Exploring SDM in HIV nursing care
Participantsnotedthatwhilsttargetscouldbepositive,theyalsocreatedanimplicitpressure`within
thesystem'toguidepatientstowardsparticularHIVcarechoices,whichcouldcreatetensionsfor
anSDMapproach:
`So if you have got global goals and you are like 90/90/90 so it tells the whole world are
going to get everyone tested, everyone on treatment, every undetectable and then HIV
doesn't spread anymore, it is the miracle fulfil ed. And then we're working with individuals
in you know very personal ways and they are telling us very personal things ... but we're
also trying to meet those targets. All I am motivated to do is get you on treatment or in
a study or to come at every agreed interval. I think that is quite a challenge for nurses
... Public Health England and al the people who we report to, we are judged against
someone who fails and even by how many people in your clinic are undetectable ­ you
know ­ you feel in the middle.'(Nurse2,FocusGroup3)
Similarly, nurses noted that budgetary considerations placed constraints on patient choice of
treatmentoptions.Hence,ifpatientswantedtoswitchtheirmedicationorchoosenottooptfor
certainmedication,thiscouldbeaproblemforthenursesindeliveringSDM:
`These are the choices, but the choices are constrained by the London Consortium or
whatever deciding about you know, yes a patient can choose whether they go on or off
treatment if they want to but there are some limitations ... Also, the fact that we're using
maybe slightly different drugs you know that someone saying I want that one pill, well it
is actually well, we're not prescribing that one pill so much now we are prescribing it in
two because it is cheaper.'(Nurse1,FocusGroup3)
Inconclusion,SDMwassomethingthatnursesfelttheydidonaday-to-daybasis.Nonethe
less,theissuesraisedwithinthissectionshowthatnursesfacemultipleinterlinkedchallengesin
enactingSDMinpractice.
2016
www.nhivna.org
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