Discussion Patient Preferences and Decision Making

Hello Instructor and Professor,

As an ICU nurse, the majority of the clients I tend for are severely diseased and their time in my care for most of them is the culmination of their lives. As the nurses are doing their best to rescue both patients and nurses from their welfare, they have also learnt how to be pragmatic and foresee the patient’s end. However, the previous state of the patient is often taken into account in assessments. Clinicians should work in the best interests of the patient and use evidence focused decision-making to assist the patients decide (Melynk & Fineout-Overholt 2018).

Recently, I had a 92-year-old patient who exercised several miles a day until nine months ago. She had trouble with her gallbladder and wanted surgery. The surgeon had to consult his discretion and judgment as the patient was very involved and was able to take advantage of the intervention. She underwent a cholecystectomy and established an ileus whilst at the hospital. She was later sent with a sludge drain home to remain with TPN for a few operations. She endured the TPN for 9 months, inducing intra-abdominal abscess, before more drainage complications. She returned to some more abdominal procedures that lead to sepsis and ARDS complications.

The nursing and medical staff was completely transparent with the family throughout the entire process, and after several days of the most intense measures to save her life, including but not limited to CRRT, maxed out vent settings, the and the use of several pressers.  Palliative care was consulted and several discussions between the medical staff and family was made to determine course of action, and despite the grim prognosis with almost no hope the family kept pressing.  Some family members stated they believed it wasn’t right and the patient was being “tortured”.  When they finally decided to withdraw care, the patient died within minutes.  Had a shared decision-making patient (surrogate) decision aid been used earlier in the process, the outcome may have been different.

Throughout this whole process, health care and medical professionals were fully open with the families, and after several days of the most rigorous life conservation steps, including, but not limited to, CRRT, maxed venting and the use of multiple pressures. A variety of consultations between the medical team and the family have been held with the intention of deciding a plan of action and after the dreadful prognostic, the family was almost beyond optimism. Any members of the family said they felt it wasn’t fair and that the patient was “tortured.” The patient died within a matter of minutes before they eventually agreed to withdraw. If a mutual patient decision-maker (surrogate) decision-making assistance had been used historically, the effect could have been different.

The choice of the patient and surrogates to continue their lives is essentially a choice. No one will make these choices easily. Professionals require communication experience to promote decision-making (Kon, Davidson, Morrison, Danis & White, 2016). Our role in the collaborative decision-making process as healthcare practitioners is to have the qualitative experts possible when keeping patient values, objectives and expectations into consideration (Kon et al, 2016). The physician’s concept can be accompanied by a decision-making inventory by increasing surrogate details (Schroy, Mylyaganam & Davidson 2014).

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