Please reply to this discussion and offer alternative views on the impact of pat
Please reply to this discussion and offer alternative views on the impact of patient preferences on treatment plans or outcomes, or the potential impact of patient decision aids on situations like the one shared. A situation I see fairly often in Labor and Delivery is the patient is coming in with a self-written birth plan and having preset conditions of how they want their labor to go. Some of the birth plans I have seen are handwritten or typed, and others printed from a template premade on the internet. With a birth plan, I feel that it can positively or negatively impact patient preferences in the treatment plan, depending on the provider and patient communication. I have taken care of patients who have come in with plans stating they do not want anything to help them progress in their delivery and do not want any interventions done by the nurses like IV administration of oxytocin if needed. One positive outcome for birth plans is allowing the patient to feel in control of their birthing experience. Education by the nurse and the doctor is essential in incorporating birth plan requests to ensure both the mother and unborn child’s safety. I have noticed that many birth plans are standard and do not plan for complications in labor. Every labor is different, and every pregnancy is different. I took care of a patient who came in with a birth plan stating she did not want any interventions to help with progressing her labor. The patient had come in because her water had ruptured several hours ago, and she was only dilated one or two centimeters on admission. With ruptured membranes on a laboring mother, time is essential because the longer time passes from ruptured membranes to birth, the greater the risk of infection to the mother and unborn baby. Prolonged rupture membranes can lead to a complication of infected amniotic fluid called Chorioamnionitis, which is dangerous for the mother and the fetus. After reviewing the patient’s preferences and birth plan with myself and the provider, the patient’s wishes were acknowledged. Education was provided on the risks of prolonged rupture of membranes on a laboring mother and infection risks. The mother acknowledged understanding of the dangers of prolonged latent labor and ruptured membranes. A collaborative decision was made between the provider and patient to allow her to go a few more hours without labor augmentation to see if she made a cervical change independently. The patient agreed to have IV Pitocin started if her cervix was unchanged after the next check in a few hours. The patient and the provider were both happy with that decision. This example shows a positive result by allowing the patient to choose her care plan for their hospital stay. From the Ottawa Hospital Research Institute (2019), a patient decision aid I found relevant to Labor and Delivery is titled pregnancy: should I have an epidural during childbirth? This decision aid is valuable because it quickly and clearly explains the key points, risks, benefits, and side effects of an epidural. This tool would help with patient decision-making regarding getting an epidural and assisting with patient anxiety related to epidurals. I have noticed many patients come in with stories they have heard from friends about epidurals or misconceptions they have read on the internet about epidurals. The patient decision aid also has a section talking about why the doctor might recommend an epidural. This aid would be very beneficial to have printed out and given to patients on admission. I also think it would be helpful to have this aid given to women at their OB visits once getting close to term gestation. References The Ottawa Hospital Research Institute. (, 2019). Patient decision aids. Retrieved from https://decisionaid.ohri.ca/
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