Posted: September 4th, 2023

Decision-Making Models for Providing Care in a Challenging Clinical Scenario

CASE STUDY:

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.

Please be sure to adhere to the following when posting your weekly discussions:

3. As a reminder, all discussion posts must be minimum 250 words, references must be cited in APA format 7th Edition, and must include minimum of 2 scholarly resources published within the past 5-7 years.

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Discussion 1: Michael Cabrera

Applying Decision-Making Models in Mr. K’s Case

In the case study of Mr. K, the advanced practice nurse (APN) faces a challenging situation where she must provide care not only to the patient but also to the patient’s spouse, Mrs. K. To navigate this complex scenario, the APN can utilize three types of decision-making models, namely the Evidence-Based Model, the Ethical Decision-Making Model, and the Shared Decision-Making Model. Each model presents unique approaches to decision-making, and by comparing and contrasting them, the APN can make informed choices to address the case’s challenges.

Evidence-Based Model:
The Evidence-Based Model emphasizes making decisions based on the best available evidence from scholarly research, clinical expertise, and patient preferences. The APN will critically assess recent peer-reviewed literature and apply evidence-based guidelines to determine the most appropriate care for Mr. K. This model’s strength lies in its reliance on empirical data, which enhances the likelihood of optimal patient outcomes. However, limitations may arise when evidence is scarce or inconclusive, as is often the case with unique and complex situations like Mr. K’s.

Ethical Decision-Making Model:
The Ethical Decision-Making Model involves considering moral principles and ethical frameworks when making choices. In this scenario, the APN would engage in a thorough ethical analysis to determine the right course of action for Mr. K and Mrs. K. Addressing issues like withholding or withdrawing care, the APN will weigh beneficence, non-maleficence, autonomy, and justice to arrive at ethically sound decisions. The strength of this model lies in its ability to uphold patient rights and moral values. However, ethical dilemmas may arise when principles conflict, requiring the APN to prioritize one aspect over another.

Shared Decision-Making Model:
The Shared Decision-Making Model involves collaboration between the healthcare professional and the patient (or family) to arrive at mutually agreed-upon decisions. The APN will foster open communication with Mrs. K, ensuring her values and preferences are considered. This model’s benefit is the empowerment of patients and their families in the decision-making process, leading to greater satisfaction and adherence to the chosen plan. However, challenges may emerge if the patient or family lacks medical knowledge, hindering their ability to fully participate in the decision-making process.

The Rationale for Choosing the Decision-Making Models:

The selection of these decision-making models is crucial in addressing Mr. K’s complex case. The Evidence-Based Model ensures that the APN’s decisions are guided by the latest research findings, enhancing the likelihood of favorable outcomes. The Ethical Decision-Making Model ensures that the APN adheres to moral principles, maintaining integrity and ethical conduct in patient care. Lastly, the Shared Decision-Making Model promotes patient-centered care and empowers Mrs. K to actively engage in decision-making, fostering trust and collaboration.

The Best Decision-Making Model for the APN:

Considering the sensitive nature of Mr. K’s case, the best decision-making model for the APN is the Shared Decision-Making Model. This model will enable the APN to collaborate closely with Mrs. K, providing emotional support, addressing her concerns, and respecting her autonomy. By engaging Mrs. K in the decision-making process, the APN can create a care plan that aligns with Mrs. K’s values and preferences, ensuring the best possible outcome for both Mr. K and his family.

References:

Greenberg, J., & Knight, M. (2016). Evidence-Based Decision Making: Global Evidence, Local Decisions. Healthcare Policy, 11(2), 146-152.
Beauchamp, T. L., & Childress, J. F. (2019). Principles of Biomedical Ethics. Oxford University Press.
Légaré, F., Ratté, S., Stacey, D., & Kryworuchko, J. (2017). Theoretical and Empirical Challenges of Implementing Patient Decision Aids in Clinical Practice. The Milbank Quarterly, 95(4), 778-801.
Robinson, E. M., & Crigger, N. (2018). Ethical decision-making models and the resolution of dilemmas in professional counseling. Journal of Counseling & Development, 96(3), 259-269.

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