The role of hospital nurses in shared decision‐making about life‐prolonging treatment: A qualitative interview study

다국어 초록 (Multilingual Abstract)

To examine hospital nurses’ perception of their actual and potential contribution to shared decision‐making about life‐prolonging treatment and their perception of the pre‐conditions for such a contribution.
A qualitative interview study.
Semi‐structured face‐to‐face interviews were conducted with 18 hospital nurses who were involved in care for patients with life‐threatening illnesses. Data were collected from October 2018‐January 2019. The interviews were recorded, transcribed verbatim and analysed using thematic analysis by two researchers.
Nurses experienced varying degrees of influence on decision‐making about life‐prolonging treatment. Besides, we identified different points of contact in the treatment trajectory at which nurses could be involved in treatment decision‐making. Nurses’ descriptions of behaviours that potentially contribute to shared decision‐making were classified into three roles as follows: checking the quality of a decision, complementing shared decision‐making and facilitating shared decision‐making. Pre‐conditions for fulfilling the roles identified in this study were: (a) the transfer of information among nurses and between nurses and other healthcare professionals; (b) a culture where there is a positive attitude to nurses' involvement in decision‐making; (c) a good relationship with physicians; (d) knowledge and skills; (e) sufficient time; and (f) a good relationship with patients.
Nurses described behaviour that reflected a supporting role in shared decision‐making about patients’ life‐prolonging treatment, although not all nurses experienced this involvement as such. Nurses can enhance the shared decision‐making process by checking the decision quality and by complementing and facilitating shared decision‐making.
Nurses are increasingly considered instrumental in the shared decision‐making process. To facilitate their contribution, future research should focus on the possible impact of nurses’ involvement in treatment decision‐making and on evidence‐based training to raise awareness and offer guidance for nurses on how to adopt this role.
研究医院护士对延长生命治疗共同决策的实际贡献和潜在贡献的认识,以及对此类贡献前提条件的认识。
定性访谈研究。
对18名医院护士进行半结构化的面对面访谈,这些护士均参与了患有命危疾病患者的护理工作。收集2018年10月至2019年1月之间的数据。两名研究员对访谈内容进行录制、逐字转录和主题分析。
护士对延长生命治疗决策有着不同程度的影响作用。此外,我们确定了护士在治疗过程中可以参与治疗决策的不同接触点。护士对可能促进共同决策行为的可描述为以下三个角色:检查决策质量、对共同决策进行补充和促进共同决策。履行本研究中确定角色作用的先决条件是:(a)护士之间以及护士和其他保健专业人员之间的信息传递;(b)对护士参与决策持积极态度的文化;(c)与医生的良好关系;(d)知识和技能;(e)充裕的时间;以及(f)与患者的良好关系。
护士会说明能反映对患者延长生命治疗共同决策中起到支持作用的行为,尽管并非所有护士都会经历此类参与过程。护士可以通过检查决策质量、补充和促进共同决策来增强在共同决策过程中的作用。
护士在共同决策过程中的作用越来越大。为促进他们的贡献,未来的研究应侧重于护士参与治疗决策的影响可能性,以及循证培训,以提高他们对于其如何发挥这一作用的认识并提供相关指导。