifestyle changes in high blood pressure control. In this case, the patient chooses the preference while knowing the benefits and side effects. Patient decision aids ensure that decisions are explicit by providing adequate and clear information about the options and expected outcomes (The Ottawa Hospital Research Institute, 2019). I will continue using this decision aid inventory to guide patients and families in making rational choices regarding high blood pressure control.

References

Bombard, Y., Baker, G. R., Orlando, E., Fancott, C., Bhatia, P., Casalino, S., … & Pomey, M. P. (2018). Engaging patients to improve quality of care: A systematic review. Implementation Science, 13(1), 1-22. https://doi.org/10.1186/s13012-018-0784-z

González-Bueno, J., Calvo-Cidoncha, E., Sevilla-Sánchez, D., Molist-Brunet, N., Espaulella-Panicot, J., & Codina-Jané, C. (2018). Patient-centered prescription model to improve therapeutic adherence in patients with multimorbidity. Farmacia Hospitalaria, 42(3), 128-134. https://doi.org/10.7399/fh.10961

Healthwise Staff. (2022). High blood pressure: should I take medicine? https://www.healthwise.net/ohridecisionaid/Content/StdDocument.aspx?DOCHWID=zx1768

Melnyk, B. M., & Fineout-Overholt, E. (2018). Evidence-based practice in nursing & healthcare: A guide to best practice (4th ed.). Wolters Kluwer.

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

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.

References

Kon, A. A., Davidson, Judy, Morrison, W., M.D., Danis, M., M.D., & White, Douglas B,M.D., M.A.S. (2016). 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. Retrieved from https://www.proquest.com/scholarly-journals/shared-decision-making-intensive-care-units/docview/1797885427/se-2

McAlpine, K., Lewis, K. B., Trevena, L. J., & Stacey, D. (2018). What Is the Effectiveness of Patient Decision Aids for Cancer-Related Decisions? A Systematic Review Subanalysis. JCO clinical cancer informatics, 2, 1–13. https://doi.org/10.1200/CCI.17.00148

Olejarczyk, Jacob. (2022). Patient Rights And Ethics. https://www.ncbi.nlm.nih.gov/books/NBK538279/

Thank you for sharing about your experience as a nurse and how you protected your patients values and preferences throughout their care. This is so important in nursing and should always be considered when caring for patients. I have experienced situations even seeing my primary care doctor where it didn’t feel as though my values and preferences were being respected, which is never a good feeling as a patient. 

One of the best ways that we can ensure that our patients values and preferences are being met is by educating patients before they have to make any decisions about their medical care. This can sometimes be difficult in time sensitive situations, but I believe as nurses it is always our responsibility to ensure that our patients are educated and that their voice is heard and respected in care decisions. Even something as simple as ensuring that care is clustered can allow a patient to feel respected and valued when receiving care. 

This technique is called shared decision making and it is when a clinician provides their patient with information about diagnostic or treatment options including all of the benefits and risks (Supporting Patients’ Roles in Their Healthcare Decisions, 2022). From here the patient is prompted to explain their preferences about the potential outcomes, any concerns they may have, and any other issues of importance to them (Supporting Patients’ Roles in Their Healthcare Decisions, 2022). After this the clinician and patient discuss which treatment option makes the most sense given the patient’s preferences (Supporting Patients’ Roles in Their Healthcare Decisions, 2022). Unfortunately, it seems that clinicians do not always have the time to do this but I am sure that patients would feel much more heard and confident in their care if this could be done in every situation. Patient centered care revolves around the patient and involves ensuring that the way of caring for patients is meaningful and valuable to the patient (O’Neill, 2022). 

References 

O’Neill, N. (2022, April 18). The Eight Principles of Patient-Centered Care. Oneview Healthcare. https://www.oneviewhealthcare.com/blog/the-eight-principles-of-patient-centered-care/

Supporting Patients’ Roles in Their Healthcare Decisions. (2022, July 11). Supporting Patients’ Roles in Their Healthcare Decisions | PCORI. https://www.pcori.org/blog/supporting-patients-roles-their-healthcare-decisions

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Name: NURS_6052_Module06_Week11_Discussion_Rubric

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		Excellent	Good	Fair	Poor
Main Posting		Points Range: 45 (45%) – 50 (50%) Answers all parts of the discussion question(s) expectations with reflective critical analysis and synthesis of knowledge gained from the course readings for the module and current credible sources. Supported by at least three current, credible sources. Written clearly and concisely with no grammatical or spelling errors and fully adheres to current APA manual writing rules and style.	Points Range: 40 (40%) – 44 (44%) Responds to the discussion question(s) and is reflective with critical analysis and synthesis of knowledge gained from the course readings for the module. At least 75% of post has exceptional depth and breadth. Supported by at least three credible sources. Written clearly and concisely with one or no grammatical or spelling errors and fully adheres to current APA manual writing rules and style.	Points Range: 35 (35%) – 39 (39%) Responds to some of the discussion question(s). One or 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. Post is cited with two credible sources. Written somewhat concisely; may contain more than two spelling or grammatical errors. Contains some APA formatting errors.	Points Range: 0 (0%) – 34 (34%) Does not respond to the discussion question(s) adequately. 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 sources. 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 Post: Timeliness		Points Range: 10 (10%) – 10 (10%) Posts main post by day 3.	Points Range: 0 (0%) – 0 (0%)	Points Range: 0 (0%) – 0 (0%)	Points Range: 0 (0%) – 0 (0%) Does not post by day 3.
First Response		Points Range: 17 (17%) – 18 (18%) Response exhibits synthesis, critical thinking, and application to practice settings. Responds fully to questions posed by faculty. Provides clear, concise opinions and ideas that are supported by at least two scholarly sources. Demonstrates synthesis and understanding of learning objectives. Communication is professional and respectful to colleagues. Responses to faculty questions are fully answered, if posed. Response is effectively written in standard, edited English.	Points Range: 15 (15%) – 16 (16%) Response exhibits critical thinking and application to practice settings. Communication is professional and respectful to colleagues. Responses to faculty questions are 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.	Points Range: 13 (13%) – 14 (14%) Response is on topic and may have some depth. Responses posted in the discussion may lack effective professional communication. Responses to faculty questions are somewhat answered, if posed. Response may lack clear, concise opinions and ideas, and a few or no credible sources are cited.	Points Range: 0 (0%) – 12 (12%) Response may not be on topic and lacks depth. Responses posted in the discussion lack effective professional communication. Responses to faculty questions are missing. No credible sources are cited.
Second Response		Points Range: 16 (16%) – 17 (17%) Response exhibits synthesis, critical thinking, and application to practice settings. Responds fully to questions posed by faculty. Provides clear, concise opinions and ideas that are supported by at least two scholarly sources. Demonstrates synthesis and understanding of learning objectives. Communication is professional and respectful to colleagues. Responses to faculty questions are fully answered, if posed. Response is effectively written in standard, edited English.	Points Range: 14 (14%) – 15 (15%) Response exhibits critical thinking and application to practice settings. Communication is professional and respectful to colleagues. Responses to faculty questions are 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.	Points Range: 12 (12%) – 13 (13%) Response is on topic and may have some depth. Responses posted in the discussion may lack effective professional communication. Responses to faculty questions are somewhat answered, if posed. Response may lack clear, concise opinions and ideas, and a few or no credible sources are cited.	Points Range: 0 (0%) – 11 (11%) Response may not be on topic and lacks depth. Responses posted in the discussion lack effective professional communication. Responses to faculty questions are missing. No credible sources are cited.
Participation		Points Range: 5 (5%) – 5 (5%) Meets requirements for participation by posting on three different days.	Points Range: 0 (0%) – 0 (0%)	Points Range: 0 (0%) – 0 (0%)	Points Range: 0 (0%) – 0 (0%) Does not meet requirements for participation by posting on 3 different days.
Total Points: 100

Name: NURS_6052_Module06_Week11_Discussion_Rubric