Wk8 resopnses 6052

Monica Cooper (6052) Week 8 /Module 5 - Initial Posting by Monica M. Cooper: Patient Preferences and Decision Making

I previously managed a weight loss prevention program at a long-term care facility for three years.  Considering that weight loss is one of the most significant risk factors for mortality amongst older adults, patient interventions were implemented, received, and revised to ensure optimum patient outcomes.  The Registered Dietitian would recommend patients who were experiencing weight loss to have all meals served in the formal dining rooms vs. their private rooms.  Incorporating this invention had positive benefits such as close supervision and meal consumption monitoring, but it completely removed all autonomy from the patients.  As stated by Lindberg et al. 2018, it is a moral duty for staff to be more attentive to their personal traits, conditions, and wishes, generating opportunities for patients to be more participatory and with greater potential to influence their care.

The patient preference I suggested to the interdisciplinary team to counter negative consequences was to start an "all hands on deck" approach at mealtimes.  No matter their role or position, every employee was assigned designated units for which rounds were made at each meal.  This approach allowed for increased visibility of patients' in their living quarters and monitoring meal consumption for all patients and not just for those experiencing weight loss.  The patients were happy, and so were their families.  Some family members even partook in their loved one's treatment plan by making intentional visits at mealtimes.  For example, there was one patient whose daughter would visit at breakfast.  Her grandson would visit at lunch and another at dinner.  Meal consumption increased, making including the family a bonus!

According to Latenstein et al. 2020, decision aids present comparative information about the advantages and disadvantages of available options and evaluate the patient's values and preferences.  They are proven to effectively improve knowledge, reduce decisional conflict, and change patients' preferred treatment (Latenstein et al., 2020).  While decision aids do not assure compliance to treatment, they present a realistic overview of personalized guidelines for condition management. 

I chose the Malnutrition: Options to Limit Weight Loss in Older Adults decision aid (OHRI, 2019).  The aid's value is relatively practical as it offers general information and specific recommendations based on preference.  I could not apply it to the exact experience I described; however, I completed it for myself as my eating habits are not satisfactory.  My appetite fluctuates depending on high busy I am.  I usually skip breakfast, and other days I only eat one meal.  After exploring my options, I made an informed choice to incorporate oral nutritional supplements into my diet.  They can be taken as a liquid supplement or as fortified food once or twice a day, between meals.

I might use this decision aid inventory further in my personal life by sharing it with friends who also struggle with meal imbalances.  I do understand that it is unhealthy to skip meals as it increases fatigue and other health concerns.  The decision aid helped me have a starting point to rectify my poor eating habits, and I think it would be beneficial to others.

Latenstein, C. S. S., Thunnissen, F. M., Thomeer, B. J. M., Wely, B. J., Meinders, M. J., Elwyn, G., & Reuver, P. R. (2020). The association between patients’ preferred treatment after the use of a patient decision aid and their choice of eventual treatment. Health Expectations, 23(3), 651–658. https://doi-org.ezp.waldenulibrary.org/10.1111/hex.13045

Lindberg, C., Fagerström, C., & Willman, A. (2018). Patient autonomy in a high‐tech care context—A theoretical framework. Journal of Clinical Nursing (John Wiley & Sons, Inc.), 27(21–22), 4128–4140. https://doi-org.ezp.waldenulibrary.org/10.1111/jocn.14562

The Ottawa Hospital Research Institute. (2019). Patient decision aids. Retrieved from https://decisionaid.ohri.ca/

Tiffany Dennis

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Being a mental health nurse, I have often found myself being the patient advocate because some healthcare workers believe that patients with mental illnesses do not have the same right as patients being treated in the hospital for any other medical reason. Evidence-based medicine (EBM) and shared decision making (SDM) should co-exist; however, this concept is not appreciated. SDM is the clinician and patient process jointly participating in a health decision after discussing the options, the benefits, and harms, and considering the patient's values, preferences, and circumstances (Hoffmann et al., 2014). Sadly, this is the first time I have heard of decision aids, and I have been a nurse for 13 years. Position aids are used to increase a patient's knowledge of options, improve awareness concerning medication and non-medicinal options; it provides a sense of comfort and control for patients (Melnyk & Fineout-Overholt, 2018). Often in an acute psychiatric setting, we receive patients in acute psychosis or mania. When the patient is in a state of mind, it is challenging to discern between reality and delusions.

One time I remember a very physically fit and robust patient arriving at the unit out of control. The drug of choice in this situation was to administer a Thorazine injection stat. The patient kept yelling; I cannot take that; I cannot take that. I am allergic to that medicine. Of course, the nurse assumed the patient was lying and did not want to be sedated; therefore, the medication was given regardless after a glance to make sure that the medicine was not an allergy listed on the transfer paperwork. Within minutes after the injection, the patient had an adverse reaction. Once the nurse had the opportunity to look over the patient's history, Thorazine was listed as an allergy with a severe reaction. In this particular situation, if the nurse would have just taken a little longer to research or allow the patient to speak and validate the patient concerns and contact the physician for another medication, perhaps the patient would not have required a higher level of care and lapse in the treatment of the acute mental illness. It is vital to include patient preferences and values while providing nursing care.

Especially in mental health because most of the time, patients are admitted on an involuntary basis. Allowing the patient to be a part of the treatment and hearing a doctor's reasoning behind medication changes could improve medication compliance. I did not find a decision aid for Schizophrenia, but I did see one on Bipolar II. The Bipolar II decision aid is broken down into three main sections, medications, psychological options, and making decisions. It is designed to help patients and their families decide about treatment and prevent relapse (Bipolar II DECISION AID, 2019).  A rule of thumb that has stuck with me since nursing school is that if a patient questions a procedure, medication, or statement, "this is not what I usually take," is always to pause, re-look, and double-check. I can utilize these positions aids to help educate patients and also as resources during nursing education groups.

References

Bipolar II DECISION AID. (2019). The Ottawa Hospital Research Institute. Retrieved October 20, 2020, from https://www.bipolardecisionaid.com.au/guideline/introduction.html

Hoffmann, T., Montori, V., & Del Mar, C. (2014). The Connection Between Evidence-Based Medicine and Shared Decision Making. Journal of the American Medical Association, 312(13), 1295–1296. https://doi.org/10.1001/jama.2014.10186

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

3 SOURCES ON EACH DISCUSSION