This study explored the SDM process and experiences of the clinical nursing staff and summarised the abilities that should be possessed to participate in SDM. This study found that the process of SDM is complex for clinical nursing staff. The abilities required in the process include: basic professional skills, the ability to search for and integrate empirical data, communication and response skills, respect, cultural sensitivity, the ability to form a co-operative team, and basic media editing abilities.
The scope of a clinical decision could range from relatively simple (such as general clinical treatment) to complex (such as cancer treatment); discrete (such as birth method) to continuous care management (such as formulating chronic disease treatment and care plans); and could involving multiple stakeholders (such as the professional care team and care members of the patient) [14]. The interviewees in this study all pointed out that the basic professional skills of clinical nursing staff are extremely important in the SDM process. Additionally, clinical nursing staff should understand the professional concepts related to SDM. Our results work in concert with what Friesen-Storms et al. [7] pointed out: nursing staff with the knowledge of SDM, skills, and positive attitudes can facilitate the process of SDM. Our interviewees also believed that they should first establish and be familiarised with the concept of SDM, then agree with it and be willing to implement it before conducting the SDM process. This results of this study support the results of Mathijssen et al. [15], whose study pointed out that improving the understanding of medical professionals of the concept of SDM was a crucial first step in improving SDM in clinical practice.
SDM is a framework formed when health professionals and patients co-operate to make decisions during the implementation of a series of medical procedures [16]. Good clinical communication skills of the nursing staff are the basic skills required to establish effective SDM [7]. The subjects of this study all agreed on the importance of communication and response skills to SDM. The final decision makers in the SDM are the doctor, the patient, and/or family members. However, nursing staff still account for the majority of medical care professionals [6, 7]. The interviewees indicated that sometimes the attending physician did not have much time to participate at the bedside when performing clinical SDM, which limited the implementation of SDM. The result not only works in concert with the finding of Mathijssen et al. [15], who determined that time limitation was an issue for the implementation of SDM in the clinic, but also showed the importance of the nursing staff playing the role of a communication bridge with good communication and response skills in the implementation of SDM.
The respect and cultural sensitivity of nursing staff during the process of SDM were one of the most important findings of this study. The key to the implementation of SDM is the effective participation of patients. As different patients have different backgrounds, characteristics, and value preferences, each patient may have different choices and value judgments when it comes to clinical decisions [17]. Several studies have shown that the cultural factors of the patient should be considered when performing SDM [9, 18, 19]. Patients have independent autonomic rights and informed rights, as well as the right to insist on care and choose treatment plans. Unlike other medical care measures that could directly improve uncomfortable symptoms of patients through care behaviour, SDM may have a positive impact on the future medical treatment of patients, and ultimately lead to better health outcomes for patients [20]. This study pointed out that nursing staff should be able to listen to the requirements of the patient and/or family members who do expect SDM, and the patient and/or family members should fully consider what they want before making a decision. This result works in concert with the finding of Mathijssen et al. [15], who found that understanding the willingness and degree to which patients wish to participate in the decision making was also important to medical professionals.
The interviewees indicated that it is challenging to promote SDM without the approval and participation of the decision leader (doctor). This is another important finding in this study. Therefore, showing the ability to form a co-operative team is an essential factor in promoting SDM. The result works in concert with several studies. Hofstede et al. [21] pointed out in a study on SDM for rheumatology patients that although the medical staff had the same knowledge, attitudes, and experience with SDM in rheumatology, the lack of co-operation between professional groups was an essential obstacle to the implementation of SDM. Patients may receive conflicting information from different medical professionals. Therefore, SDM requires better communication between medical professionals to provide structured information to patients [15]. The interviewees in this study said that the theme of SDM was related to the treatment of the patient, doctors were the primary role in implementing SDM, and nursing staff were to assist doctors in promoting it. This result works in concert with what Mathijssen et al. [15] pointed out in their study: that under the SDM, the topic of diagnostic tests was based on doctors’ input, which was logical as the patient's disease treatment and diagnostic testing was not the task or responsibility of nursing staff.
Most clinics have used interprofessional practice (IPP) to improve the quality of care in recent years. Therefore, the subject of co-operation between the interprofessional team and SDM has also been valued. Dawn and Legare [2] pointed out that oncology nursing staff were the key members of IPP in exerting influence, especially when patients faced prevention, screening, or treatment options during the SDM process. The importance of the role of nursing staff in SDM can be seen in IPP as well.
In addition, the interviewees in this study thought that the ability to search for and integrate empirical data and basic media editing abilities were critical abilities for implementing SDM continuously. This result works in concert with what Tones et al. [22] found: to effectively implement SDM when providing the patient with various educational and intervention measures, it is necessary to collate relevant literature and evidence comprehensively and discuss the priorities of various behavioural changes in language that the patient and family can understand. Then, the development of individualised patient health education through the SDM process can follow to provide patient-centred and evidence-based health education to patients and their families. Several studies have shown that nursing staff form the majority of medical care teams and are their key members. To help patients make choices, nursing staff not only need to use research evidence, but also must interpret that evidence or provide recommendations to meet the requirements of the patient in the decision-making process. Therefore, as well as the ability to search for and integrate empirical data, understanding the basic concepts and principles related to SDM is very important for nursing staff [6, 7]. This study found that nursing staff could help patients understand the disease, clinical progress, and the meaning of treatment options, and use information software to help patients think about clinical decision options during the implementation of SDM. Therefore, the results showed that the nursing staff believed that a basic ability to edit media was also indispensable. This result works in concert with a study by Friesen-Storms et al. [7], who found that providing nursing staff with SDM training, such as PDAs and media editing tools and guidance in developing a patient-centred attitude, could significantly improve the use of SDM by nursing staff. The subjects of this study were chosen from the nursing staff in a medical centre in northern Taiwan. The results cannot be inferred to apply to all nursing staff. Additionally, the self-response of the medical and nursing staff to attitudes and experiences with SDM (such as 'In what situation do you think is suitable to use SDM?') may be affected by their definition of SDM. In addition, nursing staff with a positive attitude towards SDM may have been more inclined to participate in this study. Therefore, the probability of bias in sample selecting cannot be ruled out. Future research could expand the sample sources to obtain the SDM experience of multiple nursing staff members, and thus, provide a more complete reference base for relevant patient care.