ESSENTIAL OF EVIDENCED BASED PRACTICE

MIGUEL POST

In psychiatry and mental health, nurses and prescribers work tirelessly with patients and present them with the best alternatives to manage their conditions. These plans of care are designed with the patient’s best interest in mind; according to Melnyk and Fineout-Overholt (2018), patient-centered care is an approach that increases patient engagement in their healthcare and leads to a better perception of healthcare outcomes. Since the facility I work for treats patients with acute psychiatric disorders that require emergency stabilization, the practitioner and the nurses could sometimes take the initial treatment measures without the patient’s consent.

For this week’s discussion, the issue that comes to my mind is the involuntary treatment of patients with episodes of psychosis in the psychiatric ward. Sometimes a patient refuses acute psychiatric treatment, but the multidisciplinary team determines that the patient will benefit from being medicated and has obtained a legal proxy to accept treatment for the patient. We can still honor the patient’s values by listening to the patient express their feelings and concerns about the medication therapy; sometimes, the patient may have had a bad experience with side effects. They can inform you what has worked for them and what has not. Preserving the patient’s preference plays a significant role in future compliance and overall outcomes; according to Hoffman et al. (2014), including the patient’s values and preferences in implementing EBP in their treatment plan is crucial for its success.

Patients can sometimes be unable to make informed choices about their care and will need a healthcare surrogate (Sisti, 2017). Determining a patient’s ability to consent to treatment is a skill only psychiatrists are legally entitled to in my facility. Still, nurses can advocate for the patients by communicating and identifying those alternatives that were effective for them in the past.

Hoffman, T., Montori, V., & 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

Melnyk, B. M., & Fineout-Overholt, E. (2018). Evidence-based practice in nursing & healthcare: A guide to best practice (4th ed.). Philadelphia, PA: Wolters Kluwer.

Sisti, D. A. (2017). Nonvoluntary Psychiatric Treatment Is Distinct From Involuntary Psychiatric Treatment. JAMA, 318(11), 999–1000. https://doi.org/10.1001/jama.2017.10318

TERESA POST

Patient Preferences and Decision Making

It is the obligation to offer quality medical services to patients. One way to ensure quality health service is practicing patient-centered care (Russo et al., 2019). Traditionally, physicians and other healthcare providers entirely made decisions regarding patients’ health. Currently, the implementation of evidence-based practice has encouraged healthcare providers to involve patients in the decision-making process (Melnyk & Fineout-Overholt, 2018). If at all, the patient should make an informed choice, and healthcare workers are obliged to respect patients’ preferences.

During my rotations, I came across a 23-year-old female patient struggling with weight control. On physical examination, the patient had a calculated body mass index of 27. She had elevated cholesterol on the lipid profile test. According to the Ottawa Hospital Research Institute’s Decision aids, the patient was informed of three available treatment options, including weight loss and observing diet control, pharmacological drugs for obesity, and surgery. The patient was advised that the best option was weight loss and diet control while doing a serial lipid test to assess her lipid levels. The patient chose to use a diet plan and do regular exercises. She added that she would prefer bicycle riding and swimming routinely. Fortunately, when the patient returned for the next visit, she had lost about 3kg. Dealing with obesity is a patient’s responsibility, and they should be involved in the decision-making process on how to control their weight (Jackson et al., 2020). Involving the patient in the decision-making was essential because she took it as her responsibility to reduce her weight.

I chose obesity decision aid, which offers three options for treating obesity, including weight loss and diet control, use of medications, and bariatric surgery. The decision aid provides options from which the patient can choose their preference, as illustrated in my experience during my rotations. As a future registered nurse, I would use the decision aid while giving health education to obese patients or individuals struggling with weight control. Additionally, I would use the decision aid to help me maintain a healthy weight by exercising regularly and eating a healthy diet to prevent being overweight.

References

Jackson Leach, R., Powis, J., Baur, L. A., Caterson, I. D., Dietz, W., Logue, J., & Lobstein, T. (2020). Clinical care for obesity: A preliminary survey of sixty‐eight countries. Clinical obesity10(2), e12357. https://doi.org/10.1111/cob.12357

Melnyk, B. M., & Fineout-Overholt, E. (2018). Evidence-based practice in nursing & healthcare: A guide to best practice (4th ed.). Philadelphia, PA: Wolters Kluwer.

Russo, S., Jongerius, C., Faccio, F., Pizzoli, S. F., Pinto, C. A., Veldwijk, J., & Pravettoni, G. (2019). Understanding patients’ preferences: a systematic review of psychological instruments used in patients’ preference and decision studies. Value in Health22(4), 491-501. https://doi.org/10.1016/j.jval.2018.12.007

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