Exploring SDM in HIV nursing care
withHIVas well as long-term chronic diseases, we have to avoid hospital admissions ­
so you find that in a way, this is at the back of your mind. You know what is best for the
person and you really would like them to avoid being an inpatient and interrupting a lot
of other things in their life.'(Nurse2,FocusGroup3)
Participantsnotedthatallfourrolefunctionswerecruciallydependentonbeingabletodevelop
trustingrelationshipswiththeirpatients,sothatpatientswouldrecognisetheirexpertise,fol owtheir
adviceandfeelabletoexpresstheirviewsandconcerns:
`What helps is when you trust that person and it is like ... if they see a doctor, but
then they come away and then talk to us and we have a different relationship with
the patient so we can like validate that this doctor's opinion is a good opinion, it is
then ... I think people feel like they are making more of an informed decision about it.
That trusting relationship ... you know, you can't put a price on that because, you know,
'cause they'll actually open up and share things that they may not with someone else.'
(Nurse1,FocusGroup4)
Insum,theroleofthenurseinSDMwashighlyvaried.Insomecases,nursessoughttopromote
SDMbyactingasadvocateforpatients.Inothersituations,thenurses'roleinSDMwasmore
ambiguous,particularlywherenurses(asinformationgivers,expertsandpromotersofhealth)felt
thattheoptimalcourseofactionwasclear.
Theme 3: proficiencies for SDM
Generally,nursesfeltthatSDMwassomethingthatcouldnotbetaughtbutthatdevelopedwith
experience over time. A range of attributes and skil s was identified that could facilitate SDM
(describedbelow);however,participantsnotedthatknowledgewasakeyunderpinningrequirement
forthesetobeputintopractice.Knowledgewasseenasessentialintermsofprovidingaccurate
informationtopatients,butalsointermsofbeingabletopresentcareandtreatmentoptionsinan
individualisedway:
`I think you've got to start from the point of view of knowledge, so, you have to understand,
every decision that that patient makes, what's the impact on their care? And you've got
be able to explain to them what that impact is, negative or positive ... otherwise, they
can't make informed choices. So you've got to have that strong confident knowledge.'
(Nurse2,FocusGroup1)
In terms of attributes, nurses noted that SDM required them to be flexible, perceptive, non-
judgemental and understanding. These attributes were col ectively referred to as `intuition' ­
an ability to read between the lines, to assess non-verbal behaviour and to discern a clearer
understandingofwhatapatientmaybefeeling:
`I think using your senses, all of your senses is quite important because sometimes what
is coming out of a patient's mouth isn't often what they are feeling or they are thinking
and by looking at them and listening to them, and sometimes touching them you can tell
that actually that isn't the route that they want to go down, that isn't really what they're
feeling is their decision and I think using all of those skills eventually leads to quite good
intuition and I think that often when professionals follow their intuition it is often the right
thing for the patient.'(Nurse4,FocusGroup4)
2016
Nurses'holisticperspectivewasalsomentionedasessentialinfacilitatingSDM:
`I think from a nursing point of view it is looking at the whole person. Looking at al
elements as well. That is a big skill actually isn't it?'(Nurse2,FocusGroup2)
Withinallthefocusgroups,participantswereunanimousthatthekeyskillrequiredforSDMwas
communication. In particular, participants identified listening as an essential skil for delivering
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