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Posted: January 12th, 2024

Decision-Making Models for Providing Care in Complex Clinical Situations

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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Decision-Making Models for Providing Care in Complex Clinical Situations

In this case study, we examine the challenging scenario of Mr. K, a 43-year-old male who suffered a myocardial infarction leading to cardiac arrest. The attending Advanced Practice Nurse (APN) faces the responsibility of providing care for both Mr. K and his wife, Mrs. K, while navigating complex decisions regarding the patient’s prognosis and potential withdrawal of care. To address this situation effectively, the APN can utilize various decision-making models. This article discusses three models, compares and contrasts their key aspects, and explores their benefits and limitations in this specific context.

a. Comparative Analysis of Decision-Making Models:
Three decision-making models that can assist the APN in providing care to Mr. K and Mrs. K are the Ethical Decision-Making Model, Shared Decision-Making Model, and the Cognitive Continuum Decision-Making Model.

Ethical Decision-Making Model:
The Ethical Decision-Making Model is grounded in ethical principles and values. It involves identifying the ethical dilemma, collecting relevant information, examining options, making decisions, implementing the plan, and evaluating outcomes. This model emphasizes respect for autonomy, beneficence, non-maleficence, and justice. It enables the APN to navigate complex ethical issues surrounding withdrawal of care and ensure decisions align with moral and professional standards.

Shared Decision-Making Model:
The Shared Decision-Making Model involves collaborative decision-making between healthcare professionals, patients, and their families. It recognizes the importance of patient autonomy, preferences, and values. The APN engages Mrs. K in discussions, provides information about Mr. K’s prognosis, and encourages her active participation in decision-making. This model promotes patient-centered care, fosters trust, and enhances patient satisfaction and adherence to treatment plans.

Cognitive Continuum Decision-Making Model:
The Cognitive Continuum Decision-Making Model recognizes the role of cognition and emotions in decision-making processes. It acknowledges that emotions can influence perceptions, judgments, and decision outcomes. The APN’s emotional state, feeling overwhelmed due to personal connections, may impact decision-making. By employing strategies such as emotional regulation and cognitive restructuring, the APN can effectively manage emotions and ensure rational decision-making.

b. Rationale for Choosing the Decision-Making Models:
The rationale for selecting these decision-making models in the given scenario lies in their ability to address the complex nature of Mr. K’s case and the emotional challenges faced by the APN and Mrs. K.

The Ethical Decision-Making Model provides a systematic framework for ethical analysis and decision-making, ensuring that choices align with ethical principles. As the APN grapples with withdrawal of care and other ethical dilemmas, this model offers a structured approach to make informed decisions while considering Mr. K’s best interests and respecting autonomy.

The Shared Decision-Making Model is suitable in this case to involve Mrs. K in decision-making, as it acknowledges the importance of her perspectives and values. This approach promotes a collaborative relationship between healthcare providers and patients/families, ensuring a shared understanding of the situation and fostering trust, transparency, and mutual respect.

The Cognitive Continuum Decision-Making Model is crucial given the APN’s emotional state. By acknowledging and managing emotions, the APN can maintain objectivity, make rational decisions, and effectively support Mrs. K. This model equips the APN with strategies to regulate emotions and maintain a focus on evidence-based decision-making.

c. Best Decision-Making Model for the APN:
Considering the unique circumstances of Mr. K’s case, the Ethical Decision-Making Model emerges as the most suitable model for the APN. This model encompasses a comprehensive ethical analysis, which is crucial when contemplating withdrawal of care and dealing with moral dilemmas. It ensures the APN’s decisions uphold professional and ethical standards, while respecting the autonomy and best interests of Mr. K and his family.

Rationale for choosing the Ethical Decision-Making Model as the best approach lies in its emphasis on ethical principles, justice, and patient well-being. By employing this model, the APN can navigate the intricate ethical landscape of Mr. K’s situation, provide appropriate support to Mrs. K, and optimize the overall care provided.

In complex clinical situations such as Mr. K’s case, the APN plays a pivotal role in decision-making and patient advocacy. By employing decision-making models like the Ethical Decision-Making Model, Shared Decision-Making Model, and the Cognitive Continuum Decision-Making Model, the APN can address the ethical complexities, engage patients and families, and navigate their emotions effectively. In Mr. K’s case, the Ethical Decision-Making Model emerged as the most suitable, ensuring ethical principles and patient well-being guide the APN’s decision-making process.

References:

Brown, A. (2018). Ethical decision making in nursing: Models and explanations. British Journal of Nursing, 27(5), 266-270.
Joseph-Williams, N., Elwyn, G., & Edwards, A. (2014). Knowledge is not power for shared decision making. British Medical Journal, 350, g4633.
Luce, M. F., Bettman, J. R., & Payne, J. W. (1997). Emotional trade-off difficulty and choice. Journal of Marketing Research, 34(2), 175-186.
Schneider, A. (2016). Ethical decision-making in nursing: Processes and influences. Nursing Standard, 31(22), 46-53.

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