This is a request for an initial post and a reply to two different classmates. T

This is a request for an initial post and a reply to two different classmates. The instructions are below:
Changes in culture and technology have resulted in patient populations that are often well informed and educated, even before consulting or considering a healthcare need delivered by a health professional. Fueled by this, health professionals are increasingly involving patients in treatment decisions. However, this often comes with challenges, as illnesses and treatments can become complex.
What has your experience been with patient involvement in treatment or healthcare decisions?
In this Discussion, you will share your experiences and consider the impact of patient involvement (or lack of involvement). You will also consider the use of a patient decision aid to inform best practices for patient care and healthcare decision making.
To Prepare:
Review the Resources and reflect on a time when you experienced a patient being brought into (or not being brought into) a decision regarding their treatment plan.
Review the Ottawa Hospital Research Institute’s Decision Aids Inventory at https://decisionaid.ohri.ca/.
Choose “For Specific Conditions,” then Browse an alphabetical listing of decision aids by health topic.
NOTE: To ensure compliance with HIPAA rules, please DO NOT use the patient’s real name or any information that might identify the patient or organization/practice.
By Day 3 of Week 11
Post a brief description of the situation you experienced and explain how incorporating or not incorporating patient preferences and values impacted the outcome of their treatment plan. Be specific and provide examples. Then, explain how including patient preferences and values might impact the trajectory of the situation and how these were reflected in the treatment plan. Finally, explain the value of the patient decision aid you selected and how it might contribute to effective decision making, both in general and in the experience you described. Describe how you might use this decision aid inventory in your professional practice or personal life.
By Day 6 of Week 11
Respond to at least two of your colleagues on two different days 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.
Here is the first post from Nicole to reply to:
Initial Discussion Post
Patient preferences are important to follow, especially when it comes to end of life choices and decisions. When I was a new nurse, I had an elderly lady who was admitted to my unit, she was in her mid-nineties, had a feeding tube, was not alert or oriented and had several large pressure ulcers on her sacrum. She had been a DNR and on hospice care when the family decided over the holiday season that they wanted to remove her DNR. During this time the feeding tube was accidentally pulled out, and she was experiencing some end-of-life symptoms such as severe bradycardia and was admitted to the hospital. There were different opinions of the family of this patient. Some of her children wanted to reinstate her DNR order and allow her to pass peacefully, while others wanted the hospital staff to do everything medically possible to keep her alive. This became a large issue that ended up involving nurse managers, physicians, social workers, and hospital administrators. “Often, DNR orders are the most controversial in family dynamics (Tajari, 2018). Families often try to convince the healthcare team to overturn the DNR directive. As a nurse, the patient is the priority of care and nurses are the patient’s advocate” (Haley, B, 2021). If a patient makes themselves a DNR when they are in their right mind, should someone at a later time be able to revoke this decision? As a healthcare professional, it is imperative that we provide patient-centered care, and not based on our feelings. “Failure to employ appropriate decision-making techniques can lead to significant problems” (Kon, A.A., et al., 2016). There are decision-making aides available for patients and family members to look over when making these end-of-life decisions (Healthwise Staff, 2021).
After several meetings with the family and support staff, the family came to the agreement of reinstatement of the DNR order. “Patients rely on clinicians to be clinically wise and make sound judgment as experts in their profession. When clinicians do not meet this expectation, they fail patients and communities” (Melnyk, B. M., & Fineout-Overholt, E., 2018, p 224). Changing the code status takes away from the patients’ autonomy, and as healthcare providers we are to deliver patient-centered care.
References
Haley, B., Smith, B., Scott, K., Capps, M., Riley, H., & Clavet, M. (2021). DNR: An Ethical Dilemma in Healthcare. Arkansas Nursing News, 16(2), 18–20.
Healthwise Staff. (2021). Retrieved May 4, 2022, from https://www.healthwise.net/ohridecisionaid/Content/StdDocument.aspx?DOCHWID=tu2951
Kon, A. A., M.D., Davidson, Judy E,D.N.P., R.N., Morrison, W., M.D., Danis, M., M.D., & White, Douglas B,M.D., M.A.S. (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://www.proquest.com/scholarly-journals/shared-decision-making-intensive-care-units/docview/1797885427/se-2?accountid=14872
Melnyk, B. M., & Fineout-Overholt, E. (2018). Evidence-based practice in nursing & healthcare: A guide to best practice (4th ed.). Philadelphia, PA: Wolters Kluwer
Here is the second post from Arthur to reply to:
Several years ago I had a patient that was in an accident and needed blood. However, the patient was a Jehovah’s witness. Jehovah’s witnesses do not accept blood transfusions. This religious belief caused lots of turmoil in my unit because everyone was worried about this patient. The patient was requiring large amounts of oxygen. Due to the family’s refusal of blood the patient’s care was dramatically affected. Crowe and DeSimone (2019) state that “refusal of blood products in the setting of critical anemia is associated with a significant risk of morbidity and mortality” (Crowe & DeSimone, 2019, p. 125). Because of this risk nutrition, respiratory, hemodynamic monitoring, and many other factors of the treatment plan were altered to meet the religious demands of the family. As the patient’s health deteriorated, ethics was consulted to inform the patient’s family of the dire need for blood. The patient’s family refused and later that day the patient ended up passing. In our country, religious freedom is one of the most important aspects of society. However, it makes it very challenging to lose someone when there were ways to keep them alive. Strides in technology are leading to ways to counteract the use of blood transfusions in Jehovah’s witness patients. Rishad et al. (2019) state that “progress has been made in the field of synthetic blood alternatives” (Rishad et al. 2019, p. 125). This advancement in technology could save countless lives for people who refuse a blood transfusion from a donor.
One of the decision aids I found via the Ottawa Hospital Research Institute is the debate on whether or not to bank blood before surgery. I think that it is a very interesting question and would lead to much fewer transfusion reactions in patients that require blood during surgery. Banking blood prior to surgery could save countless lives and decrease the chance of incorrect blood being administered. Despite this debate, it is not applicable to the patient I described above. This patient was in an accident and was not aware that they would be needing blood. I feel that the topic of banking blood could become much more frequent in the years to come. If blood banking was allowed by my hospital, I would offer the choice to my patients and let them come to their own conclusion if it was a route they would like to consider.
References
Crowe, E. P., & DeSimone, R. A. (2019). Transfusion support and alternatives for Jehovah’s Witness patients. Current opinion in hematology, 26(6), 473–479. https://doi.org/10.1097/MOH.0000000000000535
Rashid, M., Kromah, F., & Cooper, C. (2021). Blood transfusion and alternatives in Jehovah’s Witness patients. Current opinion in anaesthesiology, 34(2), 125–130. https://doi.org/10.1097/ACO.0000000000000961
The Ottaway Hospital Research Institute. (2019). Patient decision aids. https://decisionaid.ohri.ca/

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