Patient Involvement in Shared Decision-Making: Do Patients Rate Physicians and Nurses Differently?

BACKGROUND: Shared decision-making implies that patients and healthcare professionals make decisions together about clinical exams, available treatments, choice of options, and the benefit or downside of every choice. Patients involved in the shared decision-making process are more compliant with treatments and have a reduced risk of complications related to the pathology. In Italy, patient involvement in caring processes is still barely investigated. AIM: To investigate patients' perceptions about shared decision-making with physicians and nurses, respectively, and to examine the relationship between shared decision-making and patient satisfaction and perceived quality of care/treatment. METHODS: The study was performed between March and June 2019 in two wards of one Italian hospital. A questionnaire was administered to inpatients at the time of admission and again at discharge, including demographic information and measurement scales regarding patient involvement in shared decision-making, patient satisfaction, and perceived quality of treatment/care. RESULTS: A total of 151 out of 301 patients completed questionnaires at both admission and discharge. Patients' scores for shared decision-making (information, patient needs, treatment planning) were significantly different for physicians and nurses. At both admission and discharge, patients rated shared decision-making significantly higher for physicians compared to nurses, while there were no differences in their satisfaction ratings. Patient ratings of physicians did not change from admission (information: mean (M) = 3.50, standard deviation (SD) = 0.81; patient need: M = 3.05, SD = 1.05; treatment planning: M = 2.75, SD = 1.23) to discharge (information: M = 3.50, SD = 0.79; patient need: M = 3.17, SD = 1.02; treatment planning: M = 2.66, SD = 1.23) (p = 0.924, p = 0.098, p = 0.293, respectively), but patients' ratings of nurses' behavior increased significantly from admission (information: M = 2.44, SD = 1.23; patient need: M = 2.27, SD = 1.17; treatment planning: M = 2.12, SD = 1.19) to discharge (information: M = 2.62, SD = 1.22; patient need: M = 2.53, SD = 1.24; treatment planning: M = 2.35, SD = 1.21) (p = 0.019, p = 0.001, p = 0.003, respectively). Attention to patients' needs was the key determinant of both satisfaction with nurses (OR = 3.65, 95% CI = 1.31-10.14, p = 0.013) and perceived quality of care (OR = 3.97, 95% CI = 1.49-10.55, p = 0.006). Providing appropriate information about disease progress and treatments was a key determinant of both satisfaction with physicians (OR = 19.75, 95% CI = 7.29-53.55, p < 0.001) and perceived quality of treatment (OR = 8.03, 95% CI = 3.25-19.81, p < 0.001). DISCUSSION: Nurses should be sensitized to involving patients in the decision-making process, especially upon hospital admission. Specific training about effective communication techniques can be implemented to manage relationships with patients in different caring situations. Practical implications and future directions are discussed.

Caring efficacy: nurses' perceptions and relationships with work-related factors.

BACKGROUND AND AIM OF THE WORK: Caring nursing practice is central aspect of quality of services. It is important to assess nurses' caring experience in terms of perceived caring efficacy to make them aware of their outcomes and improve their strategies. The aims of the study was to analyze: (1) the caring efficacy level, (2) differences between the caring efficacy levels concerning  positive and negative work attitudes, (3) individual and organizational predictors of perceived caring efficacy. METHODS: 200 nurses were recruited from a University Hospital in Southern Italy. A self-reported questionnaire was administered. T-test was performed to analyze differences between caring efficacy levels concerning outcomes variables. Regression analysis was carried out to examine how some work factors were related to perceived caring efficacy. RESULTS: Participants referred high confidence to care (CC) for 55%, and low doubts and concerns (DC) for 72.9%. Nurses who had low DC had lower emotional exhaustion than nurses with moderate DC. Nurses with low DC had higher job satisfaction than nurses with high DC. Regarding CC levels, there were no differences between mean values for both attitudes at work. The emotional dissonance significantly predicted DC and CC. The supervisor support had a negative link with emotional dissonance, which in turn was negatively related to CC. CONCLUSIONS: Education and training should be addressed to reduce doubts and concerns to care and improve the ability to manage emotions. A work environment that value caring and give support in managing emotions can reduce emotional dissonance and improve caring self-efficacy.