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.
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: The ethical decision-making model provides a systematic framework for addressing ethical dilemmas. It typically involves a step-by-step process, such as identifying the problem, gathering relevant information, considering alternative courses of action, evaluating the consequences, and making a decision. This model emphasizes ethical principles and values, such as autonomy, beneficence, non-maleficence, and justice. It helps guide the APN in considering the ethical implications of the situation, such as the withdrawal of care and supporting Mrs. K through the process.
- Shared Decision-Making Model: The shared decision-making model involves active collaboration between healthcare professionals and patients/families in making healthcare decisions. It recognizes that patients have unique values, preferences, and goals that should be respected and incorporated into the decision-making process. The APN can engage Mrs. K in shared decision-making by providing her with information about Mr. K’s prognosis, discussing treatment options, and considering her values and wishes regarding the withdrawal of care. This model promotes patient-centered care and enhances the involvement and satisfaction of patients and their families.
- Cognitive Continuum Decision-Making Model: The cognitive continuum decision-making model acknowledges that decision-making can occur on a spectrum ranging from intuition-based decisions to analytical decisions. It recognizes that some decisions are routine and can be made quickly based on experience and intuition, while others require more deliberate analysis and consideration of available evidence. The APN can utilize this model to assess the complexity of the situation and determine the most appropriate decision-making approach. For example, in this case, the APN may rely more on analytical decision-making given the gravity of the situation and the need to consider multiple factors and potential consequences.
Benefits and limitations:
- Ethical Decision-Making Model:
- Benefits: Provides a structured approach to addressing ethical dilemmas, promotes ethical awareness and consideration of key principles, helps ensure a systematic and consistent decision-making process.
- Limitations: Relies on individual interpretation of ethical principles, may not fully account for cultural or contextual factors, can be time-consuming and may not always yield a clear resolution.
- Shared Decision-Making Model:
- Benefits: Enhances patient autonomy and involvement, promotes collaborative decision-making, improves patient satisfaction and adherence to treatment plans.
- Limitations: Requires effective communication skills and time, may be challenging if patient preferences conflict with medical recommendations, potential for decisional conflict or uncertainty.
- Cognitive Continuum Decision-Making Model:
- Benefits: Recognizes the diverse nature of decision-making, allows flexibility in choosing the most appropriate approach, incorporates both intuition and analytical thinking.
- Limitations: Relies on the experience and judgment of the decision-maker, potential for biases or errors in decision-making, may not provide a clear guideline for complex situations.
b. The rationale for choosing these decision-making models in this case study scenario is as follows:
- Ethical Decision-Making Model: This model is relevant because the APN needs to navigate the ethical complexities surrounding the withdrawal of care and support Mrs. K through the process. It provides a systematic framework to consider ethical principles and values in decision-making, ensuring a thoughtful and ethical approach.
- Shared Decision-Making Model: This model is appropriate as it emphasizes collaboration and respect for Mrs. K’s autonomy. In a situation where withdrawal of care is being considered, involving Mrs. K in the decision-making process is crucial to ensure her values and preferences are acknowledged, and she feels empowered and supported.
- Cognitive Continuum Decision-Making Model: This model is relevant given the complexity of the situation. The APN needs to balance intuition and analytical thinking to make well-informed decisions. By utilizing this model, the APN can assess the level of complexity and choose the most suitable decision-making approach accordingly.
c. The best decision-making model to use for the APN in this case would be the shared decision-making model. The rationale for this choice is that the shared decision-making model promotes collaboration, patient autonomy, and patient-centered care. In a situation where withdrawal of care is being considered, involving Mrs. K in the decision-making process is vital to ensure her values and wishes are respected. This model allows the APN to provide Mrs. K with the necessary information, discuss treatment options, address her concerns, and ultimately make a decision that aligns with her preferences. It fosters a partnership between the APN and Mrs. K, promoting a sense of empowerment and support during a difficult and emotionally challenging time.