Exploring SDM in HIV nursing care
TakingsuchaholisticapproachtoSDMmeantthattheprocesswasstil consideredimportanteven
whenitconcernedapatient'srefusaltoengageincare:
`... when a person actual y refuses something it is stil part of a choice, it is shared
decision making so you cannot force the patient, you have to respect their decision ...
So it is good to respect both sides. I think in decision making that the patient has the
right to say no and to say yes or to be involved in their care.'(Nurse3,FocusGroup4)
Theme 2: the nurse's role in SDM
Typical y, nurses described complex multi-faceted roles involving interactions with multiple
stakeholdersacrossmultiplesettings.Nursesidentifiedfourdifferentfunctionswithintheirroles
thatcouldsupportSDM.
Thefirstwasof`advocate',speakingforthepatientcaughtinthemidstofacomplexhealth
system.
`You're an advocate aren't you? As well, even though it's their decision, you're there to
advocate for them, so you're listening to their views so you then have to advocate for
what they want.'(Nurse1,FocusGroup1)
Wheredecisionswerebeingtakeninthepatient'sabsence(forexample,withinanMDTmeeting),
nursesattemptedtofacilitateSDMbyspeakingupforwhattheythoughtthepatientwouldwant:
`I think we make sure for our patients that we shout up loud don't we? If we're not
happy, if we think that the patient wouldn't be happy about that or they have expressed
that they're not happy about that, we are prepared to shout up loud on behalf of that
patient because they are not there at that meeting and talking about their health.'
(Nurse2,FocusGroup4)
Thesecondrolefunctionwasthatof`informationgiver'inordertoempowerpatientstomake
choices:
`... to give them the knowledge so that they can make the decision of what would
happen if you ... if you made different decisions? If you decided to go on this treatment
or that treatment or no treatment and so I think that is a big empowering ... that we
have got the information because they generally, they might not know. Like what would
happen with all the different outcomes.'(Nurse4,FocusGroup2)
Thecomplexityofinformationavailable,however,meantthatprovidinginformationwasnota
straightforwardactivitybutalsoencompassedanexplicitteachingrole,i.e.itwasanurse'sjobnot
justtoshareinformationbutalsotoensurethatthepatienthadunderstoodit:
`If you are wanting patients to make an informed decision, you are not only a nurse
you are also a teacher, you are going to teach them about how they are going to have
that knowledge to make that shared decision ... so it is very important that you be an
informed professional as well as a teacher.'(Nurse3,FocusGroup4)
Theteachingdimensionofinformationgiving,however,carriedanimplicitconnotationthatthere
wasa`right'answertoaparticularchoice.Forexample,nursesnotedthatakeypartoftheirjob
wastoachieveoptimalclinicaloutcomesfortheirpatients.Therefore,therewasanimplicitpressure
2016
tohelpsupportpatientstomakechoicesthatwouldachieve(medical ydefined)positiveoutcomes.
Nursesnotedthatwhenpatientsmadechoicesthatwerecontrarytotheprescribedcourseof
action,therewasatemptationtofeelthattheirteachinghadnotbeenadequateratherthanthat
thisoutcomemayalsobeanacceptableconsequenceofSDM.Forexample,onenursestated:
`I personal y don't think I wil ever feel I have given this person enough information if
especially if they are still deciding not to take the medication.'(Nurse2,FocusGroup3)
www.nhivna.org
page 9 of33

---