NURS-6052 DISCUSSION: PATIENT PREFERENCES AND DECISION MAKING – assignmenthandlers
Module 6 Initial Discussion Post
EXPERIENCE
As a nurse working in long-term care, we often must talk to the residents and their families about palliative care. Sometimes, all the decisions are made by the family because the patient cannot do so. Sometimes the person can still think, but their body is giving out. Every time, these talks are complex, but they are always necessary. Even though hospice care has many benefits, few LTC residents currently get it (Xiong, B., Freeman, S., Banner, D., Spirgiene, L., 2020).
One resident has a liver failure that has reached the end stage. The only treatment left is a liver transplant, but she is not a good candidate. This person has been in and out of the hospital because they have a high level of lactic acid and feels sick. She came home from the hospital and told us that they told her she wouldn’t get better without a new liver and that they wouldn’t even consider her for this surgery. This information was given to the staff but not to the resident, who is mentally healthy.
Then it was up to me to talk to this resident about her prognosis and what she could do. I told her the truth, and when we were done talking, she decided that hospice care would be best for her. Before COVID-19, this resident spent her days with family and friends. Now, she spends her time doing things and is happy and pain-free. Considering her values and wishes, we decided to bring in hospice care. She is no longer going to and from the hospital, is no longer in pain, is not limited in what she can drink or eat, and is happy. The resident knows what to expect with her prognosis and is satisfied with her treatment plan.
WHAT THE PATIENT WANTS
When a treatment plan considers what the patient wants and values, the patient is more likely to follow the procedure. When a patient can be cured, more compliance often means faster healing. When a patient can’t be cured, following their care plan makes them and their family happier and improves their relationship with the healthcare team.
Before she decided to be a hospice patient, she wasn’t supposed to drink as much coffee as she does now. She was in a lot of pain every day, and now that she is in hospice, more potent painkillers can be thought about. Pain is a common symptom in the last stages of a disease (Xiong, B., Freeman, S., Banner, D., Spirgiene, L., 2020). This resident is also diabetic and was on a strict diet. Now that she is in hospice care, she can eat whatever she wants, making her happier and easier for her to get along with the staff.
Her treatment plan works because it no longer focuses on keeping her as healthy as possible. Instead, it now focuses on making her as happy as possible. The resident is happy, her family is there for her, and she gets along well with the people who care for her.
DECISION AID
Looking Ahead: Choices for Medical Care When You’re Seriously Ill is a tool used to help people make decisions when they have a severe illness that is likely to end in death. This decision-making tool is often used with people who are staying in hospitals. This guide is mostly about making decisions about feeding, hydrating, breathing machines, and CPR. This DA was okay and helpful. Many of the participants said they wished this had been part of their treatment plan sooner because they had already made some of these decisions. With this tool, the patients felt like they had more control over their treatment plan and were more involved in it (Matlock, D. D., Keech, T. A. E., McKenzie, M. B., Bronsert, M. R., Nowels, C. T., & Kutner, J. S., 2014).
When used at the right time, this DA could help patients with terminal illnesses work with their healthcare team to make a treatment plan that considers all possible outcomes during their illness. When patients know what to expect and their choices, they can make more informed decisions. If this patient had been able to decide like this before she got sick, it could have saved her from some of the worry, fear, and uncertainty she went through (Matlock, D. D., Keech, T. A. E., McKenzie, M. B., Bronsert, M. R., Nowels, C. T., & Kutner, J. S., 2014).
PRACTICE ON YOUR OWN
Now, we use a questionnaire about advance directives that asks a few general questions about their wishes. Being in long-term care, it would be helpful to have a more advanced and detailed decision-making tool. A patient decision aid is a tool that can help the patient and their family understand the different options and talk about them. This lets the patient’s values be considered (Malloy-Weir, L. J., & Kirk, A., n.d.).
We could teach the residents about their specific diagnoses and outlooks and tailor the help to these facts and the residents’ needs. If this tool is used when a person with dementia is still in the early stages of the disease, their wishes can be carried out at every stage of their care and disease (Malloy-Weir, L. J., & Kirk, A., n.d.). It could take a long time to fill these out for all 80 residents, but they could be instrumental and helpful in the long run.
References
Malloy-Weir, L. J., & Kirk, A. (n.d.). Development and pilot testing of a decision aid for the initiation of antipsychotic medications in persons with dementia in long-term care using a systematic approach: a study protocol. BMJ OPEN, 7(10). https://doi-org.ezp.waldenulibrary.org/10.1136/bmj…Links to an external site.
Matlock, D. D., Keech, T. A. E., McKenzie, M. B., Bronsert, M. R., Nowels, C. T., & Kutner, J. S. (2014). Feasibility and acceptability of a decision aid designed for people facing advanced or terminal illness: a pilot randomized trial. Health Expectations, 17(1), 49–59. https://doi-org.ezp.waldenulibrary.org/10.1111/j.1…Links to an external site.
Xiong, B., Freeman, S., Banner, D., & Spirgiene, L. (2020). Hospice Utilization Among Residents in Long-Term Care Facilities. Journal of Palliative Care, 825859720907415. https://doi-org.ezp.waldenulibrary.org/10.1177/082…Links to an external site.
