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Evidenced-based practice is made up of three components: best evidence, clinical expertise, and patient preference (Laureate Education, 2018). Patient preferences are the values that patients hold along with their choices regarding their care and treatment (Melnyk & Fineout-Overholt, 2018). These preferences can shape the care a patient wants and expects.
In the emergency room, we see critical patients daily. Some have had the talk with their family about what they want regarding resuscitation efforts. But many families and patients aren’t sure what to do. Many times I have seen families chose full code for their frail, elderly family members with no regard for what their family member may want. I’ve even seen families change their family members to full code even when the patient requested do not resuscitate.
One patient that I always think of was a 98-year-old woman who came in as a respiratory arrest. She was found down in the nursing home by staff after choking on a piece of candy. She was a comfort measures only code status recently agreed upon by the patient and family. When the nursing home contacted the family, they demanded the nursing home start CPR. The patient was subjected to over an hour of compressions and invasive procedures with multiple broken ribs and tubes everywhere. As the family arrived and viewed the efforts, they were visibly shaken by what they witnessed. Many families do not understand what is all involved in CPR.
“Cardio-Pulmonary Resuscitation (CPR): A Decision Aid For Patients And Their Families” (2009) is an excellent patient decision aid to help open the conversation. This document can help bridge the gap in understanding about what CPR is and what are the consequences of either choosing to receive it or not. Patients and families need to understand that no CPR will not hinder their care in any way (Frank, 2009). This brochure would be a great tool to get the conversation started with patients and families.
Frank, C. (2009). Cardio-Pulmonary Resuscitation (CPR): A Decision Aid For Patients And
Their Families [Brochure]. Queens University, Canada: The Ottawa Hospital Research Institute.
Laureate Education (Producer). (2018). Evidence-based Decision Making [Video file].
Baltimore, MD: Author.
Melnyk, B. M. & Fineout-Overholt, E. (2018). Evidence-based practice in nursing &
healthcare: A guide to best practice (4th ed.). Philadelphia, PA: Wolters Kluwer