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Types of decision-making models that will assist the APN

CASE STUDY:
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 the best decision-making model to use for APNs? Provide a rationale.

Sample Answer

Case Study Analysis: Decision-Making Models for Mr. K and Mrs. K

a. Three Decision-Making Models

1. Problem-Solving Model:

Key Aspects: This model involves identifying a problem, generating solutions, evaluating options, implementing a solution, and evaluating the outcome.
Benefits: It is a systematic approach that can be applied to a wide range of clinical situations.
Limitations: It may be less effective in complex situations with multiple variables and uncertainties.

2. Clinical Reasoning Model:

Key Aspects: This model involves a cyclical process of data gathering, hypothesis generation, testing hypotheses, and evaluating outcomes.

Full Answer Section

Benefits: It emphasizes critical thinking and clinical judgment, allowing for flexibility and adaptation to changing circumstances.
Limitations: It can be time-consuming and may require a high level of expertise.

Intuitive Decision-Making:

Key Aspects: This model relies on intuition, experience, and gut feelings to make decisions.
Benefits: It can be quick and efficient, especially in high-pressure situations.
Limitations: It can be susceptible to biases and errors, particularly when there is limited information or time.

b. Rationale for Choosing the Decision-Making Models

In the case of Mr. K and Mrs. K, a combination of these models would be most appropriate:

Problem-Solving Model: This model can be used to identify and address specific clinical problems, such as managing Mr. K’s condition and providing emotional support to Mrs. K.
Clinical Reasoning Model: This model is essential for making complex decisions about Mr. K’s care, such as determining the appropriate level of care and timing of withdrawal of life-sustaining treatment.
Intuitive Decision-Making: In high-pressure situations, such as a cardiac arrest, intuitive decision-making can be valuable for rapid response and immediate action.

c. Best Decision-Making Model for APNs

While intuitive decision-making can be helpful in certain situations, a more structured approach is generally recommended for APNs. The clinical reasoning model is particularly well-suited for APNs, as it emphasizes critical thinking, evidence-based practice, and patient-centered care. By using this model, APNs can make informed decisions that are grounded in clinical knowledge and ethical principles.

Additional Considerations:

Ethical Decision-Making: APNs must consider ethical principles, such as autonomy, beneficence, non-maleficence, and justice, when making decisions about patient care.
Communication Skills: Effective communication with patients, families, and healthcare team members is essential for successful decision-making.
Cultural Competence: Understanding and respecting the cultural beliefs and values of patients can influence decision-making and improve patient outcomes.

By utilizing a combination of these decision-making models and considering ethical and cultural factors, APNs can provide high-quality, compassionate care to patients like Mr. K and Mrs. K.

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