Evidence-Based Practice Nursing: Respond to at least two of your colleagues on two different days and offer alternative views on the impact of patient preferences…
Instructions: 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. ( 2 separate responses – 2 citations / references for each response provided )
Patient Preferences and Decision Making.
Health care workers are encouraged to engage in Evidence-Based Practice with a focus on patient-centered care. Sometimes it could be challenging for health care workers trying to consider the patient’s family members. It has been proven that engaged nurses have the background of acknowledging the social and cultural factors both in treatment and related social and cultural influences that could lead to more efficient and effective health outcomes. Clinicians must act in the patient’s best interests and use evidence-based decision-making, including their judgment, to help patients make decisions (Melynk & Fineout-Overholt, 2018).
Whenever I plan for my patients, I always want to make their care plan all about them. Patients are more likely to be compliant and follow through when they are included in planning their care. Patients who participate in their decisions making report higher levels of satisfaction with their care; having increased knowledge about conditions, tests, and treatment leads to having more realistic expectations about benefits and harms. Hence, patients are more likely to adhere to screening, diagnostic, or treatment plans.
Having reduced decisional conflict and anxiety are less likely to receive tests or procedures which may be unnecessary and, in some cases, even have improved health outcomes (Krist, Tong, Aycock & Longo, 2017). Also, when completing my assessment, it is always very useful to include this question: “Are there any spiritual or cultural preferences that need to be met while in this facility.”
Although these conversations are complicated and may be unproductive at first, it is critical to encourage patients to be open about their personal goals to inform how clinicians can best meet them. As a psych Nurse, I come across mentally ill patients who oftentimes do not understand the disease process. I initially encountered a patient with Acute psychosis from Africa; he was brought into the psych Emergency, activated by the family members for bizarre behavior.
When the patient started getting better at a point, he presented himself to the clinical team as somebody that must go back to his home country because according to the patient that “whatever he is going through now is a result of not performing the burial rites of his late parents” that was the reason they are tormenting him from the spiritual world and appearing to him in his dreams as well.
The clinical team was taken by surprise by what the patient was claiming was the cause of his ill health but at the same time, had an obligation to respect the patient’s wish. In the end, the patient was discharged from the hospital even though it was uncertain if the patient going back to his country home to perform some cultural ritual rite in order to calm the spirit of his parents in order to help him recover from his mental illness. It is also essential to respect the decision and preference of the patient during his plan of care.
Although these conversations are difficult and may be unproductive at first, it is critical to encourage patients to be open about their personal goals will inform how clinicians can best meet them (Lindsey Lord, n.d.). The treatment plan must be based on the patient’s wants and needs to be successful. Patient preferences and values will impact the trajectory of the situation in a positive way if it is based on their preferences and values. If a patient’s preferences and values are disregarded, they most likely will not follow through or be compliant with the care plan because it has nothing to do with their needs and goal.
Krist, A.H., Tong, S.T, Aycock, R.A., & Longo, D.R. (2017). Engaging patients in decision-making and behavior change to promote prevention. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6996004
Lord, L. (n.d.). The value of understanding patient preferences in treatment plans and protocols. Retrieved from, https://cipherhealth.com/blog/the-value-of- understanding-patient-preferences-in-treatment-plans-and-protocols/
Melnyk, B. M., & Fineout-Overholt, E. (2018). Evidence-based practice in nursing & healthcare: A guide to best practice (4th ed.). Philadelphia, PA: Wolters Kluwer
Patient Preference Experience
As a nurse that floats within my hospital’s women/children service line, I have worked in labor and delivery and have aided in the insertion/management of an epidural in laboring patients. The choice to have natural labor versus medicated labor has been a debate for years, with benefits and drawbacks to each. Expecting mothers usually always have a specific delivery plan; however, rarely do all of the plans go perfectly according to that plan.
One patient experience I have personally been involved in is a woman who said she wished to not use any form of pain medication as a part of her delivery plan. As it is a woman’s right to make this decision, this wish, of course, was granted if the baby and mom remained safe throughout the delivery. Sometimes in medicine, there is no “correct” option, and delivering a baby naturally or medicated is one of those choices.
What we do know is that patient-centered care has a direct correlation with evidence-based practice; without involving patients and their loved ones in their medical decisions and treatment plans, we are not providing good care at all. (Fineout-Overholt, Long, & Gallagher-Ford, 2018). The expecting mother, in my experience, valued her choice of natural birth, and the staff worked to try to provide every option of care to make this happen; however, in some cases, patient safety trumps patient preference.
Patient Preference Impact on Treatment Plan
Hours into pushing, the mother could not bear the pain of completing the delivery. In response to this, the baby started to have late and variable decelerations in heart rate. Sung & Abramovitz (2021) and Pillarisetty & Bragg (2021) state variable decelerations indicate that the umbilical cord is compressed or prolapsed, and late decelerations indicate the baby is not getting enough oxygen by either baby positioning or cord entanglements.
After minutes of seeing the baby decline, doctors decided this form of delivery was not safe for the baby and completed an emergency C-section that resulted in keeping all involved from experiencing a bad medical outcome. The baby had to spend a little time in the NICU after delivery but was otherwise healthy. Had the baby’s mother decided to receive an epidural, outcomes might have been different in either a better or potentially worse way.
Patient Decision Aid
The patient decision aid is a helpful tool to weigh medical options that have benefits and downfalls to various health topics; this tool gives individuals the information to make the best choice for them and to include them in their health options (The Ottawa Hospital Research Institute, 2019). The health topic I chose to evaluate was ‘Pregnancy: Should I Have an Epidural During Childbirth?’ because I provide care to women who deliver regularly, and this is also a question that I still have yet to answer for myself if I decide to have babies in the future.
This tool gives women the pros and cons of having an epidural, such as pain relief if receiving it versus avoiding the adverse effects of not receiving one (severe headache, too numb to push effectively or drop in blood pressure) (The Ottawa Hospital Research Institute, 2021). Maybe if the mother in my personal experience used the ‘Your Feelings’, ‘Your Decision’, and ‘Quiz Yourself’ sections present within the patient decision aid, she could then evaluate the summary of her answers and realize from those results that may be intense pain is not manageable for her and that receiving an epidural would outweigh the pros of a natural birth (The Ottawa Hospital Research Institute, 2021).
E. Fineout-Overholt, L. E. Long, & L. Gallagher-Ford. (2018). Making the case for evidence-based practice and cultivating a spirit of inquiry. In Melnyk, B. M., & Fineout-Overholt (Eds.), Evidence-based practice in nursing & healthcare: A guide to best practice (4th ed., pp. 7–32). Wolters Kluwer.
Pillarisetty, L.S., & Bragg, B.N. (2021, July 19). Late decelerations. StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK539820/
Sung, S., & Abramovitz, A. (2021, August 11). Variable decelerations. StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK546627/
The Ottawa Hospital Research Institute. (2019). Patient decision aids. https://decisionaid.ohri.ca/
The Ottawa Hospital Research Institute. (2021). Pregnancy: Should I have an epidural during childbirth? https://www.healthwise.net/ohridecisionaid/Content/StdDocument.aspx?DOCHWID=tn9762