Critical Care Medicine Discussion Paper
Discussion
I work as a nurse in an ICU and so many of the clients I attend to are critically ill. It mostly involves the end of life care. Although practitioners struggle to save all patients and everyone back to healthy lives, they have also understood how to be practical and understand what to anticipate once the patient reaches the end of life. Nevertheless, the past condition of the patient is often considered when making decisions. Healthcare professionals should work in the best interests of the patient and make evidence-based decisions, particularly by utilizing their judgment to facilitate the decision-making of patients (Melynk & Fineout-Overholt 2018)Critical Care Medicine Discussion Paper.
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I had an 89-year-old patient recently who walked many miles a day until six months ago. He had problems with gall bladder and required surgical intervention. The surgeon utilized his judgment and found that the patient was an extraordinarily active 89-year-old who was likely to gain from the surgery. He underwent cholecystectomy, and acquired an ileus while in the facility. After a number of operations, he was discharged with a sludge drain and lived on total parenteral nutrition. He lasted for seven months on TPN before he experienced more complications with his drain, which caused an intra-abdominal abscess. He returned to many more abdominal operations, which also resulted in ARDS and sepsis. The clinical professionals were entirely open with the patient’s family during the whole time, and the most intensive life-saving interventions, including many pressors, maximized ventilation measures, and CRRT. A variety of consultations were held between the healthcare workers and family to decide the action to take, and the family remained pressing, notwithstanding the grim prognosis. Certain family members mentioned that they thought that was not appropriate and that the patient was being tormented. Once they eventually agreed to withhold the treatment, the patient died in a very short time. The situation could have been different if a joint surrogate decision-maker was used early enough Critical Care Medicine Discussion Paper.
Inevitably, decisions on the continuation of life are the choice of the patient and aides. No one has the comfort to make these decisions hence healthcare professionals should have adequate communication skills to promote care decisions (Kon et al., 2016). The responsibility of healthcare providers in joint decision-making is to provide the highest quality research information while considering the patient’s beliefs, priorities, and desires (Kon et al, 2016). By enhancing surrogate awareness, a decision – making support inventory can supplement the practitioner’s plan Critical Care Medicine Discussion Paper.
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.
Melnyk, B. M., & Fineout-Overholt, E. (2018). Evidence-based practice in nursing & healthcare: A guide to best practice (4th ed.). Philadelphia, PA: Wolters Kluwer
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/ 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 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.