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Community nurse behaviours related to patient involvement in decision making varied on a continuum of non-involving to involving

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 Q To what extent do community nurses involve patients in decision making in everyday clinical practice?

DESIGN

Practitioner ethnography.

SETTING

Patients’ homes and clinics in the UK.

PARTICIPANTS

Purposeful sample of 22 community nurses directly involved in care in patients’ homes and 107 patients (57% women).

METHODS

137 nurse-patient interactions were observed (observer as participant). Data from field diaries were coded according to level and style of nurse decision making and extent of patient involvement in the process. Using a complex, interpretive approach, decisions were categorised as “involving or non-involving” and then “spoken or silent,” and themes were developed.

MAIN FINDINGS

The extent to which patients were involved in the decision making process varied within and between nurses. Only 2 nurses were consistent in their practice; other nurses varied their approach to care from one patient to another. Nurse behaviour was presented on a continuum of non-involving to involving, with 5 typologies of behaviour. Differences in the 5 typologies were related to differences in the social and professional dimensions of interactions. (1) Completely involving. In …

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