Exploring SDM in HIV nursing care
Introduction
This report presents a mixed-methods research study, exploring the views, practices and
experiencesofUKHIVnursesinrelationtoshareddecisionmaking(SDM).
Thereportispresentedintwoparts,reflectingtwodifferentphasesoftheresearch.Part1
presentstheresultsofaqualitativestudythatusedfocus-groupdiscussions(FGDs)toexploreHIV
nurses'viewsandpracticesaroundSDM.Theresultsofthisphasewerethenusedtodevelop
Part2inwhichanonlinesurveywassenttoallmembersoftheNationalHIVNursesAssociation
(NHIVNA).Thesurveysoughttoidentifyknowledge,challenges,gapsandtrainingneedsinrelation
toSDM.
Study aims and objectives
TheoverallaimoftheresearchwastoexplorecurrentviewsandpracticesamongstUKHIVnurses
regardingSDMinordertoidentifytrainingandsupportneeds.
Specificstudyobjectiveswere:
l
ToexplorewhatnursesunderstandbySDM;
l
Toexploreperceivedbarriers/facilitatorstoSDMinHIVcare;
l
ToexplorehowSDMispractisedineverydayHIVclinicalsettings;
l
To explore HIV nurses' views of current SDM resources and to identify what additional
resourcesmayberequired;
l
ToidentifyspecifictrainingneedsinrelationtoSDMinHIVcare;
l
Toestablishthemostacceptableformatforadditionallearningmaterialorskillsdevelopment
inrelationtothistopic.
Background
PeoplelivingwithHIVarerequiredtomakecomplexandmultipledecisionsaboutmanagingtheir
condition[1].Shareddecisionmaking(SDM)isincreasinglyadvocatedasthepreferredmodelfor
engagingwithpatientsinmakingchoicesabouttheircare.AcommonlyuseddefinitionforSDMis
providedbyCoulterandCollins(p.2)[2].
`Shared decision-making is a process in which clinicians and patients work together to
clarify treatment, management or self-management support goals, sharing information
about options and preferred outcomes with the aim of reaching mutual agreement on the
best course of action ... Shared decision-making explicitly recognises a patient's right
to make decisions about their care, ensuring they are fully informed about the options
they face. This involves providing them with reliable evidence-based information on the
likely benefits and harms of interventions or actions, including any uncertainties and risks,
eliciting their preferences and supporting implementation.'
SDMisembracedasakeyfeatureofrecentNHSpolicywherebypatientsshouldbeattheheartof
al aspectsofhealth-relateddecisionmaking[3].Currenthealthcarepolicyencouragesanincreased
focusonself-management;indeed,evidencesuggeststhatpoorhealthliteracycontributesto
suboptimalcare,poorerhealthoutcomesforaffectedindividualsandavoidablecostswithinhealth
systems[3,4].Assuch,thephilosophyandpracticeofSDMisconcernedwithlisteningtopatients'
2016
wishes,informingandeducatingpatientsaboutdifferentoptions,beingsensitivetopatients'needs,
andengaginginanongoingdialoguetodevelopmutual yagreedappropriatetreatmentorcare
pathways[2].
www.nhivna.org
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