Undergraduate nursing students supporting patients with difficult health decisions: a theory-informed learning...

There are few opportunities in undergraduate nursing curriculum for students to acquire knowledge and skills in shared decision-making (SDM). Through a learning assignment based on the Ottawa decision support framework (ODSF), we aimed to explore how undergraduate nursing students understand and participate in SDM in their clinical placements.

A descriptive analysis of a theory-informed undergraduate nursing learning assignment was conducted. Upon completion of the Ottawa Decision Support Tutorial, undergraduate nursing students wrote a reflective note about a clinical placement experience in which they were involved with a patient facing a difficult healthcare decision. We inductively analyzed these written reflections to identify decisional needs, interventions, and outcomes that were mapped onto the ODSF. We used content analysis to synthesize barriers and facilitators influencing nursing students' involvement in SDM.

Analysis of 34 reflective notes from 34 nursing students showed that they typically were involved in difficult medical, surgical, and end-of-life decisions. Frequently identified decisional needs included complex decisional characteristics (n=26; 76 %) and inadequate knowledge (n=23; 68 %). Patient decision aids were the most cited intervention (n=27; 79 %). Quality decisions were conceptualized as values-based and/or informed. Factors influencing nursing student participation in SDM were identified at the level of the student nurse, patient/family, environment, and SDM intervention.

A theory-based learning assignment permitted undergraduate nursing students to identify difficult health decisions faced by their patients and engage with key SDM concepts. A focus on decision support in undergraduate nursing curriculum can sensitize nursing students to recognize and engage in SDM. As healthcare becomes increasingly globalized, nurses need the skills to adapt SDM to diverse cultural and social contexts to support patient involvement and high-quality, person-centred care across diverse healthcare systems.