Tag: Informed Choice

Everything Has Risks

I am a fierce supporter of informed choice and autonomy in healthcare. I have worked for 23 years to give my clients and patients the freedom to choose what they feel is best for them. That means carefully educating to avoid bias, coercion, intimidation, or the appearance of authority.

“Every choice we have made leading up to that moment has created outcomes that pertain only to us and only to that moment.“

Informed choice involves the review of the risks and benefits of options and is not solely a medical treatment issue. It often impacts the choices we make in our daily lives that have little to do with healthcare. Additionally, the choices we have made before this point, especially the choices we have made with our bodies, and our lifestyle, impact our options and the risks of those options.

This is the risk-benefit ratio.  These are the options and choices where you have to consider the risks versus the benefits and is highly individualized.  My risks and benefits pertain to my circumstances and center around previous choices and outcomes. This is the reason why routine care policies and standard practices can be harmful. Every choice we have made leading up to that moment has created outcomes that pertain only to us and only to that moment.  It is our risk-benefit ratio, and no one has the right to tell us what risks are too much, and what benefits are too few or vice versa.

I have had clients/patients who want their nurse or provider to make their care decisions. In those cases I take that responsibility very seriously and try to consider the risks and benefits within their treatment.  I then introduce options with the least risk first, ask their preference, and continue to involve them in their care as much as they desire.  I never want to be responsible for making decisions for a human who can choose for themselves. Even as a parent, the “because I said so” was very rare, and there were almost always two choices and an explanation of why. I’m not going to let you run into the street and get hit by a car or grab a hot pan, but if you try to do those things, we will talk about the risks.

“We don’t get to choose the risks or consequences, as they are a part of the natural order of humanity.“

The fact is, everything has risks, even those choices that do the most good or have the highest reward, we perceived the benefit so greatly outweighs the risks that we do not consider there to be negatives.  We don’t get to choose the risks or consequences, as they are a part of the natural order of humanity, and even when we only see the benefits or positives of our choice, there will be a negative aspect.

“My risks and benefits pertain to my circumstances and center around previous choices and outcomes. “

For those that do not want children, either temporarily or permanently, the risk of pregnancy is so high that they will do everything to prevent it.  They accept the risk of their decisions, namely birth control or surgery, because the risk of a pregnancy is much higher. For those who want children, they view pregnancy as a positive without risk, or the benefits so greatly overshadow the risks they are minimized to the point of null.  However, the risks still exist, and usually show up to be dealt with; such nausea and vomiting, fatigue, stretch marks, bone and joint aches, and ultimately birth. 

“However, the choice is ultimately ours, and no one has the right to remove our ability to choose which risks and benefits are acceptable to the individual.“

When we generalize healthcare and create an environment where everyone has the same interventions, we take away informed choice and force negative impacts creating a high risk, low benefit care environment.  This is especially true with “you will” interventions – and often these are presented as you will have or we will be doing this intervention, and the options are often timed.  For example: at 20 weeks you will have an ultrasound – at 37 weeks you will have a GBS (beta-strep) swab – we will break your water at 3 pm. These are suggested as interventions without risk, or where the benefit is assumed and the risk minimized, yet no one but us can assess the risks and benefits, and there lies the problem.  For me, the option presented may carry acceptable risks, but for you the risks may outweigh the benefits and carry more harm.

“Additionally, the choices we have made before this point, especially the choices we have made with our bodies, and our lifestyle, impact our options and the risks of those options.“

I live the consequences of my choices.  Yes, some of those choices impact others around me, and that should be considered in the assessment of risks and benefits.  However, the choice is ultimately ours, and no one has the right to remove our ability to choose which risks and benefits are acceptable to the individual. As patients we have the right and responsibility to question, investigate, research, and expect feedback regarding our options.  As providers we have to acknowledge that we do not fully know the risks or benefits for our patients, and since we do not live their life, we have to defer to their personal assessment.   This means taking the time to listen and educate without the bias or our belief system or personal experiences. 

*Sometime the options available are outside of the providers skills or ethical beliefs.  The solution is referring or deferring to a different provider that can meet your patient’s needs.*

Part 1 Being a Nurse During Covid

 

*Disclaimer: I will not waiver that personal autonomy and informed choice is a human right. No one has the right to coerce, threaten, mandate, or legalize away the right of each of us to choose our risk. I do not have to agree with your choices to support the right to determine what risks and benefits are acceptable in your decision-making.   

There are many activities that humans participate in where they have chosen their comfort with risk, yet other humans find those activities too risky. I have no desire to skydive, swim with sharks, free climb a cliff, ride a motorcycle, race a car, use tobacco, use marijuana, etc. For me, those carry too much risk. However, I had several children; I became a nurse, stopped for and ran toward accidents, broke up fights, and defended a victim, putting my safety at risk. Personal risk evaluation is just that, personal. No one can tell you what risk ratio is appropriate for you.  

The hospital is a hard place to be for staff and patients right now. We have lived in a constant state of stress and anxiety. Restrictions in the name of Covid and safety have removed support from friends and family that often grounds us and helps us feel safe when we are sick. We have forsaken therapeutic touch and empathy for patient isolation and PPE, setting restrictions and limitations where people need humanity. The fear and politics of Covid have created a system of isolation so complete that some patients would rather go home to die than sit behind a closed door fighting to breathe. The very thought of being isolated from friends and loved ones is so debilitating that patients refuse medical help or leave AMA to continue to have access to that support system.  

Nurses are used to working around hospital politics and red tape while advocating for their patients. The current environment goes beyond these limitations and creates daily moral and ethical challenges that drain us emotionally and psychologically.  Every shift comes with the knowledge that we are short-staffed and do not have the resources to care for our patients the way they need us to care for them.  

I know some amazing nurses, and yet no superpower on earth can make time slow or create resources out of air. While doing our best is not enough, it is all we have to give, and we have given our all every shift for the past year and a half.   We are required to stretch ourselves beyond the stretchable in the name of sacrifice.  What started in March 2020 has turned into a constant draw of energy that has brought us to our surge capacity both emotionally and psychologically.  

Interestingly one of the arguments for our continued sacrifice comes from the choice to become a nurse, as if obtaining a nursing degree automatically makes one a permanent martyr for the sake of the medical system’s greater good. I don’t know about you, but no nurse on this planet could have foreseen Covid when they chose nursing for their degree. The very fact that choosing nursing as a profession equates to sacrifice of ones mental and physical health highlights why nurses are leaving bedside critical care and choosing travel and contract nursing. AT some point, we have to take our advice and focus on our physical, emotional, psychological, and familial health.