Patient Preferences and Decision Making

Patient Preferences and Decision Making

Being an ICU nurse, a number of the patients that I care for are extremely sick, and most of them are end of life patients that demand the end of life care. As nurses are increasingly trying hard to nurse everyone and save lives, they have learned to be realistic and known when to expect that the patient has reached the end of life. However, the patient’s condition has to be taken into consideration through decision making. Therefore, clinicians need to act in the best interest of the patient and rely on evidence-based decision-making practices that include using judgment to assist the patients in decision making (Melynk & Fineout-Overholt, 2018).

Recently, I had a 92-year-old man who had been walking a mile a day. The man developed gall bladder issues that required surgery. The surgeon assumed that this was an active man and extraordinary since he could make a mile at that age. The patient went for cholecystectomy, and while in the hospital, he developed ileus. Several surgeries were done where he was later sent home with a sludge drain and was living on Total parental nutrition. The patient survived with TPN for nine months, where he developed further problems with his drain that led to an intra-abdominal abscess. He later came for more abdominal surgeries that led to ARDS and sepsis complications.

Patient Values and Preferences and Their Impact on the Trajectory of the Situation

The medical and nursing staff were completely transparent with the family throughout. At this time, there was a need for more intense measures to save the life of the patient, which included but not limited to Continuous Renal Replacement Therapy and the use of various pressors. Considerably, several discussions were done with palliative care, the family, and the medical staff. This was to determine the most appropriate course of action despite fewer hopes for the family. However, some of the family members believed that actions that would torture the patient, such as CRRT, were not appropriate.

When the family agreed to withdraw care, unfortunately, the patient died in a couple of minutes. The outcome of the process could be different if there was a shared decision making a patient decision. When a clinician fails to engage the patient during treatment, the evidence-based practice can only be considered as evidence. Helping the patient share and acknowledge their unique preferences is important in patient-centered care.

The continuation of life decisions is dependent on either the decision of the patient or the surrogate. Considerably, decisions on ending life are sensitive, and everyone feels uncomfortable in making these decisions. Clinicians need to be trained on how to communicate effectively to facilitate effective treatment decisions (Hoffmann, Montori, and Del Mar 2014). This is because healthcare professionals must offer shared decision making through the essential scientific evidence while considering the values, preferences, and goals of the patient.

Decision Aid Inventory

A decision inventory aid inventory will be essential in complimenting the approach of evidence-based practice through an increased surrogate and patient’s knowledge. The inventory of decision aids has been structured to help in finding the decision aid that will meet the objectives (Carhuapoma and Hollen, 2018). Before implementing a treatment plan, it’s effective to offer the decision aid, which helps the patient, surrogate, and clinical come to a decision regarding the treatment plan depending on several factors.  The inventory decision aid was appropriate for end of life care in such difficult situations such as the ICU settings. The decisions made in the ICU setting are challenging for the clinicians, nurses, family and the patient. The decision aid will lead through options, facts, and awareness that the treatment plan is the best possible way for the situation (Ottawa Hospital Research Institute,2016). Therefore, decision aids are essential since they offer information on the benefits and limitations of the available options and thus guiding the patient decision making.

 

 

References

Carhuapoma, L. R., & Hollen, P. J. (2018). The Use of Decision Aids for End-of-Life Surrogate Decision Making for Critically-ill Stroke Patients: A Systematic Review. STROKE, 49.  Retrieved from:  https://doi.org/10.1161/str.49.suppl_1.TP360

Hoffmann, T. C., Montori, V. M., & Del Mar, C. (2014). The connection between evidence-based medicine and shared decision making. Jama312(13), 1295-1296.

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

Ottawa Hospital Research Institute. (2016). Advance Care Planning: Should I Stop Treatment That Prolongs My Life? Retrieved from https://decisionaid.ohri.ca: https://decisionaid.ohri.ca/docs/das/OPDG.pdf

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