Discussion Response

**This is due on 7/23/20 at 7:00 PM Central Time, not 7:00 AM as it appears on the order.

This will need to be a response to a classmate's discussion post. It must be directed towards them as if you were having a conversation with them. Please DO NOT critique their writing and/or grammar. 

** Response will offer alternative views on the impact of patient preferences on treatment plans or outcomes, or the potential impact of patient decision aids in situations like the one shared.

**Must have TWO scholarly resources to support your response.

Below is what needs to be responded to. 

Patient Scenario

            I recently had an admitted patient held in the Emergency Department as an overflow patient due to not having available beds on the Medical-Surgical floor. This patient was in his 80’s with multiple co-morbidities. He had a scheduled peg tube to be placed; however, the patient was adamant that he did not want the peg tube and repeatedly informed the physician of this each time they talked about the procedure. The patient was completely oriented during these discussions, and even his living will stated he did not want any feeding tubes placed. The family was just as adamant that they wanted the peg tube placed. They eventually convinced the patient that he should have the peg tube placed, and he agreed to the surgery. The patient wound up having a perforation. Now, this patient is going to be placed on Hospice due to his declining health. I think in this scenario; the patient’s wishes were not respected. I think the primary nurse and physician should have advocated for the patient’s original request. The family should have been provided more education and stressed the importance of following the patient’s wishes.

Decision Aids

            A decision aid is a tool that allows patients and families to be involved in the decision-making process by providing information about different options and outcomes for a specific issue or condition (The Ottawa Hospital, 2019). One particular decision aid that could have helped this patient and family is Making Choices: Feeding Options for Patients with Dementia. This decision tool includes nutrition via feeding tube and other ways to help with oral feedings (The Ottawa Hospital, 2019). If the family and patient had utilized the decision-making aid, they could have possibly found other options for getting the patient to eat. He would not have had a poor surgical outcome and could have a much longer life expectancy than he is currently facing.

Conclusion

            Evidence-based practice combines patient preferences and values, clinician expertise, and research for best practice (Melnyk & Fineout-Overholt, 2018). Patient involvement is essential during their care. Their values, beliefs, and preferences should be considered in all care plans by family and healthcare professionals. The summit of exceptional patient care resides in the combination of utilizing evidence-based medicine and shared decision-making between patients, families, and clinicians (Hoffmann, Montori, & Del Mar, 2014). I never knew these decision-making tools existed. I believe this could help so many families as well as myself on difficult decisions. I believe in facing difficult decisions, both personally and while caring for patients, it would be a wise idea to see if any of the decision aids are applicable and can be used. They should be printed and provided to the patient and family to aid them in making their decisions.

References

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

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

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