Exploring SDM in HIV nursing care
Table3: Qualitativestudythemes
Theme
Subthemes
InterpretationofSDM
Variedunderstandings
Variedgroupsinvolved
Variedfocus
TheroleofthenurseinSDM
Advocate
Informationgiver,teacher,translator
Expert
Healthpromoter
ProficienciesforSDM
Knowledge
Interpersonalattributes
Communicationskills
ChallengesinSDM
Patientfactors
Socialfactors
Organisationalfactors
Healthsystemfactors
Theme 1: interpretation of shared decision making
Akeythemethatemergedwasthevariedunderstandingthatindividualshadofshareddecision
making.Thereweretwokeydistinctions.ThefirstwasSDMprimarilyasaconsultative,information
givingactivity:
`[Shared decision making is] Trying to check out how they feel about what you've said,
how they feel about suggestions you've made for care. Whether they're comfortable with
that, whether they're satisfied with that. Erm, and just making sure you get their feedback
along the way really.'(Nurse2,FocusGroup1)
ThesecondwasaviewofSDMmoreintermsofpartnershipworking:
`I suppose I see it as a partnership real y, working with the patients and giving them
information to help them to make decisions, supporting them in whatever decisions they
make. So I see it more as a partnership.'(Nurse5,FocusGroup2)
Allgroups,however,agreedthatSDMwasaprocess.OtherdifferencesinperceptionsofSDM
concernedwhothedecisionmakingprocessinvolved.Forexample,insomecases,SDMwas
understoodasaprocessofdecisionmakingprimarilybetweenpractitionersandpatients,whereas
forothers,SDMwasperceivedmoreasaprocessof`sharedcare',i.e.asaprocessofdiscussion
amongstamultidisciplinaryteam(MDT)wheredecisions,outcomesandplanswerethenlaterfed
backtothepatient.SuchMDTdiscussionsweredescribedastypicallydoctor-led.
`The decision, the consultant and doctors and teams meet, medical teams decide on
what needs ... what the patient needs to have.'(Nurse2,FocusGroup3)
Another aspect of SDM concerned its focus. The majority of discussion on SDM referred to
treatmentoptionsratherthanotherelementsofHIVcare.However,someofthegroupsnotedthat
SDMcouldbeappliedtoallaspectsofcare:
2016
`Yes that is what I mean about the more holistic things isn't it? And I mean we're talking
a lot about treatment but shared decision making isn't just about treatment ... for
some people it is about how often they come to clinic, who it is they're going to see.'
(Nurse4,FocusGroup4)
www.nhivna.org
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