Changing the World Through Evidence-Based Practice

Patient Preferences and Decision Making

Implementing evidence-based practice (EBP) within healthcare makes it an ever-changing environment (Pivec & Potocan, 2021). As clinicians, we often make implementing EBP a challenge along with other contributing factors. However, without successfully implementing EBP/evidence-based medicine, we cannot help our patients and surrogates in adequated shared decision-making as the two are co-dependent on each other(Hoffmann et al., 2014). For this discussion post, I will share a recent clinical experience explaining how incorporating or not incorporating patient preferences and values impacted the outcome of their treatment plan. Also, I will explain the significance of patient decision aid and how it might contribute to effective decision-making.

Clinical Experience

A 40-year-old woman presents to the emergency department for shortness of breath, fever, and malaise. Symptoms lasted three days, but she became shorter of breath and decided to come to the hospital. She presents a history of extensive comorbidities, including asthma, end-stage renal disease (ESRD), and obesity. Also, she reported recent admission at another facility for asthma exacerbation a month prior and had to be mechanically ventilated. With admission to the intensive unit and an additional diagnosis of the COVID 19 virus, she shared her experience of being intubated and ventilated and wish not to experience said event. Her wishes were honored, and treatment commenced, and high flow oxygen utilizes in the daytime with continuous BiPAP at night along with prone therapy. However, as the days passed, her progress became worse, and intubation was now the only option she refused on countless tries when asked for consent. Days passed, and she got even worse and eventually gave permission. By this time, her lungs were already far gone, and she expired shortly after being intubated.

Base on this woman’s previous experience with being intubated and mechanically ventilated, she was traumatized by the experience. She didn’t want to relive the situation even though her life was dependent on it, and she got educated on the subject regardless.

How does involving or not involving patients preference affect clinical outcome

According to Kon et al. (2016), “Shared decision-making is a central component of patient-centered care in the intensive care unit (ICU).” The shared decision-making concept, in my opinion, is first based on relationship building between patient and caregiver. As information is shared, an understanding bond is formed between the patient and caregiver, resulting in trust. Involving patients’ preferences and values into their care have everything about how the treatment plan will turn out. Decisions based on patients’ values facilitate engagement in the treatment plan and give them autonomy. Not involving them leaves them feeling powerless and may disturb the treatment regimen, lengthen hospital stays and increase the patient cost (Healthcare Value Hub, 2019).

Patient decision aid and its contribution to effective decision making

A patient decision aid designed to its best capacity provides complete information on the possible treatment options available, involving the risk, benefits, and even the burdens of the treatment plan. This better aids the patient in generating knowledge of their condition and understand the clinical evidence beyond their treatment (Healthcare Value Hub, 2019). The patient decision aid of choice for the scenario mentioned above is the Ottawa Personal Decision Guide. The Ottawa Personal Decision Guide depicts a replica of a well-designed decision aid, hence my choice. Also, the patient had multiple medical conditions; therefore, the A-Z option did not apply to the situation.

References

Healthcare Value Hub. (May 2019). The consumer benefits of patient shared decision

Discussion: Using the Walden Library
Where can you find evidence to inform your thoughts and scholarly writing? Throughout your degree program, you will use the research literature to explore ideas, guide your thinking, and gain new insights. As you search the research literature, it is important to use resources that are peer-reviewed and from scholarly journals. You may already have some favorite online resources and databases that you use or have found useful in the past. For this Discussion, you explore databases available through the Walden Library.

To prepare:

Review the information presented in the Learning Resources for using the Walden Library, searching the databases, and evaluating online resources.
Begin searching for a peer-reviewed article that pertains to your practice area and is of particular interest to you.
Identify the database that you used to search for a peer-reviewed article in your area of practice and interest.
Reflect on your experience with searching the database. Did you note any difficulties when searching for an article? What steps/strategies did you find helpful for locating a peer-reviewed article? Would this database be useful to your colleagues? Would you recommend this database?
Once you have select your peer-reviewed article, evaluate its strengths and weaknesses in terms of scholarly writing, bias, opinion, quality of evidence, and appropriateness to its target audience.
BY DAY 3
Post a brief summary of your peer-reviewed article, the database you located your article in, your database searching experience, key words utilized in the search, and analysis of the strengths and weaknesses of the article.

Support your Discussion assignment with specific resources used in its preparation using APA formatting. You are asked to provide a reference for all resources, including those in the Learning Resources for this course.

 

This week, you explore the Walden Library and consider the differences between peer-reviewed research evidence and non-peer reviewed evidence. In addition, you continue your examination of effective scholarly writing as you analyze writing in terms of its purpose, audience, bias, and quality of evidence.

The Walden Library webinars provide relevant information on accessing and evaluating scholarly sources. The information on retrieving evidence-based practice sources is especially pertinent to MSN students.

Introduction to the Walden University Library
Searching and Retrieving Materials in the Research Databases
Identifying and Evaluating Online Resources
The Walden Library and Your Total Information Network
Document: Introduction to Scholarly Writing: Finding a Scholarly Voice (PDF)
What does it mean to write with a scholarly voice? This document reinforces the information presented in the media program and provides information about how to find your scholarly voice.
Document: Introduction to Scholarly Writing: Purpose, Audience, and Evidence (PDF)
Purpose, audience, and evidence are three important topics a scholar-practitioner needs to keep in mind when writing. This document will help to reinforce the information presented in the video program and enrich your understanding of scholarly writing.
Document: Introduction to Scholarly Writing: Tips for Success (PDF)
This document, which accompanies the media program of the same title, provides resources for improving your scholarly writing and critical-thinking skills.
Document: Stages in Critical Reading of Research Articles (Word document)
This chart describes the purpose of, and questions for, six stages of critically reading research articles. Focus on the many activities and questions that make up the critical reading process. Begin to consider the journal articles and books you read in terms of these criteria.

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