Patients, surrogates, or medical power of attorneys are encouraged to have informed decisions on the patient’s medical care.
#1Patients, surrogates, or medical power of attorneys are encouraged to have informed decisions on the patient’s medical care. Providing all the information on outcomes and unanticipated effects of the care or procedure and engaging patients in their care plan are professional expectations (Krist et al., 2017). Beneficence, nonmaleficence, autonomy, and justice are the fundamental healthcare ethical principles in any patient care (Varkey, 2021). Family members who are paid caregivers for whom they are surrogate decision-makers could get in dilemmas on patient\’s care decisions (Lin et al., 2021). This dilemma could compromise the quality of patient care as well as the quality of a patient\’s life.
I had a patient whose wife was his caregiver (paid caregiver) and the patient\’s decision-maker. This patient admitted due to acute respiratory failure secondary to aspiration pneumonia. He has other comorbid conditions, including end-stage renal failure on dialysis and TBI due to a motor vehicle accident. His mentation is disoriented times 4. Long story short after two months of hospitalization, currently, he cannot tolerate hemodialysis, even he cannot tolerate continuous renal replacement therapy (CRRT). He ends up with a tracheostomy tube after multiple unsuccessful extubating trials. He still is on pressors to support his blood pressure. He had seven code blues that required ten to fifteen minutes of CPR. Despite all the possible care options provided to the wife, her focus is to take the patient home and continue her caregiver job. This patient cannot make his own decision; the wife is the surrogate decision maker.
Often some patients leave against medical advice. They initially participate in their care plan and get all the information they need. However, before the issue is resolved or stabilized, these patients leave the hospital against the provider\’s recommendation. I had a patient admitted for hypertensive crisis with a blood pressure of 270/170 in the morning and left the hospital with a blood pressure of 230s/120s. Despite the information and education provided, this patient decided to risk it. The exchanged information is not used for reliable treatment decision-making in the above circumstances. These decisions were not based on healthcare values and preferences that validate the useful knowledge and information (Kon et al., 2016).
Considering the case of the wife\’s decision, it has both economic and social aspects that affect the decision-making. According to Lin et al. (2021), there is an ethical dilemma, conflict of interest, and a burden to decide for the patient\’s benefit in this situation. The wife does not look concerned about the quality of care; all that matters to her is securing her source of income. As a social determinant, economic status and some educational factors have negatively impacted the medical decision. When it comes to the hypertensive crisis patient, he took the risk because his understanding is limited to his current situation, and he does not want to consider the detrimental consequence of having high blood pressure. There was also peer pressure on his decision. According to Hoffman et al. (2014), Shared decision-making is the process of making informed choices among evidence-based options, but the decisions by both parties in the above situations cannot be examples of shared decision-making since they both evade evidence-based practices.
Reply #2
In my care setting, a young female patient in her late twenties came to the hospital complaining of dizziness and severe headache. After a comprehensive workup, it was discovered that the patient had Hypertension. The doctor in charge of the patient and I discussed the test results with the patient. The doctor explained the illness in layman\’s terms and prescribed medication. After the doctor left the room, I inquired further about the patient\’s lifestyle and she opened up about the stress she was under from losing her business/source of income a few months back, and that had caused her to eat haphazardly. The patient and I came up with a workable treatment plan tailored to help manage her stress and improve her diet, and she agreed to follow up with her provider after a duration of time. I also gave her information on how she could apply for unemployment, food stamps, etc.
Incorporating patient values and preferences profoundly helped me tailor the interventions. For instance, through shared decision-making, the patient and I agreed that she would include daily walks and reduce salt intake in a move to curb the disease. Including the patient in the intervention planning increased her satisfaction with the care she received (Krist et al., 2017) as well as motivated her to be more proactive in her own health outcome.
The patient’s values and preferences impacted the course of this encounter. The first impact of the incorporation of preferences into the interventions plan was improved quality of clinical intervention. Another impact was the efficiency of the treatment plan. The patient happily agreed to follow the treatment plan because she was consulted before any intervention was implemented. Practicing shared decision-making has the benefit of improving patient adherence to clinical guidelines and interventions (Heath, 2023), hence improving health outcomes.
The decision aid used in this scenario is the Ottawa Personal/Family decision guide (OP/FDG). This guide can help people identify their decision-making needs, plan the next steps, track their progress, and share their views about the decision. This model was valuable because it helped us to make social and health decisions for the patient. (Melnyk & Fineout-Overholt, 2018). I can use this tool in my professional development as well as my personal life for planning goals and tracking the progress of those goals
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