Patient Preferences and Decision Making
Most patients cared for by nurses are always critically ill, and those who end up in intensive care units frequently lose their lives. Nurses always give their all to their patients in order to improve their outcomes. However, it can be difficult to treat patients without taking into account their beliefs and values. Cultural competence and patient involvement in decision-making are important because nurses and physicians must work and act in the best interests of the patient (Melynk & Fineout-Overholt, 2018). As a result, evidence-based decision-making incorporates patient participation in their care and treatment, which improves their outcomes.
During my practice, I cared for an 82-year-old patient who developed a gallbladder as a result of his daily walks of several miles. The patient required surgery because the surgeon believed she would benefit from it due to her active lifestyle. She had a cholecystectomy first but then developed an ileus. The patient had additional surgeries and was discharged with a sludge drain and on TPN. However, after eight months, she experienced more drain issues, which resulted in an intra-abdominal abscess. She was admitted again and underwent additional abdominal surgeries, which resulted in ARDs and sepsis. As a nurse caring for her, I was open and honest with her and her family throughout the process, and I used the patient’s decisions and values to save her life. Cultural competence was especially important during the CRRT and the use of multiple pressors. Palliative care also entailed several discussions with the patient’s family to determine the best course of action and care. The patient suffered because she was in excruciating pain, and the doctor believed she would not live for long and suggested euthanasia. The patient and his family were consulted about the procedure, and they all agreed to discontinue care. Thus, involving the patient and his or her family in decision-making was critical, as was adhering to all of the ethical principles required for euthanasia (Kon et al., 2016).
To summarize, the decision to perform euthanasia is made by the patient and the surrogate. As a nurse, I was unsure about carrying out the decision, which necessitated the intervention of the physician and other nurses. The process, however, included a decision-making process that included the patient and her family as well as her goals, preferences, values, and beliefs.
References
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. https://doi.org/10.1097/CCM.0000000000001396.
Melnyk, B. M., & Fineout-Overholt, E. (2018). Evidence-based practice in nursing & healthcare: A guide to best practice (4th ed.). Philadelphia, PA: Wolters Kluwer
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Question 
Changes in culture and technology have resulted in patient populations that are often well-informed and educated, even before consulting or considering a healthcare need delivered by a health professional. Fueled by this, health professionals are increasingly involving patients in treatment decisions. However, this often comes with challenges, as illnesses and treatments can become complex.
Patient Preferences and Decision Making
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.
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.
Rubric:
Main Posting–
Levels of Achievement: Excellent 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.Good 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 the 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.Fair 35 (35%) – 39 (39%) Responds to some of the discussion question(s).
One or two criteria are not addressed or are superficially addressed.
It somewhat lacks reflection and critical analysis and synthesis.
Somewhat represents knowledge gained from the course readings for the module.
The post is cited in two credible sources.
Written somewhat concisely; may contain more than two spelling or grammatical errors.
Contains some APA formatting errors.Poor 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.Feedback:
Main Post: Timeliness–
Levels of Achievement: Excellent 10 (10%) – 10 (10%) Posts main post by day 3.Good 0 (0%) – 0 (0%) Fair 0 (0%) – 0 (0%) Poor 0 (0%) – 0 (0%) Does not post by day 3.Feedback:
First Response–
Levels of Achievement: Excellent 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.
The response is effectively written in standard, edited English.Good 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.
The response is effectively written in standard, edited English.Fair 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.
The response may lack clear, concise opinions and ideas, and few or no credible sources are cited. Poor 0 (0%) – 12 (12%) Response may not be on the topic and lacks depth.
Responses posted in the discussion lack effective professional communication.
Responses to faculty questions are missing.
No credible sources are cited. Feedback:
Second Response–
Levels of Achievement: Excellent 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.
The response is effectively written in standard, edited English.Good 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.
The response is effectively written in standard, edited English.Fair 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.
The response may lack clear, concise opinions and ideas, and few or no credible sources are cited. Poor 0 (0%) – 11 (11%) Response may not be on the topic and lacks depth.
Responses posted in the discussion lack effective professional communication.
Responses to faculty questions are missing.
No credible sources are cited. Feedback:
Participation–
Levels of Achievement: Excellent 5 (5%) – 5 (5%) Meets requirements for participation by posting on three different days.Good 0 (0%) – 0 (0%) Fair 0 (0%) – 0 (0%) Poor 0 (0%) – 0 (0%)