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Discussion # 1
Patient preferences are important to follow, especially when it comes to end of life choices and decisions. When I was a new nurse, I had an elderly lady who was admitted to my unit, she was in her mid-nineties, had a feeding tube, was not alert or oriented and had several large pressure ulcers on her sacrum. She had been a DNR and on hospice care when the family decided over the holiday season that they wanted to remove her DNR. During this time the feeding tube was accidentally pulled out, and she was experiencing some end-of-life symptoms such as severe bradycardia and was admitted to the hospital. There were different opinions of the family of this patient. Some of her children wanted to reinstate her DNR order and allow her to pass peacefully, while others wanted the hospital staff to do everything medically possible to keep her alive. This became a large issue that ended up involving nurse managers, physicians, social workers, and hospital administrators. “Often, DNR orders are the most controversial in family dynamics (Tajari, 2018). Families often try to convince the healthcare team to overturn the DNR directive. As a nurse, the patient is the priority of care and nurses are the patient’s advocate” (Haley, B, 2021). If a patient makes themselves a DNR when they are in their right mind, should someone at a later time be able to revoke this decision? As a healthcare professional, it is imperative that we provide patient-centered care, and not based on our feelings. “Failure to employ appropriate decision-making techniques can lead to significant problems” (Kon, A.A., et al., 2016). There are decision-making aides available for patients and family members to look over when making these end-of-life decisions (Healthwise Staff, 2021).
After several meetings with the family and support staff, the family came to the agreement of reinstatement of the DNR order. “Patients rely on clinicians to be clinically wise and make sound judgment as experts in their profession. When clinicians do not meet this expectation, they fail patients and communities” (Melnyk, B. M., & Fineout-Overholt, E., 2018, p 224). Changing the code status takes away from the patients’ autonomy, and as healthcare providers we are to deliver patient-centered care.
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Discussion # 2
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One situation that I have experienced was with a patient who was diagnosed with diabetes but was noncompliant with insulin and was not living a healthy lifestyle. The patient was admitted because they had an infection on their foot which caused the foot to turn black in color and had extreme pain. The patient stated that they do not believe in doctors or medicine. Therefore, they were using herbal medicines from their country that they believed lowered their blood sugars. After being seen by the orthopedic doctor, the patient was advised to receive emergency surgery to remove the foot. Unfortunately, the patient refused the surgery and wanted to continue with the herbal remedies. I educated the patient, trying to explain that if not treated properly, the infection could spread to the bloodstream. However, the patient continued to refuse and wanted to be discharged home since I was not incorporating their preferences and values in the treatment plan.
Healthcare professionals should make a decision that “reflects their patient’s values and circumstances” (Hoffmann et al., 2014). However, in this situation, if I were to include the patient’s herbal remedies, it may have caused further damage to the patient’s injury because neither I nor the doctor was familiar with this particular natural medicine. Since the herbal remedies were not included, the patient was reluctant to participate in the treatment plan. Furthermore, by making treatment decisions “without attempting to understand the patient’s values, goals, and preferences, decisions will likely be predominantly based on the clinicans’ values” (Kon et al., 2016). Therefore, it was important to provide information packets and allow the patient to collaborate with the healthcare team about their plan of care to avoid unethical decision-making.
Patient decision aids are tools that help patients and providers collaborate together about care options (Washington Health Care, 2022). Brochures, an example of a patient decision aid tool, is effective in decision-making and incorporates information and teaching strategies. In this situation, the diabetes doctor and the patient reviewed a brochure that explained what diabetes is and how it affects the body as a whole. By reviewing the brochure together, the patient was more willing to cooperate and agree to the surgery. Using brochures can benefit patients admitted to the hospital because it provides information that keeps the reader engaged but does not overwhelm the reader with too much information. Lastly, brochures can benefit professional practice when implementing discharge plans for patients. For example, when this patient was able to be discharged, they were provided an additional brochure that educated them on how to monitor blood glucose at home and medication compliance. Therefore, brochures are a great patient decision aid tool that I can continue to use in professional practice when discussing new diagnoses with patients.
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