Discussion Topic: Studymr K Is A 43-Year-Old Male

Discussion Topicfollowcase Studymr K Is A 43 Year Old Male Who Has B

Discussion Topic follow 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.

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Decision-Making Models in Critical Care Nursing: Strategies and Considerations

The complex and emotionally charged nature of critical care settings demands effective decision-making models that guide healthcare professionals, especially advanced practice nurses (APNs), in providing patient-centered and ethically sound care. In the context of Mr. K's case—a 43-year-old man who suffered cardiac arrest leading to potential severe neurological injury—selecting appropriate decision-making frameworks is vital. This essay compares three decision-making models: shared decision-making, the ethical principles-based model, and the narrative (storytelling) model, exploring their key features, benefits, and limitations in addressing such complex scenarios.

Shared Decision-Making (SDM) is a collaborative process that involves healthcare professionals and patients or their surrogates working together to make informed choices consistent with the patient's values and preferences (Elwyn et al., 2017). It emphasizes transparency, mutual respect, and empowerment. The core of SDM is clear communication, where clinicians provide evidence-based information, and patients or surrogates share their wishes. In Mr. K’s case, SDM can facilitate discussions with Mrs. K regarding treatment options, including continuation or withdrawal of life-sustaining measures, while respecting her emotional state and values. Its benefit lies in promoting autonomy and ensuring that care aligns with the patient's—through surrogates—wishes. However, limitations include the reliance on surrogate understanding and potential emotional distress, which may hinder rational deliberation. The process can also be time-consuming and emotionally taxing for clinicians.

The Ethical Principles-Based Model relies on four primary principles—beneficence, nonmaleficence, autonomy, and justice—to guide decision-making (Beauchamp & Childress, 2019). This approach offers a structured framework for weighing the ethical considerations involved in critical scenarios. For Mr. K, these principles support decisions about withholding or withdrawing aggressive interventions based on expected outcomes and quality of life. For instance, beneficence and nonmaleficence guide clinicians to avoid interventions that would cause undue suffering when prognosis is poor. Autonomy is challenged when the patient’s prior wishes are unknown or unclear, making surrogate decisions rely heavily on family input. The limitation of this model is that it may oversimplify complex moral dilemmas, leading to conflicts among principles or difficulty in prioritizing one over another. Additionally, applying these principles may be subjective and influenced by individual clinician or family biases.

The Narrative (Storytelling) Model emphasizes understanding the patient's life story, values, and cultural background to inform care decisions (Chinn & Kramer, 2018). It advocates for empathetic listening and interpreting the patient's and family's narratives to guide ethical and clinical choices. In Mr. K’s case, this model allows the APN and team to connect with Mrs. K’s personal story, understanding her feelings of guilt or frustration about her husband’s condition and her perceived role during the incident. This can facilitate compassionate communication and personalized care planning. Its benefit lies in fostering trust and holistic understanding. Yet, limitations include potential subjectivity and the challenge of integrating narrative elements within urgent, resource-limited situations like critical care.

Comparison and Conclusion

While all three models aim to guide ethically sound and patient-centered decisions, they serve different purposes. Shared decision-making excels in promoting autonomy and family engagement but can be hindered by emotional distress. The principles-based model provides a systematic ethical framework but may oversimplify complex situations. The narrative approach emphasizes empathy and understanding, which is invaluable in emotional cases like Mr. K’s, but may be difficult to operationalize rapidly.

In Mr. K’s scenario, combining these models provides the most comprehensive approach. Initially, employing principles to evaluate the medical prognosis and ethical permissibility sets the foundation. Following that, shared decision-making fosters collaboration with Mrs. K, respecting her autonomy and emotional state. Integrating the narrative approach ensures that Mrs. K’s unique story and cultural background influence care planning, fostering trust and compassionate communication.

Rationale for Model Selection

For APNs working in critical care, a hybrid approach that incorporates the principles-based model with elements of shared decision-making and narrative understanding is optimal. This combination ensures ethical rigor, respects family autonomy, and promotes empathetic communication. Specifically, integrating narrative insights allows APNs to address emotional and cultural dimensions that influence decision-making, which is crucial given the emotional turmoil experienced by Mrs. K and the APN herself. Such a holistic approach aligns with contemporary bioethical standards and enhances the quality of care delivered.

Best Decision-Making Model for APNs

The most effective model for APNs is a patient- and family-centered approach that synthesizes the principles-based framework with shared decision-making and narrative understanding. This integrated model prioritizes ethical soundness, fosters collaboration, and emphasizes empathy. As suggested by Whitehead et al. (2019), APNs equipped with these combined strategies can better navigate complex ethical dilemmas, promote holistic care, and support families through challenging decisions effectively.

In conclusion, decision-making in critical care requires a nuanced, multidimensional approach. Employing a combination of models—grounded in ethical principles, collaborative engagement, and narrative understanding—provides the flexibility and depth necessary to address complex cases like Mr. K’s, ultimately leading to more compassionate and ethically appropriate care.

References

• Beauchamp, T. L., & Childress, J. F. (2019). Principles of biomedical ethics (8th ed.). Oxford University Press.
• Chinn, P. L., & Kramer, M. K. (2018). Integrated theory and knowledge development in nursing (9th ed.). Elsevier.
• Elwyn, G., Frosch, D., Thomson, R., Joseph-Williams, N., Lloyd, A., Kinnersley, P., ... & Barry, M. (2017). Shared decision making: A model for clinical practice. Journal of General Internal Medicine, 27(10), 1361–1367.
• Whitehead, L., Harkins, J., & Dorsett, M. (2019). Ethical decision-making in nursing: An integrative review. Journal of Clinical Nursing, 28(13-14), 2841–2852.
• Jones, S. A., & Brown, P. (2020). Ethical challenges in critical care: A review of key models. Nursing Ethics, 27(7), 1050-1062.