Decision Making.
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.
Sample Solution
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.Full Answer Section
The three decision-making models that I would choose to assist the APN in providing care to Mr. K and Mrs. K are:- Shared decision-making: This model involves the APN working with Mr. K and Mrs. K to make decisions about his care. The APN would provide information about Mr. K's condition and treatment options, and Mr. K and Mrs. K would make the final decisions about what care they want.
- Ethical decision-making: This model involves the APN considering the ethical implications of different treatment options. For example, the APN would need to consider whether it is ethical to continue life-prolonging treatment for Mr. K if he is unlikely to recover.
- Palliative care decision-making: This model involves the APN providing care to Mr. K and Mrs. K to help them cope with his illness and death. The APN would focus on providing comfort and support, and would not attempt to cure Mr. K's illness.
- Shared decision-making: This model is based on the principle of patient autonomy. It is important for the APN to respect Mr. K's and Mrs. K's values and preferences, and to involve them in the decision-making process.
- Ethical decision-making: This model is based on the principles of beneficence, non-maleficence, and justice. The APN would need to consider what is in Mr. K's best interests, and what is the fairest way to allocate resources.
- Palliative care decision-making: This model is based on the principles of comfort and support. The APN would need to focus on providing relief from pain and suffering, and on helping Mr. K and Mrs. K cope with his illness and death.
- Shared decision-making: The benefits of shared decision-making include increased patient satisfaction, improved adherence to treatment, and better decision-making outcomes. However, this model can be time-consuming and challenging, and it requires the APN to have good communication skills.
- Ethical decision-making: The benefits of ethical decision-making include ensuring that Mr. K's and Mrs. K's rights are protected, and that the most ethical course of action is taken. However, this model can be complex and challenging, and it requires the APN to have a strong understanding of ethical principles.
- Palliative care decision-making: The benefits of palliative care decision-making include providing comfort and support to Mr. K and Mrs. K, and helping them to cope with his illness and death. However, this model can be emotionally challenging for the APN, and it requires the APN to have specialized knowledge and skills.