Dr Marion Waite

Aim:

To explore patients’ and community nurses’ perceptions and experiences of shared decision-making in the home.

Design:

Integrative review.

Data Sources

CINAHL, British Nursing Index, Psycinfo, Medline and Social Services Abstracts were searched for qualitative, quantitative and mixed methods papers published between 1st December 2001 and 31st October 2023.

Review Methods

A systematic search of electronic databases was undertaken using defined inclusion criteria. The included papers were appraised for quality using the Joanna Briggs Institute critical appraisal checklist for qualitative research. Relevant data was extracted and thematically analysed.

Results

14 papers comprising 13 research studies were included. Patients attached great importance to their right to be involved in decision-making and noted feeling valued as a unique individual. Communication and trust between the patient and nurse was perceived as fundamental. However, shared decision-making does not always occur in practice. Nurses described a tension in managing patients’ involvement in decision-making.

Conclusion

The findings demonstrate that although patients and community nurses appreciate participating in shared decision-making within the home, there are obstacles to achieving a collaborative process. This is especially relevant when there are fundamentally different perspectives on the decision being made. More research is needed to gain further understanding of how shared decision-making plays out in practice and to understand the tensions that patients and nurses may experience.

Implications for the profession and/or patient care

This paper argues that shared decision-making is more than the development of a relationship where the patient can express their views (though of course this is important). Shared decision-making requires acknowledgement that the patient has the right to full information and should be empowered to choose between options. Nurses should not assume that shared decision-making in community nursing is easy to facilitate and should recognise the tensions that might exist when true patient choice is enabled.

Commentary on: Feeling like I’m failing a test, parents’ and adolescents’ opinions of diabetes clinic appointments.

Commentary on: Ponmani, C., Nijman, RG. Roland, D. et al. (2023). Children presenting with diabetes and diabetic ketoacidosis to Emergency Departments during the COVID-19 pandemic in the UK and Ireland: an international retrospective observational study. Arch Dis Child (0) 1-9 doi:10.1136/archdischild-2022-325280

Implications for practice and research

• In the context of newly emerging SARs-CoV-2 variants, education on self-management of sick day rules for children with diabetes and their parents is imperative to avoid decompensating diabetic ketoacidosis (DKA)
• Prospective research is needed to examine new-onset diabetes accompanied by a diagnosis of SARs-CoV-2

Introduction

High-quality pre-registration student nurse training and development is integral to developing a sustainable and competent global nursing workforce. Internationally, student nurse recruitment rates have increased since the onset of the COVID-19 pandemic; however, attrition rates for student nurses are high. During the pandemic, many student nurses considered leaving the programme due to academic concerns, feeling overwhelmed, and doubting their clinical skills. Little was known about the extent to which nursing education prior to COVID-19 had prepared students for their role in managing the healthcare crisis or the impact on their resilience. Thus, this study aimed to explore how the COVID-19 pandemic impacted on the resilience levels of student nurses across the United Kingdom.

Methods

Data were collected as part of a multi-site qualitative study named ‘COV-ED Nurse’ and involved pre-placement surveys, placement diaries, and post-placement interviews with nursing students. Student nurse participants were recruited from across the United Kingdom, from all years of study, and from all four nursing branches: children, adult, mental health, and learning disabilities. Participants were asked to complete a pre-placement survey that collected demographic details and information about their placement expectations. They were also asked to record a weekly audio-visual or written diary to describe their placement experiences, and, on completion of their placements, students were interviewed to explore their experiences of this time. Data were thematically analysed using the Framework Approach. Ethical approvals were obtained.

Results

Two hundred and sixteen students took part in the wider study. The current study involved a subset of 59 students’ data. Four main themes were identified: ‘coping with increased levels of acuity’, ‘perceived risks of the pandemic’, ‘resilience when facing uncertainty and isolation’, and ‘the importance of coping mechanisms and support structures.’

Discussion

From this study, we have generated insights that can be applied to nursing research, education, policy, and practice and identified the wide-ranging impact that the COVID-19 pandemic had on student nurses and their abilities to remain resilient in an unstable environment. The value of communication and support networks from a wide range of sources was highlighted as key to navigating many uncertainties. In addition, the extent to which students were able to navigate their personal and professional roles and identities influenced their ability to cope with and continue along their training pathways.

Commentary on: McGill, D E., Volkening, D.A., Wasserman, R.M., Anderson, B.J., and Laffel, L.M. (2019). Text-message responsiveness is associated with HbA1c benefit in teenagers with Type 1 diabetes. Diabetic Medicine. Diabet Med. 2019 May;36(5):600-605. doi: 10.1111/dme.13929.

Implications for practice and research: 1) Use of ShotBlocker or Buzzy during insulin administration was effective in reducing self-reported, parental and observer assessments of pain in comparison with no intervention. 2) ShotBlocker or Buzzy was effective in lowering self-reported, parental and observer assessments of fear and anxiety prior to and during insulin administration in comparison with no intervention. 3) Further research is needed to examine the effectiveness of the devices over a longer time.

Aims: (a) To explore how mobile technology can support self‐management in adults with type 1 diabetes (T1DM). (b) To inform a usability study in the design of a mobile application to facilitate self‐management of T1DM. Design: Qualitative exploratory design. Methods: Semi‐structured interviews were undertaken with adults with T1DM (N = 8). The data collected were analysed using a thematic analysis approach. Results: Mobile technology has the potential to support adults in their self‐management of T1DM through facilitating their decision‐making, saving time and enabling them to easily share their data with their healthcare professional. Participants identified four main visualization characteristics for technology to aid in decision‐making; relationships between inputs, trends, graphs and colours, and identified essential features such as ease of use, convenience and connectivity.

Background: People with T1DM are confronted with self-management tasks and for which they need to develop strategies to balance the risks of long-term complications with those of hypoglycemic events. The potential of advanced and evolving technology to address these issues involves consideration of psychological and behavioral constructs alongside evaluation of the usability of devices. Access and uptake of advanced technology is further influenced by economic factors and health care provider capacity to support such interventions. Previous reviews have either focused upon clinical outcomes or descriptively scoped the literature. In addition, some have synthesized studies on adults with those on children and young people where human factors are different. Objective: The objective of this review was to describe the relationship between

human factors and adherence with technology for data logging processes in adults with T1DM and to explore the factors which influence this association. Methods: A systematic search of the literature was undertaken in accordance with the PRISMA guidelines. Quality appraisal of each study was undertaken. Data were abstracted and categorized into the themes that underpinned the human factor constructs that were examined. Results: Eighteen studies were included in the review. Six constructs emerged from the data analysis: The relationship between adherence to data logging and measurable outcomes; Satisfaction with the transition to advanced technology for self-management; Use of advanced technology and time spent on diabetes related activities; Strategies to mediate the complexities of diabetes and the use of advanced technology; Cognition in the wild and, Meanings, views and perspectives from the users of technology. Conclusions: evidence of increased treatment satisfaction was found on transition from traditional to advanced technology use (insulin pump and continuous glucose monitoring (CGM)); the most significant contributing factor was when blood glucose (BG) levels were consistently

evidence that logging of data was positively correlated with increasing age when using an app that provided meaningful feedback (regression coefficient = 55.8 recordings/ year; P = 0.009). Furthermore, there were benefits of CGM for older people in mediating complexities and their fears of hypoglycemia with reported significant differences in well-being (P= .009). Qualitative studies within the review aimed to explore the use and uptake of technology within the context of everyday lives. There were ‘frustrations’ with CGM, continuous subcutaneous insulin infusion (CSII), calibration of devices and alarms. This created implications for “body image” and the way in which “significant others” impacted on the behavior and attitude of the individual towards technology use. There were wide variations in the normal use of and interaction with technology across a continuum of sociocultural contexts, which has implications for the way in which future technologies should be designed. Many of the quantitative studies in the review were limited by small sample sizes. This may make it difficult to generalize findings to other contexts. This is further limited by a sample that was predominantly Caucasian, well-controlled and engaged with their self-care. However, the use of critical appraisal frameworks has highlighted areas where research into human factors and data logging processes of individuals could be improved. This includes engaging people in the design of the technology especially hard-to- reach or marginalized groups.

This paper reports on a pilot project in which two postgraduate students were supported to function in the role of teaching assistants (TAs) as part of their learning experience. The project embraced the notion of students as producers rather than consumers. Using a reflective approach, this case study was jointly written by TAs and their teaching staff. It incorporates feedback from other students collected through an anonymous module feedback survey, which was analysed by attribution to themes. The role of TAs benefitted others students, staff, and the TAs; the project is a strong affirmation of the principle of treating students as producers. The impact of the role on both the students undertaking the TA role and the tutors was profound, and student experience was enhanced as a result. TAs can assist in bridging student-teacher communication gaps and support students’ learning through sharing their knowledge by creating resources. This article is written from the perspectives of both the TAs and the tutors.