Nursing Practices of Certified Nurses in Intensive Care and their Perceptions of Factors Facilitating and Impeding Shared Decision Making

Abstract

Objective: The state of nursing practice is unclear for shared decision making (SDM) with family members and other proxies who make treatment choices on behalf of acutely critically ill patients unable to make decisions. Also unclear are nurses’ perceptions of factors that support or obstruct SDM. The objectives of this study were to determine the actual state of nursing practice regarding SDM and perceptions of its supportive or obstructive factors in the intensive care area in Japan.

Methods: A survey was conducted by mailing questionnaires to certified intensive and critical care nurses nationwide. Data were collected from nursing practice items for SDM based on individual and departmental characteristics and previous findings. Descriptive responses were obtained regarding factors that support or obstruct nursing practice for SDM.

Results: Analysis of the responses of 259 participants (response rate, 24.5%) showed that the awareness of nursing practice for SDM was increased by a high awareness of the interprofessional joint items of the departmental characteristics “support from management” and “securing time for SDM.” Factors that support or obstruct nursing practice for SDM were the knowledge and skills of health care providers, family relationships, and the readiness of family members and other proxies for decision making.

Conclusion: The findings of this study suggest that multidisciplinary education, SDM awareness-raising activities, and information sharing systems should be established to enhance the nursing practice SDM. Furthermore, support from certified/specialist nurses and managers as role models is required for the experiences and competence of nurses which affect their perception of team medicine.