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Q1. Given the two pieces of evidence, what are the key clinical questions to consider when caring for this patient?
First, given the patients fragile health, age, and that the care given to the patient is primarily palliative, there is the need to ease pain, discomfort, and pressure ulcers. There is a high level of quality evidence to suggest that using higher-specification foam mattresses can reduce the risk of pressure ulcers and thus improve the patients current quality of life. Second, although lower quality evidence is available, there is a suggestion that reducing the use of urinary catheters is preferable, and that difficulties in managing incontinence should not justify automatically resorting to this device to deal with the patients issues.
Q2. If you are going to take a patient-centered approach to caring for this patient, what further information do you need?
One accepted definition of patient-centered care is care which honors patients preferences, needs, and values; applies a biopsychosocial perspective rather than a purely biomedical perspective; and forges a strong partnership between patient and clinician (Greene et al., 2012, par.2). Asking the patient about her feelings regarding her care, including her comfort level in bed, her pain threshold, and her personal feelings about her dignity regarding her toileting situation, is essential.
Q3. What questions would you ask of the patient and family? Of the physician?
Asking the patient how she feels most comfortable positioned in bed, her end-of-life care plans, and also her pain threshold and management are all critical. It is also important to ask the family...…Conversely, some patients are reluctant to move as much as is necessary to reduce pressure ulcer risk, although that the patient experienced a significant fall, despite her fragility, suggests she is still desirous of some physical autonomy.
Q7. How could you use the principles of patient-centered care to resolve any conflict between the evidence and patient desires?
Creating a plan with the patient to move about while assisted (for example, having a nurse or family member assist her moving to the bathroom), and also a plan to increase her comfort in bed with a better mattress, scheduled movement, and adjusting her pain medication and nutritional intake is advisable. The patient should have input into prioritizing what aspects of her care she would like improved, even though the nurse can offer feedback about some…
References
Greene, S. M., Tuzzio, L., & Cherkin, D. (2012). A framework for making patient-centered care front and center. The Permanente Journal, 16(3), 49–53. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3442762/
Oben P. (2020). Understanding the patient experience: A Conceptual Framework. Journal of Patient Experience, 7(6), 906–910. https://doi.org/10.1177/2374373520951672
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