Discussion: Patient Preferences and Decision Making

Want create site? With Free visual composer you can do it easy.

Discussion: Patient Preferences and Decision Making

Discussion: Patient Preferences and Decision Making

ORDER NOW FOR AN ORIGINAL PAPER: 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/.

o 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 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.

Assignment: Evidence-Based Project, Part 5: Recommending an Evidence-Based Practice Change

The collection of evidence is an activity that occurs with an endgame in mind. For example, law enforcement professionals collect evidence to support a decision to charge those accused of criminal activity. Similarly, evidence-based healthcare practitioners collect evidence to support decisions in pursuit of specific healthcare outcomes.

In this Assignment, you will identify an issue or opportunity for change within your healthcare organization and propose an idea for a change in practice supported by an EBP approach.

To Prepare:

· Reflect on the four peer-reviewed articles you critically appraised in Module 4.

· Reflect on your current healthcare organization and think about potential opportunities for evidence-based change.

The Assignment: (Evidence-Based Project)

Part 5: Recommending an Evidence-Based Practice Change

Create an 8- to 9-slide PowerPoint presentation in which you do the following:

· Briefly describe your healthcare organization, including its culture and readiness for change. (You may opt to keep various elements of this anonymous, such as your company name.)

· Describe the current problem or opportunity for change. Include in this description the circumstances surrounding the need for change, the scope of the issue, the stakeholders involved, and the risks associated with change implementation in general.

· Propose an evidence-based idea for a change in practice using an EBP approach to decision making. Note that you may find further research needs to be conducted if sufficient evidence is not discovered.

· Describe your plan for knowledge transfer of this change, including knowledge creation, dissemination, and organizational adoption and implementation.

· Describe the measurable outcomes you hope to achieve with the implementation of this evidence-based change.

· Be sure to provide APA citations of the supporting evidence-based peer reviewed articles you selected to support your thinking.

· Add a lessons learned section that includes the following:

o A summary of the critical appraisal of the peer-reviewed articles you previously submitted

o An explanation about what you learned from completing the evaluation table (1 slide)

o An explanation about what you learned from completing the levels of evidence table (1 slide)

o An explanation about what you learned from completing the outcomes synthesis table (1 slide)

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. Retrieved from https://jamanetwork.com/journals/jama/article-abstract/1910118

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. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4788386/

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.

RE: Discussion – Week 8 Lesley’s Initial Post

The Situation

When a patient is admitted to the hospital, the most important question that is asked of them is, ‘what are your wishes if your heart would stop’?  It is never easy to have this conversation, but it is crucial.  A situation that comes to mind is of a 94-year-old woman who was admitted for a new diagnosis of pancreatic cancer.  She was having quite a bit of pain and was there for more pain control.  The cancer was terminal; however, she did not quite understand the severity of the situation.  The conversation was initially started upon admission, at which time she wanted to be a full code.  She wanted everything done.  She was alert and oriented; there were no deficits with her faculties.  She was admitted with that full code status, and then the other hard conversations took place in the coming days.  Her daughter was there for these conversations with the nurse, social worker, and physician.  The patient finally understood that the cancer was in its final stages already and that with her advanced age, there would be no use for aggressive treatment.  The patient and daughter finally came to an understanding and agreement that the patient would go home with hospice and live the rest of her days in the comfort of her own home surrounded by family.

Decision Aid

The patient was introduced to hospice, as hospice services include managing pain and other symptoms and keeping the patient comfortable in a familiar environment with family and friends. Hospice programs also provide services to support the needs of the family, friends, and other caregivers involved (The Ottawa Hospital Research Institute, n.d.).

References

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

The Ottawa Hospital Research Institute. (n.d.).What is palliative care? What is hospice care?Retrieved July 19, 2020, from https://www.healthwise.net/ohridecisionaid/Content/StdDocument.aspx?DOCHWID=aa6410https://www.healthwise.net/ohridecisionaid/Content/StdDocument.aspx?DOCHWID=tu1430

 

RE: Discussion – Week 8 Sarah’s Initial Post

According to Melnyk and Fineout-Overholt, patient centered care has been defined as providing care that is respectful of and responsive to individual patient preferences, needs and values, and ensuring that patient values guide all clinical decisions (2019). There in no better example of providing patient centered care then having the discussion of end of life care with a patient. This can be following a large stroke, failed cancer treatment or advanced stage diagnosis, congestive heart failure and many other situations.

I started my nursing career on an oncology unit and watched multiple different approaches used by physicians and nurses in discussing the best option for the patient. I have witnessed the difference in conversation delivery by physicians who believe in end of life care and those who believe a patient who is a DNR has just given up on life. In one scenario, I was carrying for a patient who was younger with advanced cancer. One morning, the patient and family had a meeting with nursing and social work staff. Extensive education was given on end of life care including withdrawing from receiving chemotherapy and going home (when stable) with hospice. The patient and family were given time to discuss all options and had decided to stop treatment and go home. I called the patient’s oncologist and told him the patient and family wishes and asked for an order for a DNR. The physician became upset over the phone and stated that he would come in a talk with the patient. He came in after my shift ended so I don’t know the conversation but I got in report the next morning that the oncologist had convinced the patient to complete the last few chemo treatments and see how scans were before “giving up”. The patient coded, while receiving chemo, and was not able to be saved. His family was horrified to watch CPR be done knowing that he hadn’t wanted it. His children were left with a final image of their dad in a hospital following a code, his wife voicing feeling like she failed him in letting him die that way, his parents voicing that they should have backed him up to stand up to the oncologist to have his wishes heard and followed.

While I could go on and on in this story, the lesson I learned was the importance of listening to and advocating for the patient’s preferences, supporting them when they feel backed into a corner to do something they don’t want to do. I have taken this experience with me throughout my entire career and have been able to advocate for patients, sometimes with families and sometimes with physicians, to make sure that the patient’s values and preferences are heard and followed. This was a sad but early lesson for me on the importance and impact of following a patient’s preferences.

Many decisions are made by patients in their last months of life, creating complex decision-making needs for these individuals (Phillips, Lifford, Edwards, Poolman, & Joseph-Williams, 2019) Patients and families need evidence-based information to help them make decisions. The Ottawa Hospital Research Institute has multiple links in regard to end of life care. Another resources that I have personally used to find education on this is the National Institute of Aging. There are links for families and healthcare workers looking at education. I also refer families to the American Cancer Society, even if the family member does not have cancer, because of the great information included on end of life care. The value of education derived  from any or all these decision aids is immense.

 

Links to End of Life Care Education referenced:

https://www.cancer.org/treatment/end-of-life-care.html

https://www.nia.nih.gov/health/providing-comfort-end-life

References:

Melnyk, B. and Fineout-Overholt, E. (2019). Evidence based practice in nursing and healthcare 4th edition. Wolters-Kluwer.

Phillips, G., Lifford, K., Edwards, A., Poolman, M., & Joseph-Williams, N. (2019). Do published patient decision aids for end-of-life care address patients’ decision-making needs? A systematic review and critical appraisal. Palliative medicine, 33(8), 985–1002. https://doi.org/10.1177/0269216319854186

Image result for Patient Preferences and Decision Making

650 × 959

Rubric Detail

Select Grid View or List View to change the rubric’s layout.

Name: NURS_6052_Module05_Week08_Discussion_Rubric
Grid View
List View
Excellent Good Fair Poor
Main Posting
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.
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.
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.
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
10 (10%) – 10 (10%)
Posts main post by day 3.
0 (0%) – 0 (0%)
0 (0%) – 0 (0%)
0 (0%) – 0 (0%)
Does not post by day 3.
First Response
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.
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.
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.
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
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.
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.
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.
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
5 (5%) – 5 (5%)
Meets requirements for participation by posting on three different days.
0 (0%) – 0 (0%)
0 (0%) – 0 (0%)
0 (0%) – 0 (0%)
Does not meet requirements for participation by posting on 3 different days.
Total Points: 100
Name: NURS_6052_Module05_Week08_Discussion_Rubric

Did you find apk for android? You can find new Free Android Games and apps.