Posted: August 11th, 2023

Mr. K is a 43-year-old male who has been admitted to the coronary care

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.

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Discussion:

a. Three types of decision-making models that can assist the APN in providing care to Mr. K and Mrs. K are as follows:

Ethical decision-making model: This model emphasizes ethical principles and values to guide decision-making. It involves a systematic approach that considers autonomy, beneficence, non-maleficence, and justice. The APN can use this model to assess the ethical implications of different treatment options, such as the withdrawal of care for Mr. K. By involving Mrs. K in the decision-making process and considering her values and beliefs, the APN can ensure that decisions are made in an ethically responsible manner. The benefits of this model include promoting patient-centered care and upholding ethical standards. However, the limitations include potential conflicts between different ethical principles and the subjective interpretation of values.

Shared decision-making model: This model involves collaboration between healthcare professionals and patients or their families in the decision-making process. It recognizes that patients have the right to be informed, involved, and make decisions about their care. The APN can use this model to engage Mrs. K in discussions about Mr. K’s prognosis, treatment options, and goals of care. By providing clear and understandable information, the APN can support Mrs. K in making informed decisions that align with her preferences and values. The benefits of this model include improved patient satisfaction, increased adherence to treatment plans, and a sense of empowerment for patients and their families. However, the limitations include time constraints, variations in health literacy levels, and potential conflicts when patient preferences differ from medical recommendations.

Clinical decision-making model: This model focuses on using clinical expertise, evidence-based practice, and patient preferences to guide decision-making. It involves gathering relevant information, critically appraising the evidence, and applying it to the individual patient’s situation. The APN can use this model to evaluate Mr. K’s condition, review available treatment options, and determine the most appropriate course of action based on the best available evidence and Mrs. K’s input. The benefits of this model include providing care that is based on scientific evidence and tailored to the patient’s specific needs. However, the limitations include the availability and quality of evidence, time constraints, and the potential for cognitive biases to influence decision-making.

b. The rationale for choosing these decision-making models in the case study scenario is as follows:

Ethical decision-making model: Given the complex and sensitive nature of the situation, ethical considerations are crucial. The APN needs to navigate the ethical implications of potential withdrawal of care, ensuring respect for autonomy, beneficence, non-maleficence, and justice. This model provides a structured framework to assess these ethical principles and make informed decisions.

Shared decision-making model: Involving Mrs. K in the decision-making process is essential as she is the primary caregiver and will be deeply affected by the outcome. This model allows the APN to collaborate with Mrs. K, understand her perspectives, and empower her to actively participate in decision-making, ensuring that her values and preferences are respected.

Clinical decision-making model: As a healthcare professional, the APN needs to rely on their clinical expertise and available evidence to make sound decisions. This model provides a systematic approach to gathering and analyzing information, considering treatment options, and tailoring care to the individual patient’s needs.

c. The best decision-making model to use for the APN in this case is the shared decision-making model. Given the emotional and ethical complexity of the situation, it is essential to involve Mrs. K in the decision-making process and respect her autonomy. By engaging in shared decision-making, the APN can provide emotional support to Mrs. K, address her concerns, and ensure that decisions are made collaboratively. This approach promotes patient-centered care, enhances thequality of the decision-making process, and allows for the incorporation of Mrs. K’s values and preferences. It also helps to establish a therapeutic relationship between the APN and Mrs. K, fostering trust and open communication. Considering the emotional connection the APN has with her own spouse, the shared decision-making model can provide a supportive and empathetic approach that acknowledges the APN’s own feelings while focusing on the needs and well-being of Mrs. K and Mr. K.

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