Integrating shared decision-making, expressing preferences and active participation of older adults in primary care nursing: a systematic review of qualitative studies and qualitative meta-synthesis.

OBJECTIVES: To systematically synthesise the results of primary qualitative studies on how community-dwelling older adults experience shared decision-making processes, express preferences and actively participate in care. DESIGN: Systematic review of qualitative studies and qualitative meta-synthesis. METHODS: We focused on studies about community-dwelling participants aged ≥65 undergoing a health-disease process circumscribed to a primary healthcare setting, and the central theme should focus on either shared decision-making, expressing preferences or patient participation. We searched the following databases: MEDLINE, CINAHL, Web of Science, Scopus and PsycINFO (time publication frame 2012-2022). We excluded studies in those cases where the qualitative results were not analysed or unrelated to the phenomenon addressed, phenomena were not clear enough to be included or the setting did not occur in the community. RESULTS: A total of 12 studies were included in this meta-synthesis. We appraised the quality of the selected studies through Critical Appraisal Skills Programme (CASP) Checklist. The metasummary comprised the frequency and intensity of qualitative patterns across the included studies. The meta-synthesis revealed four influential elements in their interaction: recognising personal qualities, facing professional characteristics, experiences of discrimination and a double-edged context. CONCLUSIONS: The phenomena studied were influenced by how older people approached their role in their binomial relationship with healthcare professionals. Those with a reinforced self-concept were better aware of health-disease-related situations regarding shared decision-making and the importance of being communicatively assertive. Professional characteristics were also crucial in how older people modulated their acting ability through their personality, communication skills and the approach healthcare professionals used towards older adults. Situations of discrimination generated through an imbalance of power inhibited the expression of preferences and hindered the active participation of older people. The context surrounding the participants influenced all these situations, key in tipping the balance between a therapeutic and a harmful side. PROSPERO REGISTRATION NUMBER: CRD42022363515.

Analysing Power Relations among Older Norwegian Patients and Spanish Migrant Nurses in Home Nursing Care: A Critical Discourse Analysis Approach from a Transcultural Perspective.

Power relations in care are the link between patients and nurses regarding communication and the ability to act in this context. It can be affected when there is cultural interference between members, putting mutual understanding at risk in healthcare situations. This study analyses power relations in healthcare situations between older Norwegian patients and Spanish migrant nurses regarding active listening, shared decision-making, and patient participation. We performed a hermeneutical study endorsed in critical discourse studies framework from a transcultural perspective. A purposive sampling included older Norwegian patients living alone and Spanish migrant nurses working in Norway. Eleven face-to-face semi-structured interviews were conducted with older patients and four via videoconference with migrant nurses. The analysis followed hermeneutic considerations by Crist and Tanner, and linguistic analysis was performed. Shared decision-making and active listening situations sometimes showed a power imbalance that negatively influenced older Norwegian patients. However, Spanish migrant nurses were also conditioned by care organising institutions. This power triangle negatively affected the relationship between the older patients and migrant nurses, resulting in a lack of communication, personnel, time and trust. The migratory experience influenced the care provided by Spanish migrant nurses, shaping a series of cultural competencies acquired through the migratory process.

"With your age, what do you expect?": Ageism and healthcare of older adults in Spain.

INTRODUCTION: Ageism could influence the relationship between older patients' meeting needs and healthcare professionals' answers. AIMS: To highlight the experience of older adults with healthcare systems, how they perceive ageism from their healthcare providers, and to explore the relationship between perceived ageism and self-perception of aging (SPA). METHODS: We conducted an exploratory qualitative study. The participants were 14 women over 65 who lived alone in their homes. RESULTS: Professional responses ignored the expression of preferences of the older patients and excluded them from decision-making processes. These answers influenced older patients' use of health services. Moreover, the negative aspects predominated in a SPA influenced by the internalization of stereotypes and a relationship weighed down by ageist behaviors on the part of health professionals. CONCLUSION: Explicit situations of ageism influence an imbalance in power relations between older patients and healthcare professionals, a misuse of health services, and a negative SPA.

Indignación como experiencia emocional de profesionales de enfermería / Indignation as nurses' emotional experience

Objetivo: Comprender la experiencia emocional de indignación en profesionales de enfermería de España y Reino Unido. Metodología: estudio hermenéutico desarrollado en ambos países. La población de interés incluye profesionales clínicos españoles (n=21) y británicos (n=9). La muestra cumplió criterios de "intensidad" y de "bola de nieve". La recogida de datos fue realizada a través de entrevistas en profundidad. El análisis atendió a la Teoría de la Interpretación de Ricoeur. Resultados principales: Los profesionales del estudio se indignan por acciones y omisiones de distintas disciplinas, bien sean de medicina o de enfermería -entre las que se incluyen las supervisoras-. Entre las acciones también se incluyen algunas -en forma de directrices y presiones- de las organizaciones para las que trabajan. Como última característica de su indignación, se encuentra la nacida de los recortes presupuestarios. Conclusión principal: La indignación de la enfermería española y británica da fe de su pulso ético y humanizador

Objective: To understand the emotional experience of indignation in Registered Nurses from Spain and the United Kingdom. Methods: Hermeneutic study developed in both countries. The population of interest include Spanish (n = 21) and British (n = 9) Registered Nurses. The sampling strategy met the criteria for intensity and snowball. Data collection was conducted through in-depth interviews. The analysis attended Ricoeur's Theory of Interpretation. Results: Nurses, in this study, are outraged by actions and omissions of different disciplines (medicine or nursing) -including Sisters or Nurses in Charge-. Actions, also, include some -in the form of guidelines and pressures - that come from the organizations for which they work. As a last feature of their indignation, there is the one caused by the budget cuts. Conclusions: The indignation of the Spanish and British nursing testifies to its ethical and humanizing pulse