Discussion Response Essay
Hello, I concur that working closely with healthcare providers equips nurses with the knowledge and skills needed to develop appropriate treatment plans by incorporating evidence-based interventions in their care delivery. According to Melnyk and Fineout-Overholt (2018), evidence-based practices lead to quality patient care and positive health outcomes. Additionally, Kon et al. (2016) attributed shared decision-making among healthcare professionals to quality patient care and superior health outcomes. When working together, each interdisciplinary team member provides ideas, expertise, and knowledge needed to make a good decision, leading to positive health outcomes. Schroy et al. (2014) also reported that shared decision-making is applicable in cancer screening. Thus, nurses use the knowledge acquired while interacting with other healthcare providers in cancer screening and while prescribing medication to cancer patients.
For instance, knowledge acquired from other healthcare providers can be used while prescribing medication to individuals diagnosed with Postural Orthostatic Tachycardia Syndrome (POTS), which is a type of dysautonomia. According to guidelines provided by The Ottawa Hospital Research Institute. (2019), Mestinon and midodrine are effective treatment interventions for individuals diagnosed with POTS. However, while prescribing medication to patients with this healthcare condition, a healthcare provider should carefully listen to the patient and consider his or her preferences, interests, and values in making significant decisions concerning medication and treatment plans. Additionally, I agree that healthcare providers should be careful when prescribing medication to other patients to prevent potential adverse drug interactions. Thus, healthcare professionals should consider the mechanism of action, potential side effects, and duration of action.
Kon, A. A., Davidson, J. E., Morrison, W., Danis, M., & White, D. B. (2016). Shared decision making in intensive care units: An American College of Critical Care Medicine and American Thoracic Society policy statement. Critical Care Medicine, 44(1), 188–201. doi:10.1097/CCM.0000000000001396
Melnyk, B. M., & Fineout-Overholt, E. (2018). Evidence-based practice in nursing & healthcare: A guide to best practice (4th ed.). Philadelphia, PA: Wolters Kluwer.
Schroy, P. C., Mylvaganam, S., & Davidson, P. (2014). Provider perspectives on the utility of a colorectal cancer screening decision aid for facilitating shared decision-making. Health Expectations, 17(1), 27–35. doi:10.1111/j.1369-7625.2011.00730.x
The Ottawa Hospital Research Institute. (2019). Patient decision aids. Retrieved from https://decisionaid.ohri.ca/
As a nurse who has had solid relationships with my health care providers, I have been fortunate to incorporate my preferences and values throughout many of my treatment plans. One example is the autonomy I have been able to have in “dosing” two of my prescribed medications. As someone with Postural Orthostatic Tachycardia Syndrome (POTS), a type of dysautonomia, I go through ebbs and flows of the illness. I am on two of the primary medications used to treat POTS: mestinon and midodrine. The physician that manages my dysautonomia is very well-known in the state of Florida for his experience and bedside manner. He listens thoroughly and is not forceful about treatment methods. Upon my request to try to reduce a risk of treatment regimen fatigue, he prescribed my medications cautiously. First, we started with midodrine. At my second appointment, we decided to add mestinon to improve the action of the midodrine. He gave me some information about their mechanism of action, duration of action, and side effects. By my third appointment, told me the maximum dose I could have of each medication per day. He then gave me the freedom to “dose” myself throughout the day based on my symptoms. Some days (particularly throughout the cooler weather), I only need one dose of each in the morning. Most days, though, especially during these hot Florida summers, I must take the medications more often to better manage my POTS symptoms. Allowing me the responsibility and input into my medication regimen has helped save money on my prescriptions. Because I do not always take the maximum dose of the medications (though my prescriptions are written that way), some of my refills last longer than the 30 or 90 days. Allowing me to dose my medications independently has also helped me become more in-tune to my body and its symptoms. I am more aware of when my medication is wearing off, or if I am going to engage in an activity that may require a higher dose. For example, patients living with POTS often have difficulty with air travel. On the days I fly, I increase my midodrine and mestinon doses about an hour before my flight takes off. I have also been able to make lifestyle modifications to perform certain activities or tasks when my medications are at their peak of action, such as taking a shower or walking around the grocery store (gravity is not a friend to those with POTS).
Patients are more likely to meet outcomes when they are active participants in their treatment plans (Krist et al., 2017). That is, when they feel like they are choosing to make a change as opposed to change being forced upon them. It helps patients feel like they have control of their conditions, instead of their conditions controlling them.
The decision aid I reviewed covers the topic of bariatric surgery. As someone who has had a vertical sleeve gastrectomy, I found this decision aid to be thorough. I like that the aid reviewed the types of weight loss surgery, such as a restrictive versus malabsorptive procedure and gave examples of each (Healthwise, 2021). It covered other important information such as what to expect during and after the procedure, risks, and benefits (Healthwise, 2021). I also appreciate that the aid is realistic and accurate mentioning weight re-gain is a possibility if behavior and lifestyle changes are not permanent (Healthwise, 2021). One piece of information I would have liked to see in this patient decision aid is the mention that insurance may not pay for bariatric surgery, and a range of what someone might expect to pay out of pocket. Also, it would be helpful for people to know they may be required to work with a nutritionist or dietician for a certain amount of time before getting approved for surgery. Because I have had countless people ask about some of the basics of weight loss surgery, I can see myself sharing this decision aid with others both professionally and personally.
Healthwise. (2021, December 27). Obesity: Should I have weight loss surgery? Retrieved August 7, 2022, from https://www.healthwise.net/ohridecisionaid/Content/StdDocument.aspx?DOCHWID=ug2364
Krist, A. H., Tong, S. T., Aycock, R. A., & Longo, D. R. (2017). Engaging patients in decision-making and behavior change to promote prevention. Information Services & Use, 37(2), 105–122. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6996004/