目的:探讨患者和社区护士对家庭共同决策的看法和经验。
方法:综合综述。
方法:CINAHL,英国护理指数,Psycinfo,Medline和社会服务摘要进行了定性搜索,2001年12月1日至2023年10月31日发表的定量和混合方法论文。
方法:使用定义的纳入标准对电子数据库进行系统搜索。使用JoannaBriggs研究所关键评估清单对所包含的论文进行了质量评估,以进行定性研究。提取相关数据并进行主题分析。
结果:包括13项研究的14篇论文。患者非常重视参与决策的权利,并注意到自己作为独特个体的价值。病人和护士之间的沟通和信任被认为是基本的。然而,在实践中,共享决策并不总是发生。护士描述了管理患者参与决策的紧张关系。
结论:研究结果表明,尽管患者和社区护士喜欢参与家庭内部的共同决策,实现协作过程存在障碍。当对正在做出的决定有根本不同的观点时,这一点尤其重要。需要更多的研究来进一步了解共享决策在实践中如何发挥作用,并了解患者和护士可能经历的紧张关系。
■本文认为,共同决策不仅仅是发展一种关系,在这种关系中,患者可以表达自己的观点(当然,这很重要)。共享决策需要承认患者有权获得完整信息,并且应有权在选项之间进行选择。护士不应该认为社区护理中的共同决策很容易促进,并且应该认识到当真正的患者选择成为可能时可能存在的紧张关系。
结论:本文展示了如何根据日常实践探索共同决策的想法,以便克服挑战和障碍。特别是,当病人和护士观点不一致时出现的紧张关系。本文谈到了理论上围绕共享决策的差距的潜力,以及在实践中如何发挥作用。
■本综述的报告以2020年系统评价和荟萃分析首选报告项目指南为指导(Page等。,2021)。
■这项审查是作为一项更广泛的研究的一部分进行的,该研究已向服务用户进行了咨询。
OBJECTIVE: To explore patients\' and community nurses\' perceptions and experiences of shared decision-making in the home.
METHODS: Integrative review.
METHODS: CINAHL, British Nursing Index, Psycinfo, Medline and Social Services Abstracts were searched for qualitative, quantitative and mixed methods papers published between 1 December 2001 and 31 October 2023.
METHODS: A systematic search of electronic databases was undertaken using defined inclusion criteria. The included papers were appraised for quality using the Joanna Briggs Institute critical appraisal checklist for qualitative research. Relevant data were extracted and thematically analysed.
RESULTS: Fourteen papers comprising 13 research studies were included. Patients attached great importance to their right to be involved in decision-making and noted feeling valued as a unique individual. Communication and trust between the patient and nurse were perceived as fundamental. However, shared decision-making does not always occur in practice. Nurses described tension in managing patients\' involvement in decision-making.
CONCLUSIONS: The findings demonstrate that although patients and community nurses appreciate participating in shared decision-making within the home, there are obstacles to achieving a collaborative process. This is especially relevant when there are fundamentally different perspectives on the decision being made. More research is needed to gain further understanding of how shared decision-making plays out in practice and to understand the tensions that patients and nurses may experience.
UNASSIGNED: This paper argues that shared decision-making is more than the development of a relationship where the patient can express their views (though of course, this is important). Shared decision-making requires acknowledgement that the patient has the right to full information and should be empowered to choose between options. Nurses should not assume that shared decision-making in community nursing is easy to facilitate and should recognize the tensions that might exist when true patient choice is enabled.
CONCLUSIONS: This paper demonstrates how the idea of shared decision-making needs to be explored in the light of everyday practice so that challenges and barriers can be overcome. In particular, the tensions that arise when patients and nurses do not share the same perspective. This paper speaks to the potential of a gap surrounding shared decision-making in theory and how it plays out in practice.
UNASSIGNED: The reporting of this review was guided by the 2020 guidelines for the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (Page et al., 2021).
UNASSIGNED: This review was carried out as part of a wider study for which service users have been consulted.