NURS 6052 Patient Preferences and Decision Making 

Sample Answer for NURS 6052 Patient Preferences and Decision Making  Included After Question

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. 

A Sample Answer For the Assignment: NURS 6052 Patient Preferences and Decision Making 

Title: NURS 6052 Patient Preferences and Decision Making 

 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.

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 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.

References

Congress.Gov.(1990). H.R.4449 – Patient Self Determination Act of 1990.

https://www.congress.gov/bill/101st-congress/house-bill/4449

Links to an external site.

Davoodvand S, Abbaszadeh A, Ahmadi F. (2016). Patient advocacy from the clinical nurses’ viewpoint: a qualitative study. J Med Ethics Hist Med. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4958925/

A Sample Answer 2 For the Assignment: NURS 6052 Patient Preferences and Decision Making 

Title: NURS 6052 Patient Preferences and Decision Making 

That is great news to hear about your granddaughter. According to AAMC, 2023, screening results for some patients may lead to unnecessary anxiety or false reassurance and providers lack a complete understanding of the limitations of the test. There is a big difference between a screening and a diagnostic test. The screening is offered to detect potential disease and if the screen is positive, it is appropriate to consider a diagnostic test.

NURS 6052 Patient Preferences and Decision Making 
NURS 6052 Patient Preferences and Decision Making 

Making informed decisions are hard, but it is also what is best for the patient.  An informed decision is a choice that individuals make once they have all the information related to the decision topic. It involves analyzing potential outcomes, benefits and risks associated with each option, then deciding which choice is the best for them. (Healthy People 2030, 2020). 

References         

Association of American Medical Colleges. (2023). Prenatal screenings can lead to false positives, heightened anxiety. https://www.aamc.org/news-insights/prenatal-screenings-can-lead-false-positives-heightened-anxiety

Links to an external site.

Healthy People 2030. (2020). Informed Decision Making. https://health.gov/healthypeople/tools-action/browse-evidence-based-resources/informed-decision-making

A Sample Answer 3 For the Assignment: NURS 6052 Patient Preferences and Decision Making 

Title: NURS 6052 Patient Preferences and Decision Making 

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

A Sample Answer 3 For the Assignment: NURS 6052 Patient Preferences and Decision Making 

Title: NURS 6052 Patient Preferences and Decision Making 

Your post was beautiful written and hits very close to home as I recently dealt with a very similar situation in my personal life. Through the process, the providers truly let me down. It was the nurses and genetic counselor that truly held my hand and carried me through. Having access to decision aids and resources helped me to make an informed decision independently. Thank you for being such a wonderful advocate to your patient to assure that they were provided with support and the information needed to make an informed decision.

In the beginning of a pregnancy, the mother may be first asked if they want to complete genetic testing. She will likely also be asked if she would change her birth or parenting plans if it was discovered that her fetus had a serious problem (The Ottawa Hospitals Research Institute, 2022). I would guess that most parents would say that they would not terminate the pregnancy regardless of the outcome before knowing potentially negative results from testing. Once a birth defect is identified, the mother may want to change her mind. In this situation, the mother has every right to change her mind. A decision aid would help a mother to be informed to make a decision that is best for her and her family.

In this situation, a decision aid would absolutely be helpful as it gives concrete data that can be used for making an informed decision. I am a witness that even without a family history, your fetus can have neural tube defects. Even as a health care professional, this was a scenario that I never even considered since my husband and I are both healthy, with no family history of any disease, defects, or health concerns. On the contrary, these tests can bring forth a large amount of anxiety that can come with the unknown, false negatives, and false positives. Ultimately, the patient being able to make their own informed decision is most important and the decision aid can largely help.

References

The Ottawa Hospital Research Institute. (2022). Decision Aid Summary. Pregnancy: Should I Have Screening Tests for Birth Defects? https://decisionaid.ohri.ca/Azsumm.php?ID=1179

A Sample Answer 4 For the Assignment: NURS 6052 Patient Preferences and Decision Making 

Title: NURS 6052 Patient Preferences and Decision Making 

  I enjoyed reading your post. As a mother of five children, this post resonates with me. It is so important to uphold the wishes of the patient especially when it comes to pregnancy and their birthing plans.  It has been proven that shared decision-making is vital to obtaining optimal patient care (Hoffmann et al., 2014). Having a birthing plan that is upheld by the entire healthcare team that has been formulated by the mother will make the experience more memorable. Personally, I wanted to utilize other forms of pain relief during childbirth, but was heavily discouraged by the nurse and doctor, the pushed for epidurals heavily. If I would have been given the childbirth tool on optional pain relief methods that discuss the process, the pros and cons, and the side effects, as the patient I would have felt more confident in my decision (Henna et al., 2018).

The other pertinent decision is having the option for genetic testing, to me, this is essential to know what the outcomes may be. Personally, I did have testing done with all my children not to determine to abort, but to be prepared for what challenges may come. All my pregnancies were completely healthy with all testing outcomes being completely normal, but nothing could have prepared me for the daughter I brought into this world at 38 weeks that was stillborn. There are still some things that do go unexplained despite all the medical advances. Just as there are many tests that may give an idea of what may happen, they are not always accurate.

References:

Henna, A., Shishido, E., Osaka, W., Horiuchi, S., & Ogawa, K. (2018, July 7). Finding a Way to Relieve Delivery Pain That is Right for You . Health Literacy . Retrieved February 9, 2023, from https://www.healthliteracy.jp/decisionaid/DA_epidural_anesthesia.pdf

Hoffmann, T. C., Montori, V. M., & Del Mar, C. (2014). The connection between evidence-based medicine and shared decision making. JAMA312(13), 1295. https://doi.org/10.1001/jama.2014.10186

A Sample Answer 5 For the Assignment: NURS 6052 Patient Preferences and Decision Making 

Title: NURS 6052 Patient Preferences and Decision Making 

I agree with you that patients have the right and ability to make their own choices and decisions. Therefore, patients should be involved in the treatment process. Patients and the family members’ involvement in the entire process results into informed decisions (Lee, 2019). Healthcare professionals are experts who can advise their patients on different choices. However, patients are allowed to make their choices. Occasionally, some patients’ decisions are regarded to be wrong. Still, patient participation in their treatment processes is important. Healthcare professionals are close to their patients (Desai et al., 2021).

Surprisingly, some patients confide in some healthcare workers.  Healthcare professionals are also expected to be respectful in their routines. Nurses interact with different patients and families. Respect enables these healthcare workers to build trust and create relationships. Autonomy or self-determination is at the core of all medical decision-making in the United States. The U.S government ensure that healthcare professionals maintain professionalism as they provide healthcare services.

References

Desai, A., Gainor, J. F., Hegde, A., Schram, A. M., Curigliano, G., Pal, S., … & COVID19 and Cancer Clinical Trials Working Group. (2021). COVID-19 vaccine guidance for patients with cancer participating in oncology clinical trials. Nature reviews Clinical oncology18(5), 313-319.

Lee, D. (2019). A model for designing healthcare service based on the patient experience. International Journal of Healthcare Management12(3), 180-188. https://doi.org/10.1080/20479700.2017.1359956

A Sample Answer 6 For the Assignment: NURS 6052 Patient Preferences and Decision Making 

Title: NURS 6052 Patient Preferences and Decision Making NURS 6052 Patient Preferences and Decision Making 

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/

A Sample Answer 7 For the Assignment: NURS 6052 Patient Preferences and Decision Making 

Title: NURS 6052 Patient Preferences and Decision Making 

The scenario described displays the necessity of nurses to consider patient preferences and values. I concur with you that considering patient preferences and values changes the trajectory of the situation in a way that the medical providers do not anticipate, and the outcomes may be incredible. Moreover, I love the way you took the responsibility as a nurse to get in touch with the genetic counselor to make sure the parents were provided the information and support needed to make an informed decision. Notably, failure to consider patient preferences and values would likely affect provider-patient rapport and develop mistrust, which would significantly affect therapeutic relationships (Kraetschmer et al., 2019).

A shared decision-making process is, therefore, integral to patient outcomes and care quality. You could have talked about the necessity of therapeutic relationships in enhancing patient outcomes and how shared decision-making influences the relationships to make your post more outstanding. In addition, the patient decision aid you selected for your scenario is ideal. I agree with you that the tool is clear and simple to use; hence, patients would easily access the information needed to make relevant decisions about their health.

References

Kraetschmer, N., Sharpe, N., Urowitz, S., & Deber, R. B. (2004). How does trust affect patient preferences for participation in decision‐making? Health Expectations7(4), 317-326. https://doi.org/10.1111/j.1369-7625.2004.00296.x

A Sample Answer 8 For the Assignment: NURS 6052 Patient Preferences and Decision Making 

Title: NURS 6052 Patient Preferences and Decision Making 

 Great weekly post! I really enjoyed your situational experience in the field. We as nurses often experience things with our patients and it seems to affect you as well as the patient most times. Since becoming a nurse, it seems as if patient situations are relatable, and you, as their nurse, must be there for them to ensure that they know and understand their prognosis and what they are up against. You are exactly right that often the patient and family don’t understand the severity of the diagnosis just because they don’t express to their healthcare provider that they are confused about the information that they have received.

I have learned that a method must be used to determine whether the patient truly understands their diagnosis. According to Trina Dorrah, “Teach-back allows me to address my patients’ uncertainty about the plan and clarify any misunderstandings.” (Dorrah, T., 2016). It is primarily misunderstood just how much healthcare workers are closely involved with life-altering decisions of patients. No matter how we feel on the matter, it all comes down to respecting the patient’s wishes. National Library of Medicine suggests, “The principle of respect for autonomy is usually associated with allowing or enabling patients to make their own decisions about which health care interventions they will or will not receive.” (Entwistle, V., Et al, 2010). Overall, great insight this week, and thanks for sharing.

References

Dorrrah, T. (2016, June 16). Use the teach-back method to confirm patient understanding. The Hospitalist. Retrieved from https://www.the-hospitalist.org/hospitalist/article/121632/use-teach-back-method-confirm-patient-understanding 

Entwistle VA, Carter SM, Cribb A, McCaffery K. Supporting patient autonomy: the importance of clinician-patient relationships. J Gen Intern Med. 2010 Jul;25(7):741-5. doi: 10.1007/s11606-010-1292-2. Epub 2010 Mar 6. PMID: 20213206; PMCID: PMC2881979.

A Sample Answer 9 For the Assignment: NURS 6052 Patient Preferences and Decision Making 

Title: NURS 6052 Patient Preferences and Decision Making 

 I work in a psychiatric/behavioral health hospital with adolescent patients.  Even though our hospital is a voluntary facility, adolescent patients are brought in by either their families or DCS and do not want to be there.  When the patients are brought up to the unit from intake, they have a mixture of emotions as they are often confused, nervous, and even angry being there. 

Most adolescent patients are brought in because of having thoughts of self-harm or thoughts of harming other people.  During the admission process, our job is to sit down with these patients and complete a nursing treatment plan with the patients.  When we do our assessments and treatment plans, we ask the patients what their triggers and stressors are and what helps them calm down in a situation when they get anxiety and thoughts of hurting themselves or other people.  Every patient has different types of trauma and different coping skills or lack of coping skills to deal with the trauma.  By keeping the patients fully involved in this part of the treatment plan helps tell us how we can help the patients.  It is possible to get a deeper understanding of the values, explanations, and beliefs that each patient brings to the therapeutic encounter by communicating with them in ways that elicit more information than just a report of their physical symptoms (Siminoff, 2013).

For instance, one patient told us that when he gets upset, it is easy for him to lash out at other people so the best way to calm him down is to let him be away from other people in a separate room with staff monitoring him.  Another patient told us that when she gets thoughts of self-harm, she would like to be distracted by talking to staff and sharing her feelings about why she is feeling that way. 

References

Siminoff, L. A. (2013). Incorporating patient and family preferences into evidence-based medicine. BMC medical informatics and decision making. Retrieved   February 6, 2023, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4029304/

As a pediatric intensive care nurse (ICU), I feel your post. People do not fully appreciate what it is like to be a healthcare worker being forced to provide continual life-saving measures that cause pain and suffering to the patient, especially when we know the likelihood of survival or meaningful survival is unlikely. It is part of why I did my first master’s degree in palliative care. ICU and Emergency Department (ED) physicians and many surgeons have poor communication skills when talking about potential complications and how quickly it can all go awry. There is an excellent palliative care screening tool meant to be used in the ED called SPEED (Chang et al., 2022). You may want to suggest that your hospital use this or team up with the palliative care team and ask about working on it together. I will add the questions at the end of this post.

Additionally, consider asking your management to do a journal club or offer some opportunities to work with your ethicist. I find many doctors have issues with nonmaleficence, the idea of refraining from causing unnecessary harm. In my experience, because of the pace of care in the ICU and ED, these ideas need to be revisited annually by everyone working there as reminders that it is not always best to do everything, which, especially under pressure from the family, we tend to forget (Akdeniz et al., 2021).