To provide quality and person-centred care, engaging the patients throughout the decision-making process is essential. Healthcare providers should involve patients when making decisions regarding their management (McCance et al., 2021). The rationale is that clients have the requisite expertise and can contribute to enhancing their quality of life (Goossens et al., 2020). Although shared-decision making presents with ethical challenges due to patients’ autonomy and non-professionalism it is vital in enhancing quality of care and co-productivity.
The concept of participatory though decision-making has been developed through different theoretical models and policies. Historically, a generalized model of shared decision-making has been used in interactions with clients (Hargraves et al., 2020). The framework prepares the nurses on the pros and cons of involving the clients in the decision-making process. The generalized model has been criticized for manipulating people and using token participation in legitimizing decisions (Hargraves et al., 2020). However, some scholars such as Lundy (2018) believe that tokenism is an enabler as it allows the representation of children even when they are not directly involved in the decision-making process. The implication is that there is no meaningfulness due to the inequality between the nurse and the patient during the discussion and choices. One of the contemporary approaches is the Tree of Participation (Bell and Reed, 2021). The model engages participants based on their level of insight about their conditions. The decision is cumulative such that they influence the course of the care program.
Traditionally, hospital approaches such as the teach-back method ensure that patients understand the situation before they are asked for an opinion. Recently, different policy interventions, including mandatory training of nurses, evidence-based practice, and public participation approach through opinion boxes, have been used to engage clients in decision-making (Nolte et al., 2020; Boland et al., 2019). The approaches are effective enablers in enhancing shared-decision making because they empower the nurses and their patients to learn how to work together to improve care (Gazit and Perry-Hazan, 2020; Truglio-Londrigan et al., 2018). They need to understand the aspects of the decision-making process that can be shared with patients and those of the nurses (Thomas et al., 2020; Lu et al., 2019). The patient can only have autonomy of decision if they are adults of sound mind and have been all the necessary information.
However, parity of involvement may present a significant barrier in some instances. For example, patients with mental health conditions, children, and those in intensive care may not be in a position to take an active and equal part in making choices. In one study done in Malta, findings show that failure to use a patient-centred approach and involve the family in assessment leads to an increased hospital stay (Abela et al., 2019). The nurse should understand when there is parity, and the patient is unable to help, and when they are relevant for providing vital information such as allergy and drug interaction.
For models and approaches of shared decision-making to be effective, they must meet the threshold for some key components. Particularly, a systematic review by Bomhof-Roordink et al. (2019) shows that considerations should be made on the patient’s preferences, level of awareness, deliberations, and tailor-made information. The treatment should always be patient-centred, achieved through such practices as culturally sensitive care (Radbron et al., 2022; Krist et al., 2019). Notably, failure to involve patients and their family members can have dire consequences like prolonged hospital stay (Abela et al., 2019). The other practice that serves as an enabler in the shared decision-making process is coaching by the nurse (Berger-Höger et al., 2019). Conversely, barriers occur when the patient has general data that is not customized, and there are biases or misconception. Therefore, it is the responsibility of the nurse to ensure that they adopt approaches to teaching the patients.
There is no consensus on what patient carer and public involvement (PCPI) should entail. Research conducted in South Korea revealed that for the PCPI to be valid and reliable, the core prerequisite in studying care was sympathetic engagement (Kim and Tak, 2021). Nurses have a core value of ensuring that they work with patients to improve their quality of life. Notably, a strong value system is a significant enable in the management of clients through shared decision-making approaches.
However, in instances where there is a discrepancy between the values of the nurse and those of the patients, the conflict becomes a barrier to PCPI. Patient-centred approach to care demands that the nurse respects the autonomy of the patient (Van Humbeeck et al., 2020). The implication is in shared decision making, the nurse should allow the client to independently make a choice based on the available alternatives (Holland‐Hart et al., 2019). A barrier may occur in controversial health situations, such as a teenager wanting to commit an abortion which is against the values of the nurse. Resolving the ethical dilemma will be difficult for both the patient and the nurse.
Co-production approach emphasizes service providers collaborating with the citizens to improve joint health. The campaigns on public involvement in the UK started in 1970s and more strategies are being used to encourage its integration in the healthcare system (Ocloo et al., 2019). It encourages people to actively enhance policies and practices that promote care (Holland‐Hart et al., 2019). The nurses should be professional in providing accurate and verifiable information that the public can utilize in the making shared decisions (Tiainen et al., 2021). To enable co-production, the hospital should set up a straightforward design (Prendiville, 2019). For example, if it is a diabetes clinic, all the services for nutrition, exercise, pharmacotherapy, and inpatient clinics should be together.
In addition, the public should constantly be provided with avenues for participation. For example, they can be informed of fundraising activities, workshops, and annual meetings where they get up-to-date information on the healthcare projects in their regions. Having a complex system that is difficult for the public to understand acts as a barrier to co-production. According to Ocloo et al. (2019), failure to consider inclusivity and diversity can be a barrier to co-production. Therefore, it is essential to involve all people even in research so that all communities feel represented in the care paradigm.
In conclusion, the concept of shared decision is increasingly gaining popularity in healthcare organizations due to the realization that including patients in treatment enhances positive outcomes. New models, policies, and practices are now integrated to enable patients to make choices. The key facilitators include tokenism, coaching, teaching patients, and adoption of shared decision-making models. However, drawbacks are parity of involvement, ignorance, biases, and failures to consider inclusivity and diversity.
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