Discussion: Patient Preferences and Decision Making
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.

Discussion – Week 11
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        Last year I took care of a covid patient that also had liver cancer. His prognosis was extremely poor due to the patient also having metastatic liver cancer. This patient had it all over his body including his brain. The peculiar thing was that the patient did not know that he had cancer. The family refused to tell him that he had cancer and just told him that he was in bad shape because of covid. The patient did not speak English and the family would only translate what they wanted and, in some cases, make up things. I know because I speak Spanish and as the doctor would speak and I translate, they would stop me, and they would translate. This situation was an ethical dilemma because the doctor wanted to tell the patient what was going on and discuss medical options, but the family would not let him. Code status also needed to be addressed but again the family interrupted.
          It was not until the family left to eat one day that the doctor was able to speak with the patient and informed him everything that was going on. My patients family loved him so much, but they were committing a huge injustice. The physician wanted to discuss shared decision making (SDM), a process where the doctor and patient discuss medical options, possible outcomes, things that can go wrong, and the patients wishes (Driever et al., 2022). The patient was alert, oriented, coherent, and capable of making his own decisions. The family wanted him to fight through covid and then they would tell him he had cancer, but I honestly believe he did not make it too long. It is hard to see family go through such horrible pain but as healthcare professionals, we have sworn to protect our patients and cause no harm. Patients that are more involved in their care, know the consequences of each decision, and are boldly willing to try new treatments are in better control of their health and go through less decision-making conflict (Hahlweg et al., 2020).
          Eventually, the doctor and I were able to discuss code status with the patient and he wanted to remain a full code. He was only 45 years-old. Code status is such a personal decision and family is usually against DNR orders, but that is why physician and patient conversations are vital. The Ottawa personal decision guide is a great tool for situations that are not as severe as my patients situation. I will certainly be recommending this tool to some of my patients who would benefit from this questionnaire and make the decision that best fits their situation.
 
 
 
Reference
Driever, E. M., Stiggelbout, A. M., & Brand, P. L. P. (2022). Patients’ preferred, perceived decision-making roles, and observed patient involvement in videotaped encounters with medical specialists. Patient Education and Counseling. https://doi.org/10.1016/j.pec.2022.03.025
Hahlweg, P., Kriston, L., Scholl, I., Brähler, E., Faller, H., Schulz, H., Weis, J., Koch, U., Wegscheider, K., Mehnert, A., & Härter, M. (2020). Cancer patients’ preferred and perceived level of involvement in treatment decision-making: an epidemiological study. Acta Oncologica (Stockholm, Sweden), 59(8), 967–974. https://doi.org/10.1080/0284186X.2020.1762926
The Ottawa Hospital Research Institute. (2019). Patient decision aids. Retrieved from https://decisionaid.ohri.ca/
 
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7 months ago
Sarah Lockwood 
RE: Discussion – Week 11
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Hello Claudia,
            thank you for your post. I am sorry you had to experience that situation, as well as the patient and his family. Unfortunately, I have witnessed similar situations. I agree, if a patient is completely coherent and capable of making his or her own decisions, it is his or her right. Families, especially non-medical, seem to have a more difficult time accepting terminal illnesses and try to lengthen the time they have with the patient. According to Melnyk & Fineout-Overholt (2018), patient-centeredness requires the patient’s preferences and values to guide all decisions. Additionally, it places an intentional focus on needs, wants, and desires of the patient. Unfortunately, the family did not consider patient-centered care. To assist family members with accepting end-of-life decisions of their terminal loved one, The Ottawa Hospital Research Institute (2021) provides support tools to guide shared decision making. The tools can help families understand the reality of the situation but more importantly, educated families on making patient-centered decisions.

Melnyk, B. M., & Fineout-Overholt, E. (2018). Evidence-based practice in nursing & healthcare:
            A guide to best practice (4th ed.). Philadelphia, PA: Wolters Kluwer.
Ottawa Hospital Research Institute. (2021). Patient decision aids. Retrieved on May 12, 2022,
            from https://decisionaid.ohri.ca/docs/das/Critically_Ill_Decision_Support.pdf.

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7 months ago
Memory Rinomhota 
RE: Discussion – Week 11
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It is crucial to learn and understand patients’ cultures and beliefs. I work in a jail, and one day I noticed that one of my patients, who is usually compliant with his medication regimen, did not come for his night medication. I called him and asked why he was not taking his medication. He told me that he is a Muslim and does not take anything between 6 am and 6 pm. Medication pass in the jail is done twice a day, at 8 am and 8 pm. Pt said that he had not taken his medication in two days because it was the Ramadan period, and the drug came late. The patient had not reported his concerns to the nurse because he thought no one would help him. I contacted the provider and explained the situation. The provider agreed to change the medication from 6 am to 6 pm. The nurses were advised of the changes during the huddle, and the patient received his medication. Pt was educated on how to make his need known and get involved in the treatment plan.
Incorporating the patient’s culture and treatment plan preferences helps the patient understand what is going on and comply with the treatment plan. The patient can ask questions and seek clarification which motivates them to take charge. The promotion of patient participation in decision making helps patients get involved in the treatment plan (Zang et al., 2022)
Patient educated on contacting the nursing staff and freely voicing his concerns is necessary. Implementing shared decision-making builds trust between the patient and healthcare worker and improves the quality of care and effectiveness (Giuliani et al., 2020). I will use the decision to educate the patient to be forthcoming and ask questions for clarification. The patient will have an informed decision and trusts the process, and participate in the planning of care
Reference

Chenel, V., Mortenson, W. B., Guay, M., Jutai, J. W., & Auger, C. (2018). Cultural adaptation and validation of patient decision aid: a scoping review. Patient preference and adherence, 12, 321–332. https://doi.org/10.2147/PPA.S151833
Giuliani, E., Melegari, G., Carrieri, F., & Barbieri, A. (2020). Overview of the main challenges in shared decision making in a multicultural and diverse society in the intensive and critical care setting. Journal of Evaluation in Clinical Practice, 26(2), 520-523.
Zang, Y., Liu, S., & Chen, Y. (2022). Qualitative study of willingness and demand for participation in decision-making regarding anticoagulation therapy in patient undergoing heart valve replacement. BMC Medical Informatics & Decision Making, 22(1), 1–9. https://doi.org/10.1186/s12911-022-01780-2
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7 months ago
Inderpreet Sandhar 
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7 months ago
Christina Fisher 
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7 months ago
Christina Fisher 
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7 months ago
Tosin Addeh 
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7 months ago
Sharon Muchina 
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Patient Preferences and Decision Making
Patient Preferences can help clinicians make day-to-day treatment decisions by incorporating the patient preferences and values through a collaborative process known as Shared Decision Making (S.D.M.) (Kon et al., 2016).
While working in a rehabilitation facility, one of my post-operation patients had total knee replacement surgery. I found out that this patient’s pain hindered the therapists’ opportunity to provide physical and occupational therapy because of the patient’s unbearable pain. I notified the physician that the patient routinely took a specific pain medication at home and requested to try that pain medication 1 hour before therapy. The order got started, the patients’ pain was under control, and they could participate in all their therapy sessions without experiencing uncontrolled pain.
When jointly discussing healthcare decisions with patients, clinicians must consider the patients’ values, preferences, and circumstances to ensure that incorporating their preferences brings a beneficial outcome that is not harmful (Hoffmann et al., 2014). As a clinician, when other pain treatments did not seem to remedy the pain experienced, I asked the patient what pain medicine had worked best in managing pain in the past. I then communicated with the physician, who was willing to consider adding this medication for pain management into the care plan. Despite not being on the patients’ care plan, this medication was available for use.
I selected knee replacement surgery as the decision aid. Detailed information explaining what causes knee deterioration, like arthritis, is explained to the targeted audience with knee-related issues. The benefits and possible risks of knee replacement surgery, the expected recovery process, and the timeline of how fast the knee will heal are all explained in the patient decision aids (A to Z Summary Results – Patient Decision Aids).
The value of the patient decision aids for the clinician is that it creates educational awareness for the patients of what to expect in recovery post-operation. Nurses can use the decision aid inventory as a guide to reinforce specific recovery information like the expected length of therapy, pain management techniques, and activity levels. Nurses in rehab can give this information to all patients to use to self-assess the need to go for knee replacement surgery. The findings can then be discussed with physicians to determine the most effective treatment option.
 
References
A to Z Summary Results – Patient Decision Aids – Ottawa Hospital Research Institute. 2019, from https://decisionaid.ohri.ca/AZsumm.php?ID=1112
Hoffmann, T. C., Montori, V. M., & Del Mar, C. (2014). The connection between evidence-based medicine and shared decision-making. Jama, 312(13), 1295-1296.
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
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7 months ago
Janelle McEwen 
RE: Discussion – Week 11
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Two years ago, I was working with a female patient with type 2 diabetes mellitus (T2DM). The patient had been on metformin, which effectively controlled her blood glucose levels for over three years. She, however, required medication intensification after the three years to avoid clinical inertia, which is attributed to the health care professional’s knowledge, attitudes, and perceptions, as well as the patient’s beliefs that insulin leads to hypoglycemia, weight gain, and complications (Bailey et al., 2018). When I informed the patient of the need for trade-offs between benefits and risks associated with alternative medications to metformin used in intensification, her most valued treatment attribute was weight change instead of blood glucose controlled days (Huang et al., 2022). Failure to consider the patient treatment values would have negatively influenced her decision to adhere to the medication regimen, thereby resulting to hyperglycemic events, including unsteady glucose control, vomiting, excessive hunger and thirst, rapid heartbeat, vision problems, diabetic ketoacidosis, and hyperosmolar hyperglycemic state (Huang et al., 2022).
In line with the National Institute for Health and Care Execellence (2022) guidelines, I acknowledge that individual patients have the right to be involved in discussions and make informed decisions about their treatment and care with their healthcare team. Thus, I provided the relevant information that explains the treatment and care in a way they can understand, including the possibility of adverse events associated with uncontrolled hyperglycemia. The patient decision aid (PDA) facilitated treatment decisions in collaboration with clinicians, promoting shared decision-making. Her attitude changed and the most valued treatment attribute shifted to blood glucose controlled days, followed by the frequency of hypoglycemic events, medication regimen, weight change, and blood glucose monitoring. Since then, I have not handled any case of medication non-compliance with respect to the female patient.
I can apply the above PDA in my current practice to dispel patients’ preferences, which are, at times, influenced by misconceptions, fear, and personal anecdotes not applicable to an individual’s circumstances, and empower them to develop informed clinical decisions and embrace self-care and self-management skills.
References
Bailey, R. A., Shillington, A. C., Harshaw, Q., Funnell, M. M., VanWingen, J., & Col, N. (2018). Changing patients’ treatment preferences and values with a decision aid for type 2 diabetes mellitus: Results from the treatment arm of a randomized controlled trial. Diabetes Therapy, 9(2), 803–814. https://doi.org/10.1007/s13300-018-0391-7
Huang, Y., Huang, Q., Xu, A., Lu, M., & Xi, X. (2022). Patient preferences for diabetes treatment among people with type 2 diabetes mellitus in China: A discrete choice experiment. Frontiers in Public Health, 9(February), 1–9. https://doi.org/10.3389/fpubh.2021.782964
National Institute for Health and Care Execellence. (2022). Patient decision aid: Type 2 diabetes in adults: Management. https://www.nice.org.uk/guidance/ng28/resources/patient-decision-aid-2187281197
 
 
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7 months ago
Mary Bemker-page WALDEN INSTRUCTOR MANAGER
RE: Discussion – Week 11
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I am so glad that you all were in my course section this term.  It has been a joy to work with you, and I hope you take away with you the skills you need for you MSN role. (It will happen before you know it!) 
 
 I watched the Carol Burnett Show every week when I was small- and I still watch reruns.  She always sang this song at the end of each show that seems fitting to share the last week of the course.
 
As sung by Carol Burnett:     http://www.youtube.com/watch?v=PjQuZCTLAv4
 
Dr. B.
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7 months ago
Christina Fisher 
RE: Discussion – Week 11
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A situation where a patient’s preference or values were not incorporated into their treatment plan was when a patient’s religious values were not accommodated by staff. A female patient was admitted to our inpatient mental health hospital. Upon admission, she was asked to remove her head covering as the length of the material is a potential ligature risk, and her hair needed to be inspected for lice. It was never explained to her why it was part of our process to have her remove this, and after the assessment, it was not returned. The patient did not speak up about this; her husband brought it up after their first phone call. It was explained to the patient why the process was, the staff apologized, and she resumed wearing it. The importance of safety in the hospital was explained to her, and she was understanding of the extra precautions that were necessary while she was wearing it. Unfortunately, the patient’s trust and view of the hospital’s competence were damaged by this happening. While the patient was understanding and appreciative of the situation being remedied, it still took additional time to build rapport with her. Had her husband not spoken up, her religious beliefs and values may have been overlooked during her entire stay. If this had been the case, the patient might not have received the treatment she needed or had not gotten the care she required. For example, setting aside time from groups for prayer and dietary requests would not have been honored. 
 
Including patient preference helps to build rapport with a patient. While it is challenging to be in a mental health hospital, the staff still treats those patients with dignity and respect. This is shown in the treatment plan by accommodating religious needs and preferences. Respect for a patient’s culture and religious beliefs helps the patient to feel more accepted, especially in a field with so much stigma surrounding it. Dobransky (2020) states, “Not only might these individuals have a negative self-evaluation and expect rejection, but they also experience discriminatory behavior from others in terms of jobs, housing, and general interactions” (p.249). It takes much courage to seek mental health treatment, yet patients are faced with not only the stigma of seeking help but of having received help. It is monumental that the staff makes the patients feel accepted.
 
            This led to effective decision-making in this situation because the patient did not have to worry about maintaining their religious beliefs while hospitalized, and this allowed her to focus on the treatment that she needed. In general, including patient preferences and values in the treatment plan increases compliance because that patient feels valued. According to Reed et al. (2020), “The current research is among the first to have identified that patient values, both strength, and type, may play a role in treatment compliance and outcomes” (p. 99). Therefore, the outcomes will be better by including patients’ preferences in the treatment plan and including patients in the decision-making process. 
I would use this decision aid inventory in both my professional and personal career by utilizing it when treating patients and when I am interacting with those in my personal life, especially when I am asked for advice as a nurse. The Ottawa Hospital Research Institute (2019) states “Patient decision aids are tools that help people become involved in decision making by making explicit the decision that needs to be made, providing information about the options and outcomes, and clarifying personal values.” This decision aid would be most helpful in providing resources for patients and inspiring them to better understand what they are experiencing.
 
References:
 
Dobransky, K. M. (2020). Reassessing mental illness stigma in mental health care: Competing stigmas and risk containment. Social Science & Medicine, 249.  https://doi.org/10.1016/j.socscimed.202.112861.
Reed, P. Whittall, C. M., Osborne, L. A., & Emery, S. (2020). Impact of Strength and Nature of Patient Health Values on Compliance and Outcomes for Physiotherapy Treatment for Pelvic Floor Dysfunction.Urology, 136, 95-99. https://doi.org/10.1016/j.urology.2019.11.017.
The Ottawa Hospital Research Institute. (2019). Patient decision aids. Retrieved from https://decisionaid.ohri.ca/index.html
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7 months ago
Janelle McEwen 
RE: Discussion – Week 11
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Christina, I enjoyed your insightful post. The scenario you described displays the inclination of nurses to disregard the values and preferences of mentally ill patients. I agree with you that failure to consider the patient’s views declines nurse-patient rapport and inculcates mistrust, thereby hindering the formation of a therapeutic relationship that is pertinent in clinical decision-making (Bailey et al., 2018). Kraetschmer et al. (2019) investigated how patients’ trust in their physician relate to their preferred role in medical decision-making. The findings showed that familiarity with a clinical condition increases desire for a shared (as opposed to passive) role. Shared decision-making often accompanies, and may require, a trusting patient–physician relationship.
References
Bailey, R. A., Shillington, A. C., Harshaw, Q., Funnell, M. M., VanWingen, J., & Col, N. (2018). Changing patients’ treatment preferences and values with a decision aid for type 2 diabetes mellitus: Results from the treatment arm of a randomized controlled trial. Diabetes Therapy, 9(2), 803–814. https://doi.org/10.1007/s13300-018-0391-7
Kraetschmer, N., Sharpe, N., Urowitz, S., & Deber, R. (2019). How does trust affect patient preferences for participation in decision-making ? Health Expectations, 7, 317–326.
 
 
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7 months ago
Inderpreet Sandhar 
RE: Discussion – Week 11
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Health-care workers are encouraged to engage in evidence-based practice with a focus on patient-centered care. Sometimes it can be challenging for healthcare workers to try to consider the patients’ family members. Clinicians must act in patients’ best interest and use evidence-based decision-making, including their judgement to help patients make decisions (Melnyk & Fineout-Overholt, 2018). During my shift in the medical-surgical unit, I had assignment with a 52-year-old male with Type 2 diabetes accompanied by increased of cholesterol. During this experience, I had an opportunity to provide patient-centered care in which the patient cooperated with me during assessment. During the assessment process, we exchanged information between each other, thus developing trust and respect. The patient in this case raised a need, which is to reduce the levels of bad cholesterol associated with Type 2 diabetes and consequently prevent heart problems. This patient’s need influenced his quest for solutions.  
Through building relationships, both the patient and nurse need to create a partnership when there is collaboration and power sharing. A collaborative treatment approach leads to better diagnostic tools and wellness incentives (Kelly, 2017). In this assessment, I got to know the patient and his specific preferences concerning the mode of treatment and therapy. According to the patient, subcutaneous injection worked well with his father, and he believed that it would work well with him as well. We reached an agreement and created a care plan that included daily subcutaneous injection. Besides, the patient provided all details including age, race, spiritual and cultural beliefs, education, as well as life experience. Besides, I was able to teach the patients concerning the type of exercise, diet, and medications to manage his kidney stone. The patient was able to teach me back using his own words, indicating that he understood what is entailed in his care. Implementing shared decision-making builds trust between the patient and healthcare worker and improves the quality of care and effectiveness (Giuliani et al., 2020). 
References: 
Giuliani, E., Melegari, G., Carrieri, F., & Barbieri, A. (2020). Overview of the main challenges in shared decision making in a multicultural and diverse society in the intensive and critical care setting. Journal of Evaluation in Clinical Practice, 26(2), 520-523. 
Kelly, T. (2017). Shared decision-making: Reexamining the role of patient choice. https://www.beckershospitalreview.com/patient-experience/shared-decisionmaking- reexamining-the-role-of-patient-preference.html 
Melnyk, B. M., & Fineout-Overholt, E. (2018). Evidence-based practice in nursing & healthcare: A guide to best practice (4th Ed.). Philadelphia, PA: Wolters Kluwer 
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7 months ago
Shirley Harleston 
RE: Discussion – Week 11
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Hello Inderpreet,
I enjoyed reading your post. It was concise and covered the basics. Building relationships does build trust. In your example, The 52-year-old gentleman was able to share his history and other information that were important in order for you to serve and care for him in the most valuable way.  When shared decision-making is implemented it supports improved quality of care, and effective care as well as builds a trusting relationship between the patient and the health care worker. (Giuliani, 2020).
 The Ottawa Hospital Patient decision aid summary is a means of making decisions with patient involvement. This tool asks questions about criteria to be defined as patient decisions, and criteria to lower the risk of making biased decisions. People exposed to decision aids feel more knowledgeable, better informed, and clearer about their values and risks. (Stacy, et al., 2017).
There are certain situations where shared decision-making is challenged such as cultural differences, educational background, language, and mental capacity. By engaging healthcare professionals with experts in communication, and patient representatives coming from different cultural backgrounds, languages, and education, healthcare professionals will be guided through the process,  ensuring all patients receive a comparable level of engagement. (Giuliani, 2020)
Reference:
Giuliani, E., Melegari, G., Carrieri, F., & Barbieri, A. (2020). Overview of the main challenges in shared decision making in a multicultural and diverse society in the intensive and critical care setting. Journal of Evaluation in Clinical Practice, 26(2), 520-523.
Stacey D, Légaré F, Lewis KB. Patient Decision Aids to Engage Adults in Treatment or Screening Decisions. JAMA. 2017 Aug 15;318(7):657-658. doi: 10.1001/jama.2017.10289.
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7 months ago
Chaquita Nichols 
RE: Discussion – Week 11
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7 months ago
Cory Legan 
Main Discussion – Week 11
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Patients are often turning to the internet to learn more about upcoming procedures. I believe this newfound knowledge leads to patient preferences. As a nurse, I try my best to honor the patient’s wishes. In the past, I have had a patient request to not have a foley catheter placed during surgery. They have read that this practice leads to an increased risk of infection. Their concerns are valid. Evidence based practice and patient preferences goes hand in hand, when caring for our patients (Walden University, LLC. (Producer), 2018).
If appropriate, I will always incorporate the patient’s preference in their plan of care. Listening to their concerns and advocating for their wishes has a positive impact on overall outcomes (Hoffman & et al, 2014). I believe it fosters a sense of control and fulfillment. The patient in this scenario was very pleased with his care and thanked us for honoring his request to not have a foley catheter during surgery.
Patients should be involved and have a say it their care. The Ottawa Personal Decision Guide would have been a useful tool in this situation (The Ottawa Hospital Research Institute, 2019). This guide helps analyze the benefits and the risks of choosing to decline a foley catheter during surgery (2019). In addition, this tool promotes comparison between possible choices and outcomes (2019). This tool could be used to make a variety of decisions, when regarding healthcare practice or personal matters.
References:
Hoffman, T. C., Montori, V. M., & Del Mar, C. (2014). The connection between
evidence-based medicine and shared decision making. Journal of the American
Medical Association, 312(13), 1295–1296. doi:10.1001/jama.2014.10186
The Ottawa Hospital Research Institute. (2019). Patient decision aids. Retrieved from
https://decisionaid.ohri.ca/
Walden University, LLC. (Producer). (2018). Evidence-based Practice and
Outcomes [Video file]. Baltimore, MD: Author.
 
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7 months ago
Matthew Cluderay 
RE: Main Discussion – Week 11
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Cory,
It is important to remember that patient’s need to have an active role in their own care and we need to listen to their preferences.  I think so many times nursing tend to go on autopilot and try to do what they think is best without considering what the patient wants.  There is a relationship between EVP and patient cultural preferences and as nurses we’re responsible for following the EBP (Walden  University 2018). 
I’ve used the Ottawa tool before at my job as my manager found it useful when she was going to school.  I’ve scrolled through it for work but with a narrowed focus.  Now for this class I’ve seen how expansive that tool really is.  
Have a good weekend
-Matt
 
Walden University, LLC. (Producer). (2018). Evidence-based Practice and
Outcomes [Video file]. Baltimore, MD: Author.
The Ottawa Hospital Research Institute. (2019). Patient decision aids. Retrieved from
https://decisionaid.ohri.ca/
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7 months ago
Mary Bemker-page WALDEN INSTRUCTOR MANAGER
RE: Main Discussion – Week 11
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7 months ago
Janelle McEwen 
RE: Main Discussion – Week 11
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Cory, it is true that healthy literacy is a pertinent issue in the process of involving patient preferences and values in clinical decision-making. Ruhnke et al. (2020) recognize that the core elements of shared decision-making are physician sharing of information and patient participation in decisions, which may improve patient satisfaction and health outcomes. The above authors investigated the association of hospitalized patients’ desire to delegate decisions to their physician with care dissatisfaction. The findings showed that a desire to participate in decisions was associated with reduced satisfaction and less confidence and trust in the physicians providing treatment.  The use of patient decision aids is definitely an effective plan to improve health literacy and their engagement in clinical decision-making. All the best in the subsequent courses!
Reference
Ruhnke, G. W., Tak, H. J., & Meltzer, D. O. (2020). Association of preferences for participation in decision-making with care satisfaction among hospitalized patients. JAMA Network Open, 3(10), 1–13. https://doi.org/10.1001/jamanetworkopen.2020.18766
 
 
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7 months ago
Crystal Anderson 
My initial Post
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The ten years I have been in healthcare there is never a dull moment. I have taken care of many types of patients my ten years. I have had patients with End Stage Renal Disease, Alzheimer’s disease, Parkinson’s disease, Congestive Heart Failure and so much more. I have taken care of patients in both acute and long-term care settings. One patient I never would forget was a 95-year-old female, in the nursing home who had dementia with no living will or power of attorney who just had an acute ischemic stroke patient which paralyzed patient half of their body. Dementia is a major neurocognitive disorder. Some evidence suggests that people with dementia can still articulate their values, preferences, and choices in a reliable manner (Wilkins, 2017). Well Patient had very good support system and family wanted to take her home. During the pandemic with COVID 19 being in a nursing home was lonely, family was not allowed to visit so family did not want to send patient to nursing home. When asked by the patient if they wanted to go to nursing home or go home the patient wanted to go to nursing home, the patient did not want to be a burden to his/her family. Good clinical judgement integrates our accumulated wealth of knowledge from patient care experiences, one size does not fit all (Ginex, 2018). Patient preferences can be