NURS 6052 Discussion: Patient Preferences and Decision Making

NURS 6052 Discussion: Patient Preferences and Decision Making

Having worked in the covid unit, a lot has changed in the type of care patients receive. Often, it feels like the nursing services involved are on the meter of the life-or-death spectrum. It is not like it used to be where patients had hope of getting better and going back to their homes in a short duration of time. Nowadays, patients are hospitalized for months before they can be considered safe for discharge or are transferred to critical care units after conditions worsen or death. In addition, the type of clinical expectations after covid diagnosis has made patients and their families fear health outcomes. That fear is often translated to the relationships eventually formed between clinicians and patients and their families.

For example, I was privileged to care for a very critically ill patient suffering from covid a few weeks ago. The patient was female in her late 70s, alert and oriented x4, had a do not resuscitate code status, with a history of diabetes, hypothyroidism, and hypertension. The patient was on heated high-flow and nighttime Bipap for ventilation which worked for a few weeks, and then we had to switch to Bipap continuous due to desaturation episodes. Pt continued to function with capacity, although her husband was the medical power of attorney. After several weeks passed patient condition continued to deteriorate, prompting the end-of-life care talks from the doctors. The patient was not on board with comfort care because she and the family believed comfort care is like cheating death and wanted to let it occur naturally. This situation was difficult for everyone, especially for the patient who continued to suffer. But because providers had to follow the patient and family wishes, the patient remained on the Bipap for almost two weeks before passing in agony. It was sad and heartbreaking for the nurses to watch her go through the pain without relief, but we understood it was not our place to make decisions, except we served as teachers and consultants when we were required to do so (Pattison, 2020).

However, we (doctors and nurses) informed the patient and family of what it meant to be under comfort care. The patient was aware that CC meant pain relief, comfort, and quality of life (Healthwise, 2021). Current treatments continued but gently aimed to make the patient comfortable until she was ready to stop all treatments together. As shared decision-making is the component of patient-centered care, doctors, nurses, and family members respected the patient’s decision to endure the pain until death; failure to comply would have had significant ethical consequences to the hospital (Kon et al., 2016). It is protocol in the unit that when a doctor orders palliative care, a Chaplin comes by to consult with the patient on what they would wish to receive at the end of life. Formulating a patient-oriented end-of-life care plan is crucial to include the patient’s wishes, advance directives, funeral arrangements, and post-mortem care (National Institute on Aging, 2021).

References

healthwise Staff. (2121). Advance Care Planning: Should I Stop Treatment That Prolongs My Life? Retrieved from healthwise: https://www.healthwise.net/ohridecisionaid/Content/StdDocument.aspx?DOCHWID=tu1430