Discussion Response

**This is due on 7/25/20 at 7:00 PM Central Time, not 7:00 AM as it appears on the order.

This is a response to a classmate's posting. It must be directed directly towards them as if you were having a conversation with them. Please DO NOT critique their writing and/or grammar skills.

***Respond with a comment that asks for clarification, provides support for, or contributes additional information.

**Must contain at least one scholarly reference.

This is what needs to be responded to:

Most people go into the profession of health care with the purpose of wanting to help others among many other reasons. Doctors take the “Do no Harm” oath and I believe even though we do not take an oath nurses feel the same way. Although there are of course cultural differences that play into our personal beliefs, I feel like over time we start to have a different perspective of what “do no harm” means to us and our patients.

The patient that comes to mind most recently, (I have been a nurse in critical care for 15 years and 8 years of Long term care before that) is a gentleman in his early 60’s who was a known drug and alcohol abuser, brought in for an overdose by EMS. Due to declining respiratory status he had to be intubated and could not be taken off of the ventilator. This man was estranged from most of his family except his mother and occasional contact with one sister. The mother was on her second round of chemo and the siblings mostly felt guilty for not intervening with his addiction before he got to this point. After two weeks he had to have a tracheostomy done and a PEG tube placed for nutrition. He had developed bed sores even with proper turning and skin care due to his malnourished state. He did in fact end up regaining consciousness, but was never able to adequately communicate his desires so his family continued to make the decisions for him on his care. The family came to visit once a week to bring mom up and otherwise all communication was via phone, and this was pre-covid so visiting was not limited. Even with many family meetings to discuss the course of treatment and inevitable end that he would have, the family would not agree to hospice or limited treatment. The more I got to know him, I learned that he had been a guitar player and lead singer of a moderately popular local band. He was a social person and a little “rough around the edges”. It was heartbreaking to say the least. Once he was able to regain consciousness all of us who cared for him knew he was miserable, and he tried to communicate this every day. After several bouts of pneumonia and other complications of being bedridden and having a tracheostomy his family did eventually agree to him going to a skilled nursing facility and being a DNR. He died about two weeks later. Several of us nurses talked about how there are worse things than death, and that was a perfect example.

If this man had been able to communicate effectively, most likely he would have discontinued aggressive treatment weeks sooner. We continued to perform procedures on him without his input because the family was making decisions from afar.

The decision Aid that I chose was the Breathing with a Ventilator; stop or stay on. I feel like this tool could have been a great asset to present to the family to help them better understand and make a more informed decision. I believe that it educates about what it means and what happens in both scenarios. Some of the topics discussed will help me to be a better educator in my personal practice in the future, and since people do not retain everything that they hear the first time, having a resource for them to go back to is a great tool.

References:

Melnyk, B. M., & Fineout-Overholt, E. (2018). Evidence-based practice in nursing & healthcare: A guide to best practice (4th ed.). Philadelphia, PA: Wolters Kluwer.Chapter 7, “Patient Concerns, Choices and Clinical Judgement in Evidence-Based Practice” (pp. 219–232)

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

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