Clinical Decision-Making and Evidence-Based Practice in Nursing NUR402

Question 1: Research and present a discussion of a new treatment you found for managing peripheral vascular disease. Analyse and compare the evidence regarding the efficacy and safety of this new treatment to either support or contradict its use in Ashley's case.
Answer:

New Treatment for Peripheral Vascular Disease (PVD):

Another relatively new tool in the treatment of Peripheral Vascular Disease (PVD) is the drug-coated balloons (DCBs). It has emerged in the last 5-8 years as a less invasive technique for treating arterial stenosis in patients with PVD (Stoner et al., 2016). Used during angioplasty, DCBs release an antiproliferative drug, such as paclitaxel, at the site of the arterial wall. It is known that the main advantage of DCBs is to reduce restenosis a rather frequent issue after angioplasty due to suppression of the smooth muscle cell proliferation.

Evidence of Efficacy and Safety of Drug-Coated Balloons

Several studies on the working and safety of drug-coated balloons Several case-control studies and meta-analyses have also been used to assess the efficacy of DCB. These include the IN. PACT SFA Trial (2015) and its follow-up studies with the use of DCBs have been found to reduce restenosis as compared to balloon angioplasty or plain old balloon angioplasty (POBA) (Soga et al., 2020). Subsequently, the trial concluded that, after one year of administration of DCBs, primary patency rates of 82. 2%, compared to 52. Another important factor was that the ruptured membranes rate was only 4% for those who had undergone the POBA. Altogether, the outcomes of the Lutonix and Stellarex trials support these results thereby implying that patients treated with DCB had higher rates of patency and lower TLR.

However, issues of safety came up when the long-term effects of using paclitaxel-coated devices were considered. Meta-analysis was more potent about the paclitaxel-coated balloons and stents and raised doubts regarding elevated mortality risks. Further research on the death rate with the help of the U. S. FDA and other similar structures has not confirmed the higher mortality rates connected with DCBs but has underlined the significance of the proper selection of patients and their control.

Application of Drug-Coated Balloons to Ashley's Case

Because of Ashleys comorbidities, Type 2 diabetes, heart failure, peripheral neuropathy, and her residency in rural America, DCBs are viable. This she feels would better suit her case given that low patency rates and recurrent interventions appeal to her given the risks of ensuing complications with her quality of life (Gao & Chen, 2016). Preventing restenosis is crucial because she has diabetes which has affected her peripheral vascular health and her heart failure may affect her capability of early recovery for several times of surgery.

Also, Ashleys HbA1c result is 7 and above meaning that her blood sugar level is not well controlled. 8% and moderate hypertension (BP: Normal blood pressure ranges from 120/80 mmHg to 129/80 mmHg, while the patients blood pressure is 150/95 mmHg; this means she needs treatments that do not add more stress to her cardiovascular system. Researchers such as Stevens et al. (2018) say that DCBs have lesser potential for restenosis as compared to stents, which may be quite beneficial for diabetic patients as high blood sugar levels lead to re-coiling of the arteries.

From a safety point of view, though the long-term effect of paclitaxel on mortality is still a matter of concern, there is no concrete evidence available against the use of DCB in patients with other associated comorbidities like Ashley. Despite all these, The Society for Vascular Surgery (SVS) still supports the use of DCBs in frontline treatment of PVD particularly for high-risk patients (Gul & Janzer, 2023). Also, since they signify decreased stent use, Ashley will not experience issues such as stent thrombosis together with its treatment that is a burden to her heart failure.

Conclusion:

In conclusion, DCBs possess the potential to be used to treat PVD and hence can be used to treat Ashley accordingly. The treatment outcomes which include the ability of the treatment to keep vessels open and reduce restenosis in patients with diabetes are relevant to her case. It is therefore important to assess long-term outcomes because of the emerging debates about the safety of paclitaxel.

Question 2: Review the existing literature on the ethical and psychosocial considerations associated with introducing a new treatment to Ashley. Provide a comprehensive discussion that identifies and explores the principal concerns an RN (Registered Nurse) should be aware of when caring for this patient (ULO1 and ULO5).

Answer:

Review of Ethical and Psychosocial Considerations

A Review of Ethical and Psychosocial Considerations Going through the ethical and psychosocial considerations that have been outlined above thus; Before the introduction of a new treatment, the committee was necessary to consider the ethical issues as well as the psychosocial aspects that stood out in Ashleys case. About the ethical issue, it is very crucial to ensure that informed consent has been complied with strictly (American Nurses Association, 2020). The principle of autonomy therefore requires that Ashley must have the liberty to make proper choices about her treatment without any force or influence by other parties about their treatment in harmony with taking into well-rounded understanding of the benefits and the risks associated with the treatment processes as well as other feasible treatments that can be tended to instead of certain treatments (International Council of Nurses, 2021). This includes making sure that all the information I give her and her trainer is easily understood and stating in layman's terms the routines that we have in store for her. More so, the principle of beneficence requires that the new treatment should be assessed so that it can benefit Ashley and the non-maleficence principle means that it should not cause harm.

At a psychosocial level, the Social Interaction of a new treatment affects the psychological health and overall well-being of Ashley. Inability to cope with new treatment regimens that introduce anxiety or stress in case the treatment requires a change of lifestyles or the results from the treatment are unclear(Levine et al., 2021). The nurse must evaluate Ashleys emotional well-being and provide her with some intervention to embrace and possibly take her to a counselor and a support group. Also, the social consequences which are the altered lifestyle or communications with family members or friends should not be overlooked (Xu et al., 2021). Besides the above-mentioned costs, psychosocial aspects are also significant with the discriminant impact as the new treatment may cause much stress, but efficient communication and support can minimize these impacts.

RNs Principal Concerns and Strategies

The Following are several issues connected with the new treatment, that the RN needs to consider while caring for Ashley: First of all the decision of the treatment process and its consequences should be explained to Ashley by the RN. This includes speaking to the client in simple language and as a way of gaining confidence that the understanding is clear, the client may be asked to explain certain information in his or her own words (teach-back methods) (Lukewich et al., 2022). The RN should also evaluate Ashley for factors that may influence her willingness to participate in the treatment plan and emotions of Ashley that can bar her from fully participating in the treatment.

About consent, the RN has to make sure that Ashley is capable of deciding on her own without being pressured to do or not do something by someone else. This means setting up a climate in which Ashley can freely express her fears and personally exercise her choices (Gab Allah et al., 2020). Also, the RN should take records and notes about all the aspects of consent, especially Ashelys decisions as well as the preferences and values that she holds.

The use of a person-centered approach must be integrated into practice. This entails individualized care planning in the context of Ashleys needs and preferences and her involvement in every decision-making process (Lillsj et al., 2023). The RN should be there by recommending a review of the care plan after some time and make adjustments in line with Ashleys experience with the new treatment in place.

Conclusion

It has been concluded that recommendations may be useful to strengthen Ashleys confidence and support her during the treatment that informing her about the possible need for different kinds of therapies and consultation, showing her persisting interest in her perception of herself, and providing her ongoing feedback, open-warm communication, and encouragement.

Question 3: Discuss how you would educate and involve Ashley in the decision-making process for commencing this treatment. Evaluate the strategies you would use to ensure their understanding and consent. (ULO1, ULO3).

Answer:

Educating and Involving Ashley in the Decision-Making Process

In managing and caring for an elderly and colored Transgendered female patient; named Ashley Boulton with both PVD, diabetes, heart failure, and recurring cellulitis, an individualized and patient-centered approach to treatment and decision-making is critical. This approach has to be adjusted for her medical condition, her problem with sensory integration, and her cultural identity. The following techniques are going to be used to teach Ashley modern development in PVD treatment and to get her permission (Flores et al., 2021).

Educational Strategies

1. Clear, Tailored Communication: Because Ashley has to experience extra stimuli and express herself as a child with neurodivergent features, communication shall be comprehensible and adjusted to her. Avoiding professional terms to be easily comprehensible is the key. It is useful for illustrating ideas to the viewers when explaining concepts that may be difficult to understand. Moreover, one needs to take into account Ashleys gender to make sure that she feels comfortable and that her perspectives are valued. This involves The use of correct gender pronouns and assuming how uncomfortable she could be with her rural background and history as stated in a study by (Smith et al., 2018).

2. The Teach-Back Method: Employing teach-back is useful as it will ascertain whether Ashley comprehends the new treatment. Following education, the RN should ensure they make Ashley describe the treatment process in her own words. This technique also checks whether she has understood what was said or not and which area she is hazy about (Flores et al., 2021). For example, the RN might say, Can you explain to me what you think this new treatment is about and which benefits will possibly impact you?

3. Patient-Centered Education: Education should therefore be as individualized as much as it is possible concerning Ashleys case. Taking into account her location in a rural area, where people may have restricted access to the health care facilities, then giving her written documents that she can study independently is useful. She may have additional questions or concerns and one can schedule another appointment with them or a telephonic follow-up (Hong & Moliterno, 2019). Hence it is important to ensure that materials used to educate patients are both available and easily understandable by the patients.

Ensuring Informed Consent

1. Autonomy and Voluntariness: The patient understands the benefits, risks, as well as options for treatment such that the decision to proceed with the new treatment is voluntary (Pietrzykowski & Smilowska, 2021). The RN should give Ashley all the information that she may require about the treatment; and make her understand that she has the right to refuse or withdraw from the treatment at any one time without being punished. She needs to feel valued and free from being forced to make decisions; therefore, the culture has to be nurturing.

2. Assessing Understanding: Finally, for the RN to be certain that Ashley has understood what has been said, the following open-clinical questions should be asked. For example, it is good, to begin with a question such as, I have some questions about how this new treatment may work for you and your health, with more concrete questions such as, Can you explain what you understand about how this new treatment might work for your condition? can then be asked to pinpoint misconceptions. Another issue of concern should be that the RN should be ready to explain or reiterate some aspects of the treatment that the patient may not understand as is the case with Ashley.

3. Providing Support: Ashley can seek more support, for instance inviting a family member or a close friend into the conversation to make a better decision. However, it has to be noted that such support should not overrule Ashleys choices and decisions, which might be unconstructive to her independence. The RN should also provide consolation or refer the patient to a counselor, if necessary to address the anxiety or concern the patient has concerning the new treatment.

4. Documentation and Reflection: Documentation of the educational process and the assessments made by Ashley is very important and should be correct. The RN should include the information that was given by the patient, understanding of Ashley, and consent to go ahead with the treatment. It also enables the checking and the enhancement of the next process of informed consent given that it addresses all the above parameters of informed consent as stated by (Lukewich et al., 2022).

Conclusion

It had been concluded that implementing patient-centered education by involving Ashley in the decision-making regarding a new treatment means teaching the patient, using the teach-back method of communication. To meet the requirement of informed consent then one has to respect Ashleys self-determination, evaluate her comprehension, and provide assistance if need be. Thus, by implementing such approaches the RN will be able to help Ashley to make the right decision saying that she is in the right position to choose or even respect Ashleys decision.

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