School of Health Sciences
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Item THE INFLUENCE OF THE PRACTICE ENVIRONMENT ON SHARING DECISION MAKING BETWEEN OLDER PERSONS AND NURSES IN RESIDENTIAL AGED CARE: AN AUSTRALIAN PERSON-CENTRED STUDY(Queen Margaret University, Edinburgh, 2025-05) Marriott-Statham, KellyBackground: With an ageing population and recent recommendations from the Australian Royal Commission into Aged Care Quality and Safety, there is a need to understand how older persons are enabled to participate in care decisions. While sharing decision making is promoted widely in healthcare, the practice environment plays a key role in shaping how these decisions are made and how older people are included in their care. Aims and Objectives: The aim of this research was to explore how the constructs of the practice environment domain within the Person-centred Practice Framework influence sharing decision making between older persons and nurses in residential aged care. Approach and Methods: Using a person-centred methodological approach, the research utilised emotional touchpoint interviews, observations of practice and practice development methods in a residential aged care facility in Australia. A creative hermeneutic analysis was used with participants to interpret how the practice environment shaped decision making. Findings: Seven components were found to influence the relational connectedness and sharing decision making between older persons and nurses: affirming personhood, reciprocal trustworthiness, time as presence, intentional way of being, negotiating relational boundaries, organisational values in action, and policies in practice. This research contributes a new perspective of sharing decision making as a relational process continuously influenced by people, processes and structures within the practice environment. Conclusions and Implications: This research highlighted the practice environment as key to how decision making occurs between older persons and nurses. To support sharing decision making processes, aged care organisations need flexible policies, power sharing structures, and workforce models that prioritise relationship building. Nurses should be supported to develop emotional intelligence and have the time to connect meaningfully. Creating conditions where older people are respected, heard and genuinely involved in care must be embedded within the elements of the practice environment.Item Sharing decision‐making between the older person and the nurse: A scoping review(2022-10-09) Marriott-Statham, Kelly; Dickson, Caroline; Hardiman, MicheleAbstract: Background: Sharing decision‐making is globally recognised as an important concept in healthcare research, policy, education and practice which enhances person‐centred care. However, it is becoming increasingly evident shared decision‐making has not been successfully translated into everyday healthcare practice. Sharing decision‐making has strong links with person‐centred practice. Core to person‐centredness and shared decision making, is the need to recognise that as we age, greater reliance is placed on emotion and life experience to inform decision making processes. With the world's ageing population, older persons facing more complex decisions and transitions of care, it is more important than ever it is understood how shared decision‐making occurs. Objectives: This scoping literature review aims to find out how sharing decision making between nurses and older persons in healthcare settings is understood and presented in published literature. Methods: This scoping review utilised the Arksey and O'Malley methodological framework, advanced by Levac et al. Electronic databases and grey literature were searched, returning 362 records which were examined against defined inclusion criteria. Reporting followed the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses extension for Scoping Reviews (PRISMA‐ScR). Results: Twenty‐two records met inclusion criteria for the review. Results indicate while shared decision‐making is included in research, education and policy literature, it has not been effectively translated to inform practice and the relationship between a nurse and an older person. The records lack definitions of shared decision‐making and theoretical or philosophical underpinnings. There is also no consideration of emotion and life experience in decision‐making and how nurses ‘do’ shared decision‐making with older persons. Conclusions: The findings demonstrate sharing decision‐making between nurses and older persons is not well understood in the literature, and therefore is not translated into nursing practice. Further research is needed.