Discussion: Patient Preferences and Decision Making

**DEADLINE:

FRIDAY

5/13

/2021

BY

08:00

PM

EST**

INSTRUCTIONS:

Respon

d

to

your colleague

and offer alternative views on the impact of patient

preferences on treatment plans or outcomes, or the potential impact of patient decision aids on

situations like the one shared

.

*

*

At least 2 references p

er reply, and they need to support information in the reply**

Donique

McClinton

Patient

Preferences

and

Values

Impacting

Their

Treatment

Plan

As

a

NICU

nurse,

my

patients

include

the

neonate

and

their

family.

The

family’s

patient

preferences

and

values

are

enhanced

when

deali

ng

with

an

innocent

newborn,

so

I

have

dealt

with

these

affecting

the

treatment

plan.

For

instance,

a

newborn’s

family

initially

developed

a

birth

plan

for

the

newborn’s

birth

and

after

-

birth

care.

Unfortunately,

the

newborn

was

born

with

complications,

requiring

admission

into

the

NICU.

Within

the

NICU,

the

patient’s

care

and

hea

lth

have

priority

over

the

family’s

birth

plan.

Restricting

the

family’s

preferences

and

values

during

the

critical

time

can

cause

stress

and

anxiety

to

increase

for

the

family.

The

family

usually

does

not

regain

a

stance

for

their

preferences

and

values

o

f

the

after

-

birth

plan

until

the

patient

has

recovered

and

readily

presented

for

discharge

.

Patient

Preferences

and

Values

Reflecting

Their

Treatment

Pla

n

Within

the

NICU,

the

dynamic

is

complicated.

Everyone

wants

the

best

care

to

be

performed

f

or

the

newborn,

but

it’s

at

the

cost

of

not

having

a

healthy

newborn

and

not

performing

parental

duties

as

done

with

a

healthy

newborn.

NICU

clinicians

have

been

exposed

and

trained

for

situations

like

these.

We

tend

to

give

the

newborn’s

family

a

chance

t

o

make

even

the

most

minor

decision,

as

in

the

newborn’s

hat

or

bedding

colors,

to

provide

them

with

the

feeling

of

control

that

they

mourn.

Hoffman,

Montori,

&

Del

Mar

(2014)

describes

shared

decision

making

as

the

concept

of

a

clinician

and

a

patient,

or

patient’s

family,

mutually

engaging

in

a

health

decision

after

reviewing

the

alternatives,

the

advantages

and

harms,

and

taking

into

account

the

patient’s

interests,

desires,

and

conditions.

After

making

life

-

changing

decisions,

the

newborn’s

family

appre

ciates

the

most

minor,

normalized

choices.

Patient

Decision

Ai

d

Clinicians

can

typically

begin

with

a

default

collaborative

decision

-

making

strategy

that

incorporates

the

three

key

elements

of

evidence

sharing,

deliberation,

and

treatment

decision

making

(Kon

et

al.,

2016).

Even

having

a

newborn

admitted

to

t

he

NICU,

the

newborn’s

family

values

having

the

opportunity

to

feel

in

control

whenever

possible.

Explaining

the

evidence,

reasonings,

and

hardships

given

every

chance

for

the

newborn’s

parents

to

feel

like

they

are

a

part

of

the

decision

-

making

process

.

According

to

Melnyk

&

Fineout

-

Overholt

(2018),

clinicians

must

first

consider

the

importance

of

facts

from

both

a

clinical

and

analytical

standpoint

and

effectively

participate

in

decision

-

making

for

patients

and

relatives

to

be

effective

in

evide

nce

-

based

decision

making.

In

general,

allowing

the

patient

to

be

knowledgeable

about

their

care

will

give

an

incentive

for

the

patient

to

actively

participate

in

achieving

a

healthier

outcome.

Reference

s

Hoffman,

T.

C.,

Montori,

V.

M.,

&

Del

Mar,

C.

(201

4).

The

connection

between

evidence

-

based

medicine

and

shared

decision

making.

Journal

of

the

American

Medical

Association,

312(13),

1295

-

1296.

Doi:

10.1001/jama.2014.1018

6

Kon,

A.

A.,

Davidson,

J.

E.,

Morrison,

W.,

Danis,

M.,

&

White,

D.

B.

(2016).

Shared

decision

making

in

intensive

care

units:

An

American

College

of

Critical

Care

Medicine

and

American

Thoracic

Society

policy

statement.

Critical

Care

Medicine,

44(1),

188

-

201.

Doi:

10.1097/CCM.

000000000000139

6

Melnyk,

B.

M.,

&

Fineout

-

Overholt,

E.

(2018).

Evidence

-

based

practice

in

nursing

&

healthcare:

A

guide

to

best

practice(

4

th

ed.).

Philadelphia,

PA:

Wolters

Kluwer

.

**DEADLINE: FRIDAY 5/13/2021 BY 08:00 PM EST**

INSTRUCTIONS: Respond to your colleague and offer alternative views on the impact of patient

preferences on treatment plans or outcomes, or the potential impact of patient decision aids on

situations like the one shared.

**At least 2 references per reply, and they need to support information in the reply**

Donique McClinton

Patient Preferences and Values Impacting Their Treatment Plan

As a NICU nurse, my patients include the neonate and their family. The family’s patient preferences and

values are enhanced when dealing with an innocent newborn, so I have dealt with these affecting the

treatment plan.

For instance, a newborn’s family initially developed a birth plan for the newborn’s birth and after-birth

care. Unfortunately, the newborn was born with complications, requiring admission into the NICU. Within the

NICU, the patient’s care and health have priority over the family’s birth plan. Restricting the family’s

preferences and values during the critical time can cause stress and anxiety to increase for the family. The

family usually does not regain a stance for their preferences and values of the after-birth plan until the

patient has recovered and readily presented for discharge.

Patient Preferences and Values Reflecting Their Treatment Plan

Within the NICU, the dynamic is complicated. Everyone wants the best care to be performed for the

newborn, but it’s at the cost of not having a healthy newborn and not performing parental duties as done with

a healthy newborn. NICU clinicians have been exposed and trained for situations like these. We tend to give

the newborn’s family a chance to make even the most minor decision, as in the newborn’s hat or bedding

colors, to provide them with the feeling of control that they mourn. Hoffman, Montori, & Del Mar (2014)

describes shared decision making as the concept of a clinician and a patient, or patient’s family, mutually

engaging in a health decision after reviewing the alternatives, the advantages and harms, and taking into

account the patient’s interests, desires, and conditions. After making life-changing decisions, the newborn’s

family appreciates the most minor, normalized choices.

Patient Decision Aid

Clinicians can typically begin with a default collaborative decision-making strategy that incorporates the

three key elements of evidence sharing, deliberation, and treatment decision making (Kon et al., 2016). Even

having a newborn admitted to the NICU, the newborn’s family values having the opportunity to feel in control

whenever possible. Explaining the evidence, reasonings, and hardships given every chance for the newborn’s

parents to feel like they are a part of the decision-making process.

According to Melnyk & Fineout-Overholt (2018), clinicians must first consider the importance of facts

from both a clinical and analytical standpoint and effectively participate in decision-making for patients and

relatives to be effective in evidence-based decision making. In general, allowing the patient to be

knowledgeable about their care will give an incentive for the patient to actively participate in achieving a

healthier outcome.

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

Kon, A. A., Davidson, J. E., Morrison, W., Danis, M., & White, D. B. (2016). Shared decision making in intensive

care units: An American College of Critical Care Medicine and American Thoracic Society policy

statement. Critical Care Medicine, 44(1), 188-201. Doi: 10.1097/CCM. 0000000000001396

Melnyk, B. M., & Fineout-Overholt, E. (2018). Evidence-based practice in nursing & healthcare: A guide to best

practice(4

th

ed.). Philadelphia, PA: Wolters Kluwer.