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Van Der Ploeg-Dorhout MP, Van Den Boogaard C, Reinders-Messelink H, Van Der Cingel M. Patients' experiences of shared decision-making in nursing care: A qualitative study. J Clin Nurs 2024; 33:2274-2286. [PMID: 38284506 DOI: 10.1111/jocn.17032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 12/17/2023] [Accepted: 01/16/2024] [Indexed: 01/30/2024]
Abstract
AIM To explore patients' experiences of shared decision-making, in nursing care during their stay in a healthcare institution. DESIGN This study employed a qualitative descriptive design. METHODS Twenty participants were interviewed from two rehabilitation centres, a nephrology ward of a hospital, and a rehabilitation ward of a long-term care facility. A constant comparative method was used for the inductive analysis. RESULTS The main theme was 'feeling seen and understood', in the context of person-centred care, which served as the unifying thread across five themes. The five themes included the importance of a positive nurse-patient relationship as a foundation for shared decision-making. Next, patients experienced collaboration, and this was influenced by verbal and non-verbal communication. Another theme was that patients often felt overwhelmed during their stay, affecting shared decision-making. The fourth theme was that many decisions were not made through the shared decision-making process but were still perceived as satisfactory. The final theme highlighted patients' perspectives on their role in decision-making and influencing factors. CONCLUSION Patients describe how feeling seen and understood is a prerequisite for shared decision-making as a part of person-centred care. For nurses, this implies that they should focus on aspects such as building a good relationship and acknowledgement of patients' feelings and circumstances, next to empowering patients to feel knowledgeable and valued. This way patient's motivation to participate in shared decision-making will be enhanced. REPORTING METHOD Following the EQUATOR guidelines, reporting was guided by the Consolidated Criteria for Reporting Qualitative Research (COREQ). PATIENT OR PUBLIC CONTRIBUTION Patients were involved in the study through interviews during the research process and member checks during analysis. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE Before initiating shared decision-making processes, prioritise making the patient feel seen and understood. Be mindful that patients often feel overwhelmed during their stay. Use a person-centred approach to make patients feel knowledgeable-this empowers them for shared decision-making. IMPACT Research on patients' experiences of shared decision-making in nursing care is limited, yet crucial for understanding patients' needs in shared decision-making. This study highlights patients' perceptions that shared decision-making is best facilitated within the nurse-patient relationship by nurses who primarily focus on ensuring that patients feel acknowledged and understood.
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Affiliation(s)
| | | | - Heleen Reinders-Messelink
- NHL Stenden University of Applied Sciences, Leeuwarden, The Netherlands
- Rehabilitation Centre 'Revalidatie Friesland', Beetsterzwaag, The Netherlands
- Department of Rehabilitation Medicine, University Medical Center Groningen, Groningen, The Netherlands
| | - Margreet Van Der Cingel
- NHL Stenden University of Applied Sciences, Leeuwarden, The Netherlands
- Medical Centre Leeuwarden, Leeuwarden, The Netherlands
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Feng Y, Liu C, Tao S, Wang C, Zhang H, Liu X, Liu Z, Liu W, Zhao J, Zou D, Liu Z, Liu J, Wang N, Wu L, Wu Q, Hao Y, Xu W, Liang L. Developing and validating the nurse-patient relationship scale (NPRS) in China. BMC Nurs 2024; 23:255. [PMID: 38649929 PMCID: PMC11034141 DOI: 10.1186/s12912-024-01941-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 04/15/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Poor nurse-patient relationship poses an obstacle to care delivery, jeopardizing patient experience and patient care outcomes. Measuring nurse-patient relationship is challenging given its multi-dimensional nature and a lack of well-established scales. PURPOSE This study aimed to develop a multi-dimensional scale measuring nurse-patient relationship in China. METHODS A preliminary scale was constructed based on the existing literature and Delphi consultations with 12 nursing experts. The face validity of the scale was tested through a survey of 45 clinical nurses. This was followed by a validation study on 620 clinical nurses. Cronbach's α, content validity and known-group validity of the scale were assessed. The study sample was further divided into two for Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA), respectively, to assess the construct validity of the scale. RESULTS The Nurse-Patient Relationship Scale (NPRS) containing 23 items was developed and validated, measuring five dimensions: nursing behavior, nurse understanding and respect for patient, patient misunderstanding and mistrust in nurse, communication with patient, and interaction with patient. The Cronbach's α of the NPRS ranged from 0.725 to 0.932, indicating high internal consistency. The CFA showed excellent fitness of data into the five-factor structure: χ2/df = 2.431, GFI = 0.933, TLI = 0.923, CFI = 0.939, IFI = 0.923, RMSEA = 0.070. Good content and construct validity are demonstrated through expert consensus and psychometric tests. CONCLUSION The NPRS is a valid tool measuring nurse-patient relationship in China.
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Affiliation(s)
- Yajie Feng
- School of Health Administration, Harbin Medical University, Harbin, China
| | - Chaojie Liu
- Department of Public Health, School of Psychology and Public Health, La Trobe University, 3086, Melbourne, VIC, Australia
| | - Siyi Tao
- School of Health Administration, Harbin Medical University, Harbin, China
- Anhui Medical University, No.1166, Wangjiang West Road, Shushan District, Hefei, Anhui, China
| | - Chen Wang
- School of Health Administration, Harbin Medical University, Harbin, China
- Xinqiao Hospital, Third Military Medical University (Army Medical University, 400037, Chongqing, China
| | - Huanyu Zhang
- School of Health Administration, Harbin Medical University, Harbin, China
| | - Xinru Liu
- School of Health Administration, Harbin Medical University, Harbin, China
| | - Zhaoyue Liu
- School of Health Administration, Harbin Medical University, Harbin, China
| | - Wei Liu
- School of Health Administration, Harbin Medical University, Harbin, China
| | - Juan Zhao
- School of Health Administration, Harbin Medical University, Harbin, China
- Southwest Hospital, Third Military Medical University (Army Medical University, 400000, Chongqing, China
| | - Dandan Zou
- School of Health Administration, Harbin Medical University, Harbin, China
- Jin Shan Hospital of Fudan University, 201508, Shanghai, China
| | - Zhixin Liu
- School of Health Administration, Harbin Medical University, Harbin, China
- Department of Health Policy and Management, School of Public Health, Peking University, 100191, Beijing, China
| | - Junping Liu
- School of Health Administration, Harbin Medical University, Harbin, China
| | - Nan Wang
- School of Health Administration, Harbin Medical University, Harbin, China
| | - Lin Wu
- School of Health Administration, Harbin Medical University, Harbin, China
| | - Qunhong Wu
- School of Health Administration, Harbin Medical University, Harbin, China
| | - Yanhua Hao
- School of Health Administration, Harbin Medical University, Harbin, China.
| | - Weilan Xu
- Qiqihar Medical College, Qiqihar, China.
| | - Libo Liang
- School of Health Administration, Harbin Medical University, Harbin, China.
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Pokharel S, Khawaja Z, Williams J, Mithwani AA, Strain K, Khanna P, Rychtera A, Kiryanova V, Tang K, Mathura P, Hylton C, Ambasta A. Patient perceptions of in-hospital laboratory blood testing: A patient-oriented and patient co-designed qualitative study. Health Expect 2024; 27:e13880. [PMID: 37751312 PMCID: PMC10726148 DOI: 10.1111/hex.13880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 08/25/2023] [Accepted: 09/14/2023] [Indexed: 09/28/2023] Open
Abstract
BACKGROUND Indiscriminate use of laboratory blood testing in hospitals contributes to patient discomfort and healthcare waste. Patient engagement in low-value healthcare can help reduce overuse. Understanding patient experience is necessary to identify opportunities to improve patient engagement with in-hospital laboratory testing. OBJECTIVES To understand patient experience with the process of in-hospital laboratory blood testing. METHODS We used a qualitative study design via semistructured interviews conducted online or over the phone. Participants were adult patients or family members/caregivers (≥18 years of age) with a recent (within 12 months of interview) experience of hospitalization in Alberta or British Columbia, Canada. We identified participants through convenience sampling and conducted interviews between May 2021 and June 2022. We analysed transcripts using thematic content analysis. Recruitment was continued until code saturation was reached. RESULTS We interviewed 16 participants (13 patients, 1 family member and 2 caregivers). We identified four themes from patients' experiences of in-hospital laboratory blood testing: (i) patients need information from healthcare teams about expected blood testing processes, (ii) blood draw processes should consider patient comfort and preferences, (iii) patients want information from their healthcare teams about the rationale and frequency of blood testing and (iv) patients need information on how their testing results affect their medical care. CONCLUSION Current laboratory testing processes in hospitals do not facilitate shared decision-making and patient engagement. Patient engagement with laboratory testing in hospitals requires an empathetic healthcare team that provides clear communication regarding testing procedures, rationale and results, while considering patient preferences and offering opportunities for involvement. PATIENT OR PUBLIC CONTRIBUTION We interviewed 16 patients and/or family members/caregivers regarding their in-hospital laboratory blood testing experiences. Our findings show correlations between patient needs and patient recommendations to make testing processes more patient-centred. To bring a lived-experience lens to this study, we formed a Patient Advisory Council with 9-11 patient research partners. Our patient research partners informed the research design, co-developed participant recruitment strategies, co-conducted data collection and informed the data analysis. Some of our patient research partners are co-authors of this manuscript.
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Affiliation(s)
- Surakshya Pokharel
- Ward of the 21st Century, Calgary Zone of Alberta Health ServicesUniversity of CalgaryCalgaryCanada
- Department of Medicine, Cumming School of MedicineUniversity of CalgaryCalgaryCanada
| | - Zoha Khawaja
- Ward of the 21st Century, Calgary Zone of Alberta Health ServicesUniversity of CalgaryCalgaryCanada
- Department of Medicine, Cumming School of MedicineUniversity of CalgaryCalgaryCanada
| | - Jonathan Williams
- Department of Medicine, Cumming School of MedicineUniversity of CalgaryCalgaryCanada
| | - Adnan Adil Mithwani
- Department of Medicine, Cumming School of MedicineUniversity of CalgaryCalgaryCanada
| | - Kimberly Strain
- Strategy for Patient Oriented Research (SPOR) Support UnitCalgaryAlbertaCanada
| | - Prachi Khanna
- Department of Biology, Faculty of ScienceUniversity of British ColumbiaVancouverCanada
| | - Anna Rychtera
- Strategy for Patient Oriented Research (SPOR) Support UnitVancouverBritish ColumbiaCanada
- Michael Smith Health ResearchVancouverBritish ColumbiaCanada
| | - Veronika Kiryanova
- Department of Medicine, Cumming School of MedicineUniversity of CalgaryCalgaryCanada
| | - Karen Tang
- Department of Medicine, Cumming School of MedicineUniversity of CalgaryCalgaryCanada
- O'Brien Institute of Public Health, Cumming School of MedicineUniversity of CalgaryCalgaryCanada
| | - Pamela Mathura
- Department of MedicineUniversity of AlbertaEdmontonCanada
| | - Chris Hylton
- Graduate StudiesLaval UniversityQuebec CityCanada
| | - Anshula Ambasta
- Department of Medicine, Cumming School of MedicineUniversity of CalgaryCalgaryCanada
- Department of Anesthesia, Pharmacology and Therapeutics, Therapeutics InitiativeUniversity of British ColumbiaVancouverCanada
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Zagt AC, Bos N, Bakker M, de Boer D, Friele RD, de Jong JD. A scoping review into the explanations for differences in the degrees of shared decision making experienced by patients. PATIENT EDUCATION AND COUNSELING 2024; 118:108030. [PMID: 37897867 DOI: 10.1016/j.pec.2023.108030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 09/29/2023] [Accepted: 10/16/2023] [Indexed: 10/30/2023]
Abstract
OBJECTIVES In order to improve the degree of shared decision making (SDM) experienced by patients, it is necessary to gain insight into the explanations for the differences in these degrees. METHODS A scoping review of the literature on the explanations for differences in the degree of SDM experienced by patients was conducted. We assessed 21,329 references. Ultimately, 308 studies were included. The explanations were divided into micro, meso, and macro levels. RESULTS The explanations are mainly related to the micro level. They include explanations related to the patient and healthcare professionals, the relationship between the patient and the physician, and the involvement of the patient's relatives. On the macro level, explanations are related to restrictions within the healthcare system such as time constraints, and adequate information about treatment options. On the meso level, explanations are related to the continuity of care and the involvement of other healthcare professionals. CONCLUSIONS SDM is not an isolated process between the physician and patient. Explanations are connected to the macro, meso, and micro levels. PRACTICE IMPLICATIONS This scoping review suggests that there could be more focus on explanations related to the macro and meso levels, and on how explanations at different levels are interrelated.
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Affiliation(s)
- Anne C Zagt
- Nivel, the Netherlands Institute for Health Services Research, PO Box 1568, 3500 BN Utrecht, the Netherlands.
| | - Nanne Bos
- Nivel, the Netherlands Institute for Health Services Research, PO Box 1568, 3500 BN Utrecht, the Netherlands
| | - Max Bakker
- Nivel, the Netherlands Institute for Health Services Research, PO Box 1568, 3500 BN Utrecht, the Netherlands
| | - Dolf de Boer
- Nivel, the Netherlands Institute for Health Services Research, PO Box 1568, 3500 BN Utrecht, the Netherlands
| | - Roland D Friele
- Nivel, the Netherlands Institute for Health Services Research, PO Box 1568, 3500 BN Utrecht, the Netherlands; Tranzo Scientifc Center for Care and Wellbeing, Tilburg University, PO Box 90153, 5000 LE Tilburg, the Netherlands
| | - Judith D de Jong
- Nivel, the Netherlands Institute for Health Services Research, PO Box 1568, 3500 BN Utrecht, the Netherlands; CAPHRI, Maastricht University, PO Box 616, 6200 MD Maastricht, the Netherlands
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Foote L. Intentional non-adherence in the context of antiretroviral therapy. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2023; 32:S4-S9. [PMID: 36626262 DOI: 10.12968/bjon.2023.32.1.s4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Adherence to antiretroviral therapy (ART) is a crucial determinant of treatment success in HIV. This article seeks to look closely at intentional non-adherence and why some patients choose to opt out of life-sustaining treatment. There is a range of reasons why patients intentionally stop taking their ART and the author take a more detailed look at some of those reasons, specifically religion, the need for control and social isolation. Case studies are included throughout the discussion to give more depth and increase understanding. The author goes to explore strategies that can be employed to help nurses in their response, as health professionals, to support patients and deliver high-quality and non-judgemental care.
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Affiliation(s)
- Liz Foote
- Clinical Services Manager, Sussex Community NHS Foundation Trust
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Tobiano G, Jerofke‐Owen T, Marshall AP. Promoting patient engagement: a scoping review of actions that align with the interactive care model. Scand J Caring Sci 2020; 35:722-741. [DOI: 10.1111/scs.12914] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 06/22/2020] [Accepted: 09/07/2020] [Indexed: 12/18/2022]
Affiliation(s)
- Georgia Tobiano
- Nursing and Midwifery Education and Research Unit Gold Coast Health Southport Qld Australia
- Menzies Health Institute Queensland Griffith University Southport Qld Australia
| | | | - Andrea P. Marshall
- Nursing and Midwifery Education and Research Unit Gold Coast Health Southport Qld Australia
- Menzies Health Institute Queensland Griffith University Southport Qld Australia
- School of Nursing and Midwifery, Griffith University Southport Qld Australia
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Molina-Mula J, Gallo-Estrada J. Impact of Nurse-Patient Relationship on Quality of Care and Patient Autonomy in Decision-Making. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17030835. [PMID: 32013108 PMCID: PMC7036952 DOI: 10.3390/ijerph17030835] [Citation(s) in RCA: 116] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Revised: 01/25/2020] [Accepted: 01/26/2020] [Indexed: 02/05/2023]
Abstract
BACKGROUND The patient is observed to acquire a passive role and the nurse an expert role with a maternalistic attitude. This relationship among others determines the capacity for autonomy in the decision making of patients. OBJECTIVES The aim of this study is to analyse the nurse-patient relationship and explore their implications for clinical practice, the impact on quality of care, and the decision-making capacity of patients. DESIGN A phenomenological qualitative study was conducted. SETTINGS AND PARTICIPANTS Thirteen in-depth interviews with nurses and 61,484 nursing records from internal medicine and specialties departments in a general hospital from 2015-2016. METHODS A discourse analysis and triangulation for these sources were conducted. RESULTS The category elaborated from nursing records was defined according to the following codes: Good Patient, Bad patient, and Social Problem. Analysis of the interviews resulted in a category defined as Patient as a passive object. DISCUSSION A good nurse-patient relationship reduces the days of hospital stay and improves the quality and satisfaction of both. However, in contrast, the good relationship is conditioned by the patient's submissive role. CONCLUSION An equal distribution of power allows decisions about health and disease processes to be acquired by patients, autonomously, with the advice of professionals. The nurse-patient relationship should not pursue the change in values and customs of the patient, but position the professional as a witness of the experience of the health and illness process in the patient and family.
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Hendricks-Ferguson VL, Ruebling I, Sargeant DM, Kienstra K, Eliot KA, Howell TG, Sebelski CA, Moore KS, Armstrong K. Undergraduate students' perspectives of healthcare professionals' use of shared decision-making skills. J Interprof Care 2018. [PMID: 29513119 DOI: 10.1080/13561820.2018.1443912] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Essential for future healthcare professionals (HCPs) to delivering ethical and empathetic patient-centred care (PCC) as a team is the understanding of appropriate shared decision-making (SDM) responses when facilitating discussions with patients and family members. The purpose of this study was to evaluate undergraduate students' perspectives about HCPs' use of SDM as described in a case-study reflection assignment. An exploratory qualitative approach was used to analyse student-reflection assignments. The sample included 42 undergraduate students enrolled in an interprofessional education (IPE) course at a Midwest university based in the United States. Data consisted of student responses in a course reflection assignment that captured their perspectives about recommended SDM responses by HCPs. Student assignments were randomly selected using stratified sampling to provide representation of eight HCP roles. Analysis revealed two themes related to students' use of SDM responses. Results provide evidence supporting the tenet that through IPE, healthcare students can develop an understanding of SDM and ethical principles related to PCC.
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Affiliation(s)
| | - Irma Ruebling
- Department of Physical Therapy and Athletic Training, Saint Louis University, St. Louis, MO, USA
| | - Darina M Sargeant
- Department of Physical Therapy and Athletic Training, Saint Louis University, St. Louis, MO, USA
| | - Kathleen Kienstra
- Department of Medical Imaging and Radiation Therapeutics, Saint Louis University, St. Louis, MO, USA
| | - Kathrin A Eliot
- Department of Nutrition and Dietetics, Saint Louis University, St. Louis, MO, USA
| | - Timothy G Howell
- Department of Physical Therapy and Athletic Training, Saint Louis University, St. Louis, MO, USA
| | - Chris A Sebelski
- Department of Physical Therapy and Athletic Training, Saint Louis University, St. Louis, MO, USA
| | - Karen S Moore
- School of Nursing, Saint Louis University, St. Louis, MO, USA
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Truglio-Londrigan M, Slyer JT. Shared Decision-Making for Nursing Practice: An Integrative Review. Open Nurs J 2018; 12:1-14. [PMID: 29456779 PMCID: PMC5806202 DOI: 10.2174/1874434601812010001] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Revised: 12/16/2017] [Accepted: 12/25/2017] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Shared decision-making has received national and international interest by providers, educators, researchers, and policy makers. The literature on shared decision-making is extensive, dealing with the individual components of shared decision-making rather than a comprehensive process. This view of shared decision-making leaves healthcare providers to wonder how to integrate shared decision-making into practice. OBJECTIVE To understand shared decision-making as a comprehensive process from the perspective of the patient and provider in all healthcare settings. METHODS An integrative review was conducted applying a systematic approach involving a literature search, data evaluation, and data analysis. The search included articles from PubMed, CINAHL, the Cochrane Central Register of Controlled Trials, and PsycINFO from 1970 through 2016. Articles included quantitative experimental and non-experimental designs, qualitative, and theoretical articles about shared decision-making between all healthcare providers and patients in all healthcare settings. RESULTS Fifty-two papers were included in this integrative review. Three categories emerged from the synthesis: (a) communication/ relationship building; (b) working towards a shared decision; and (c) action for shared decision-making. Each major theme contained sub-themes represented in the proposed visual representation for shared decision-making. CONCLUSION A comprehensive understanding of shared decision-making between the nurse and the patient was identified. A visual representation offers a guide that depicts shared decision-making as a process taking place during a healthcare encounter with implications for the continuation of shared decisions over time offering patients an opportunity to return to the nurse for reconsiderations of past shared decisions.
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Affiliation(s)
- Marie Truglio-Londrigan
- Pace University, College of Health Professions, Lienhard School of Nursing 861 Bedford Road Pleasantville, NY 10570, USA
| | - Jason T. Slyer
- Clinical Assistant Professor, Pace University, College of Health Professions, Lienhard School of Nursing 163 William Street, 5 Floor New York, NY 10036, USA
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