Exploring SDM in HIV nursing care
patient-centredcare.Inaddition,itwasimportanttocheckthatpatientshadunderstoodthenurse
byreflectingbackonthepatient'sfeelings.
`So definitely ­ extended communication. Understanding the patient, understanding
their ability to comprehend so the nurse has to be skilled in listening, skilled in reading,
knowledgeable and also know when they're not making headway. It's the usual, the open
questions, the you know, the reflecting back on the patients feelings, the listening skil s ...
trying to understand um, the historical perspective for some patients as to their attitudes
towards tablets in the first place. What it means to them. So it is the more advanced
counselling skills.'(Nurse1,FocusGroup1)
Motivationalinterviewingwasraisedineachofthefocusgroupsasanimportantcommunication
technique.Nurseshighlighteditsperceivedpotentialtoimprovethedeliveryofcommunicationand
careinHIVtreatment:
`I think also, again I don't know about the rest of you, but maybe using a bit of motivational
interviewing, just to see where patients are situated with that particular decision at the
time. I've found that useful.'(Nurse5,FocusGroup2)
However,althoughmanyparticipantsfeltthatmotivationalinterviewingwasanessentialskil to
have,severalnotedthattheythemselvesdidnotfeelconfidentinusingit:
`I would love to have training in motivational interviewing. I think it would be beneficial
for all of our team to have it, I know some people have but, you know, it is only just bits I
have picked up, whatever you know, but I think it would be good for nurses to get trained
in that.'(Nurse4,FocusGroup2)
Insum,participantsnotedthatacombinationofnursingknowledge,interpersonalattributesand
communicationskillswasrequiredtopractiseSDM.
Challenges in SDM
TherewasmuchdiscussioninthegroupsaboutthedifficultiesoftryingtoaccomplishSDMin
practice.Fourmainchallengeswereidentifiedbytheparticipants:patientfactors,socialfactors,
organisationalfactorsandhealthsystemfactors.
Intermsofpatientfactors,participantsnotedthat,withsomepatientgroups,languagebarriers
posedchallengesforSDM,bothintermsoflengtheningthetimerequiredwithinaconsultationand
alsothechallengeofworkingwithtranslators:
`Understanding yeah, again, it's when you use interpreters and when you don't, um,
interpreters are not ideal, um, the emotional stuff is almost impossible sometimes, um
and I had one lady, she, doesn't think there's a communication problem. She thinks that
I understand her perfectly and she understands me so why do I need an interpreter?
When I know that she's missing a whole lot and I know that I'm struggling to completely
understand everything that she's saying.'(Nurse2,FocusGroup1)
Participantstalkedatlengthaboutpatientswhowere`complex'orwhohadcomplexneeds.These
wereoftenrelatedtodrugandalcoholproblems,mentalhealthproblems,socialproblems(e.g.
homelessnessorpoverty)ormedicalproblems(e.g.multipleco-morbidities).Nursesnotedthat
SDMcouldbemoredifficultwithsuch`complex'patients.Forexample,insomecases,assessing
apatient'scapacitytomakedecisionscouldbedifficult,especial yinsituationswhereapatienthad
optedoutoftreatment,ceasedtreatmentorchosennottoengageincare:
2016
`If someone is an intravenous drug user or ex-intravenous drug user, already has nowhere
to live, chaotic lifestyle, there are problems associated with that and different kind of
resources needed to associate and support that person in their decision making and
also we don't even know the capacity at the time when they are speaking with you, their
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