peer responses week 11 class nurs 6052
imazdm25
walden.docx
Stephanie Kachin
RE: Discussion - Week 11
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A situation I see fairly often in Labor and Delivery is the patient is coming in with a self-written birth plan and having preset conditions of how they want their labor to go. Some of the birth plans I have seen are handwritten or typed, and others printed from a template premade on the internet. With a birth plan, I feel that it can positively or negatively impact patient preferences in the treatment plan, depending on the provider and patient communication. I have taken care of patients who have come in with plans stating they do not want anything to help them progress in their delivery and do not want any interventions done by the nurses like IV administration of oxytocin if needed. One positive outcome for birth plans is allowing the patient to feel in control of their birthing experience. Education by the nurse and the doctor is essential in incorporating birth plan requests to ensure both the mother and unborn child's safety. I have noticed that many birth plans are standard and do not plan for complications in labor. Every labor is different, and every pregnancy is different.
I took care of a patient who came in with a birth plan stating she did not want any interventions to help with progressing her labor. The patient had come in because her water had ruptured several hours ago, and she was only dilated one or two centimeters on admission. With ruptured membranes on a laboring mother, time is essential because the longer time passes from ruptured membranes to birth, the greater the risk of infection to the mother and unborn baby. Prolonged rupture membranes can lead to a complication of infected amniotic fluid called Chorioamnionitis, which is dangerous for the mother and the fetus. After reviewing the patient's preferences and birth plan with myself and the provider, the patient's wishes were acknowledged. Education was provided on the risks of prolonged rupture of membranes on a laboring mother and infection risks. The mother acknowledged understanding of the dangers of prolonged latent labor and ruptured membranes. A collaborative decision was made between the provider and patient to allow her to go a few more hours without labor augmentation to see if she made a cervical change independently. The patient agreed to have IV Pitocin started if her cervix was unchanged after the next check in a few hours. The patient and the provider were both happy with that decision. This example shows a positive result by allowing the patient to choose her care plan for their hospital stay.
From the Ottawa Hospital Research Institute (2019), a patient decision aid I found relevant to Labor and Delivery is titled pregnancy: should I have an epidural during childbirth? This decision aid is valuable because it quickly and clearly explains the key points, risks, benefits, and side effects of an epidural. This tool would help with patient decision-making regarding getting an epidural and assisting with patient anxiety related to epidurals. I have noticed many patients come in with stories they have heard from friends about epidurals or misconceptions they have read on the internet about epidurals. The patient decision aid also has a section talking about why the doctor might recommend an epidural. This aid would be very beneficial to have printed out and given to patients on admission. I also think it would be helpful to have this aid given to women at their OB visits once getting close to term gestation.
References
The Ottawa Hospital Research Institute. (, 2019). Patient decision aids. Retrieved from https://decisionaid.ohri.ca/
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RE: Discussion - Week 11
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In the behavioral health realm, it is not uncommon to see readmissions related to non-medication compliance. Developing a therapeutic relationship with patients allows for the discovery of underlying causes for non-medication compliance. Often, the non-compliance revolves around the patient not feeling they had any input or choice about the medications prescribed due to a lack of understanding or denial about their illness. According to Hoffman et al., shared decision-making and evidence-based medicine are crucial in providing quality health care (2014). Unfortunately, these two practices are rarely seen simultaneously in the behavioral health environment.
It is common to witness newly diagnosed patients with Bipolar Disorder refuse to take prescribed medications, whether it is denial, disliking how the medications make them feel, or having the desire to take control of their treatment, non-compliance is a regular occurrence, as are the relapses these patients experience. So common that trying to choose a specific example is difficult. In the acute inpatient mental health hospital, the attending physicians may not consistently have time to educate the patient on their diagnosis or medication options and prescribe what they believe to be best for them and their best possible outcome. Thus, resulting in the patient feeling undervalued, belittled, and ultimately, angry, and defiant. Unfortunately, any display of anger or defiance about taking newly prescribed medications can prolong their hospitalization. Kon et al. describe a default approach for shared decision making between clinicians and patients that consists of three categories: discussion of health concern and the options, considerations, and creating a treatment plan that best fits within the patient’s values and lifestyle (2016).
Unfortunately, patients do not always know the right questions to ask to elicit the pertinent information they require to make an informed decision about their treatment plan. The Ottawa Hospital Research Institute (2020) has a Bipolar II disorder decision aid that assists patients in asking the best questions. The decision aid provides education on the disorder, the primary medications used to treat the disorder, the prevalence of relapse, and psychotherapies to assist with medication compliance. It also contains a section specifically geared toward young adults and addresses common concerns. This decision aid is an excellent tool that should be incorporated regularly to help Bipolar patients understand and participate in their treatment regime.
Incorporating this decision aid or one similar enables the patient to be better informed, prompting them to ask the best questions that correlate with their concerns, values, and lifestyles. Utilizing a tool like this allows for patient and physician collaboration, thus reducing patient defiance, anger, and non-treatment compliance. This tool is one that I will personally begin incorporating. I have always been a firm advocate for patients taking ownership of their health care and providing the necessary education to make informed decisions, enabling them to take control of their disorder, not the disorder controlling them.
References
Hoffman, T.C., Montori, V.M., & Del Mar, C. (2014). The connection between evidence-based medicine and shared decision making. Journal of American Medical Association, 312(13), 1295-1296. https://doi.org/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: Executive summary of the American college of critical care medicine and American thoracic society policy statement. American Journal of Respiratory and Critical Care Medicine, 193(12), 1334-1336. https://doi.org/10.1164/rccm.201602-0269ED
The Ottawa Hospital Research Institute. (2020). Patient decision aids. https://decisionaid.ohri.ca/
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