Exploring SDM in HIV nursing care
Withintheinformation-givingrole,somenursesalsonotedthattheyactedasa`translator'inorder
tomaketherelevantinformationasaccessibleaspossible.Thisrolewasoftendescribedashaving
totranslateinformationthathadbeenprovidedtopatientsbyotherhealthprofessionals(particularly
doctors)intotermsthatapatientwouldunderstand:
`Shared means shared to me. ... the person who is having the treatment should have
some say in what is actually happening, and often ... they are not empowered or they
are not spoken to in a language that is meaningful to them. They haven't got enough
information to make a clear decision sometimes and I think often doctors ... and I am
stereotyping doctors as a big group, but they explain in doctor language and think that
they're actual y doing that, when the person comes out of the room they say "I don't
know what they are on about you know".'(Nurse2,FocusGroup4)
Conversely,anotherelementofthistranslationrolewasinhelpingdoctorstounderstandpatients'
wishes. Nurses felt wel placed to do this because of their holistic perspective and the good
understanding that they may have acquired over time about a patient's social and emotional
situation:
`But where that patient had decided to not take treatment, well in the knowledge they
will die, and that actually being the end result that they are after. That makes the doctors
feel very uncomfortable but again I think that is when the nurses come in, because the
doctors are a bit like oh they don't want care, but no that is not what they're saying.
They don't want to continue on treatment and not wanting to continue on treatment and
not wanting care are two very different things aren't they? They stil did want to be
looked after and monitored but they did not want to take tablets and they wanted to die.'
(Nurse5,FocusGroup4)
Athirdrolefunctionidentifiedparticipantsas`experts',havingaccesstospecialistknowledgeand
expertisethatgavethemaprivilegedstatusinsuggestingoptionsforpatients.
`Being able to engage patients is the heart of the process of decision making, and
number one is being an expert in the field ... to ensure that the patient has confidence
... to give them all the information required to make this, you know decision.'(Nurse1,
FocusGroup3)
Somenursesdrewcomparisonsbetweentheirworkandthatofotherexperts,forexampleacar
mechanic.Implicitinthisrepresentationwasthenotionthat,asexperts,theywerebestplacedto
adviseanoptimalcourseofactionforthepatient:
`... in shared decision making because you know it is supposed to help the patient
understand what there is to understand ­ but at the end of the day ... if I go to see a
mechanic about my car, and they say it needs a new pump and I won't say well I will just
have a look myself and check that out will I? I will say OK so what am I ... you know what
choices have I got? I haven't got a choice of ... if I want to run this car I need that new
pump so I could have the special one at £200 or I could have a slightly cheaper version,
what do you think is the difference between these two? And I wil just go yes or no
won't I?'(Nurse1,FocusGroup4)
ParticipantsidentifiedafourthaspectoftheirroleinSDMas`healthpromoter'.Withinthisrole,they
describedaprofessionalandmoraldutytofollowclinicalguidelinesandtopromotedecisionsthat
wouldyield(medicallyandeconomicallydefined)goodclinicaloutcomes.Asnotedabove,anSDM
ethossometimesconflictedwiththishealth-promoterrole,especiallywhenpatientsactedinways
2016
thatwerecontrarytoclinicalguidelinesorclinicaladvice:
`So our role as wel as looking after the general care of the patient is to encourage
them to be able to take that medication which we know works ... Then we do have the
pressures in the NHS now, I mean if you look at theStandardsofCareforPeopleLiving
www.nhivna.org
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