Mr. K is a 43-year-old male who has been admitted to the coronary care unit after experiencing a myocardial infarction which led to a cardiac arrest. Mr. K has maintained a healthy and active lifestyle since his myocardial infarction three years ago. Prior to his admission, Mr. K was at home running on his treadmill as part of his morning routine. His wife, Mrs. K, heard a loud noise and ran downstairs to find Mr. K lying prone on the treadmill with a head injury and no pulse. Mrs. K called 9-1-1. Cardiopulmonary resuscitation (CPR) was not initiated until paramedics arrived, and it was approximately 45 min until Mr. K had a return of spontaneous circulation. Mr. K was intubated at home and then brought into hospital where he was seen immediately by the cardiac team, which included an advanced practice nurse (APN). The APN’s role was to gather information about what might have led to Mr. K’s event and to consider the current goals of care. Given the estimated downtime (time without adequate blood circulation), the APN acknowledges that Mr. K would most likely suffer from severe anoxic brain injury, and his prognosis would be poor.
Although nothing had been confirmed by the physician, the APN recognizes that there is a strong possibility that she will need to support Mrs. K through the withdrawal of care for her husband. After considering this, the APN became overwhelmed with emotion as she thinks about her own spouse who is the same age as Mr. K. In addition, the APN also experienced profound frustration as to why Mrs. K did not initiate CPR for her husband. As the team continues to aggressively work on Mr. K, the APN will be Mrs. K’s initial point of contact and will work closely with her to meet the overall goals of care for Mr. K.
Discussion:
a. Choose three types of decision-making models that will assist the APN in providing care to Mr. K and Mrs. K. Compare and contrast the three chosen models making sure to discuss key aspects of these models and the benefits and limitations of these models in addressing the above situation.
b. Describe the rationale for choosing the decision-making models to apply to the case study scenario.
c. What do you feel is best decision-making model to use for APN? Provide a rationale.
In challenging healthcare scenarios, advanced practice nurses (APNs) play a critical role in decision-making and guiding patients and their families through complex care processes. This essay explores three decision-making models that can assist the APN in providing care to Mr. K and Mrs. K, who are facing a difficult situation after Mr. K’s cardiac arrest. The chosen models will be compared and contrasted, their key aspects discussed, and their benefits and limitations examined in addressing the case study scenario. Finally, a recommended decision-making model for the APN in this context will be proposed, along with a rationale for its selection.
Shared decision-making involves collaborative discussions between healthcare professionals, patients, and their families, taking into account the individual’s values, preferences, and goals. Key aspects of this model include information sharing, deliberation, and joint decision-making. It recognizes the importance of patient autonomy and considers the patient’s perspective in determining the best course of action. Benefits of shared decision-making include enhanced patient satisfaction, improved adherence to treatment plans, and increased patient engagement. However, time constraints, limited health literacy, and unequal power dynamics may pose limitations to its implementation.
Ethical decision-making models, such as the Four-Principle Approach or the Process of Ethical Decision-Making, provide a structured framework to analyze ethical dilemmas in healthcare. These models involve assessing the situation, identifying ethical issues, considering relevant ethical principles, and reaching a morally justifiable decision. The key aspects include autonomy, beneficence, non-maleficence, and justice. Ethical decision-making models help guide healthcare professionals in balancing competing values and making decisions in complex situations. However, the subjectivity of ethical principles and cultural variations may limit their application in diverse contexts.
The evidence-based decision-making model integrates the best available research evidence, clinical expertise, and patient preferences to inform decision-making. It involves asking clinical questions, searching for relevant evidence, critically appraising the evidence, applying the evidence to the patient’s situation, and evaluating the outcomes. This model promotes the use of research evidence to guide clinical practice and optimize patient outcomes. Benefits of evidence-based decision-making include improved patient safety, enhanced quality of care, and informed decision-making. However, challenges may arise in accessing up-to-date evidence, interpreting conflicting evidence, and incorporating patient preferences.
Each decision-making model offers unique advantages in addressing different aspects of the case study scenario. The shared decision-making model aligns with the emphasis on patient-centered care and respects Mrs. K’s autonomy in making decisions regarding Mr. K’s care. The ethical decision-making model provides a structured approach to navigating ethical considerations and dilemmas that may arise during the course of care. The evidence-based decision-making model ensures that decisions are informed by the best available evidence and clinical expertise. These models collectively support the APN in considering the perspectives of both Mr. K and Mrs. K, addressing ethical concerns, and incorporating research evidence to guide care decisions.
The best decision-making model for the APN in this case study scenario is the shared decision-making model. Given the complexity of the situation, involving Mrs. K in the decision-making process is crucial to respect her autonomy and promote patient-centered care. The shared decision-making model allows the APN to engage in open and honest conversations with Mrs. K, facilitating the exploration of treatment options, risks, benefits, and Mr. K’s goals of care. This approach acknowledges Mrs. K as an active participant in decision-making and promotes a collaborative and supportive relationship between the APN and Mrs. K.
Effective decision-making is fundamental in complex healthcare situations, and APNs play a pivotal role in guiding patients and their families through challenging decisions. The shared decision-making, ethical decision-making, and evidence-based decision-making models offer valuable frameworks to support the APN’s decision-making process. The shared decision-making model is particularly suitable for the case study scenario, enabling the APN to collaborate with Mrs. K, respect her autonomy, and navigate the complexities of Mr. K’s care. By applying the appropriate decision-making model, the APN can enhance patient-centered care and support Mrs. K during this difficult time.
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