What role does the level of evidence—i.e., the confidence in the evidence—play in determining the interplay between the evidence and patient preferences?

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Sep 21, 2022

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Instructions
Using the case study provided, respond to the critical thinking questions. Each response should be original (in your own words) and a minimum of 2–3 sentences in length.
Case Study
Your patient is in the last stages of metastatic lung cancer. She is receiving oral pain medications to control pain associated with the metastatic involvement of her spine. She is in the hospital after falling at home but has not suffered a fracture; her length of stay is estimated to be no more than 3 to 4 days. She eats very few calories, but she can take in about 250 kcal in supplemental nutrition.
85-year-old woman in hospital bed with oxygen
You assess her risk for pressure ulcers, and she is at high risk due to her nutritional status, time spent in bed, and need for assistance to move in the bed. She has no breaks in her skin at this time, and she is on a regular hospital mattress. She has been incontinent of urine.
Two key pieces of evidence for her care include:
Use higher-specification foam mattresses rather than standard hospital foam mattresses for all individuals assessed as being at risk for pressure ulcer development. (Strength of evidence = A)
Strength of evidence A: The recommendation is supported by direct scientific evidence from properly designed and implemented controlled trials on pressure ulcers in humans (or humans at risk for pressure ulcers), providing statistical results that consistently support the guideline statement (Level 1 studies required). (NPUA-EPUAP, 2009)
Avoid use of urinary catheters in patients and nursing home residents for management of incontinence. (Category 1B)
Category 1B: A strong recommendation supported by low-quality evidence suggesting net clinical benefits or harms or an accepted practice (e.g., aseptic technique) supported by low- to very low-quality evidence Inappropriate catheter use includes “a substitute for nursing care of the patient or resident with incontinence” (Center for Disease Control and Prevention, 2009).
Acceptable use is to improve comfort for end-of-life care if needed (Centers for Disease Control and Prevention, 2009).
Critical Thinking Questions
Given the two pieces of evidence, what are the key clinical questions to consider when caring for this patient?
If the evidence of meaning existed, what questions would you ask about the meaning of a patient’s experience?
What are the potential conflicts between the decision that the evidence would point to and what the patient may desire?
How could you use the principles of patient-centered care to resolve any conflict between the evidence and patient desires?
What is the role of patient-centered care and patient preferences in evidence-based practice?
Do you think the weight that patient preferences take in evidence-based clinical decision-making should be equal to the evidence?
What role does the level of evidence—i.e., the confidence in the evidence—play in determining the interplay between the evidence and patient preferences?
What is nursing’s role in negotiating patient-centered, evidence-based clinical decisions?

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