THE INFLUENCE OF THE PRACTICE ENVIRONMENT ON SHARING DECISION MAKING BETWEEN OLDER PERSONS AND NURSES IN RESIDENTIAL AGED CARE: AN AUSTRALIAN PERSON-CENTRED STUDY

Abstract

Background: 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.