Patient autonomy in nurse‐led shared care: a review of theoretical and empirical literature

Moser, Albine; Houtepen, Rob; Widdershoven, Guy

doi:10.1111/j.1365-2648.2007.04105.x

Cited by 40 publications

(44 citation statements)

References 21 publications

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“…Our findings reinforce the need to give the nurses time during pre-intervention training to critically reflect on their current provision of patient-centred self-management support [33, 45] and the constructs of true shared decision making based on a patient’s own goals [43, 44]. A change in the way patients present their goals prior to the review would also have to be considered [72]. …”

Section: Discussionsupporting

confidence: 60%

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Achieving Good Outcomes for Asthma Living (GOAL): mixed methods feasibility and pilot cluster randomised controlled trial of a practical intervention for eliciting, setting and achieving goals for adults with asthma

Hoskins

Williams

Abhyankar

et al. 2016

Trials

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BackgroundDespite being a core component of self-management, goal setting is rarely used in routine care. We piloted a primary care, nurse-led intervention called Achieving Good Outcomes for Asthma Living (GOAL) for adults with asthma. Patients were invited to identify and prioritise their goals in preparation for discussing and negotiating an action/coping plan with the nurse at a routine asthma review.MethodsThe 18-month mixed methods feasibility cluster pilot trial stratified and then randomised practices to deliver usual care (UC) or a goal-setting intervention (GOAL). Practice asthma nurses and adult patients with active asthma were invited to participate. The primary outcome was asthma-specific quality of life. Semi-structured interviews with a purposive patient sample (n = 14) and 10 participating nurses explored GOAL perception. The constructs of normalisation process theory (NPT) were used to analyse and interpret data.ResultsTen practices participated (five in each arm), exceeding our target of eight. However, only 48 patients (target 80) were recruited (18 in GOAL practices). At 6 months post-intervention, the difference in mean asthma-related quality of life (mAQLQ) between intervention and control was 0.1 (GOAL 6.20: SD 0.76 (CI 5.76–6.65) versus UC 6.1: SD 0.81 (CI 5.63–6.57)), less than the minimal clinically important difference (MCID) of 0.5. However, change from baseline was stronger in the intervention group: at 6 months the change in the emotions sub-score was 0.8 for intervention versus 0.2 for control. Costs were higher in the intervention group by £22.17.Routine review with goal setting was considered more holistic, enhancing rapport and enabling patients to become active rather than passive participants in healthcare. However, time was a major barrier for nurses, who admitted to screening out patient goals they believed were unrelated to asthma.ConclusionsThe difference in AQLQ score from baseline is larger in the intervention arm than the control, indicating the intervention may have impact if appropriately strengthened. The GOAL intervention changed the review dynamic and was well received by patients, but necessitated additional time, which was problematic in the confines of the traditional nurse appointment. Modification to recruitment methods and further development of the intervention are needed before proceeding to a definitive cluster randomised controlled trial.Trial registration ISRCTN18912042. Registered on 26 June 2012.Electronic supplementary materialThe online version of this article (doi:10.1186/s13063-016-1684-7) contains supplementary material, which is available to authorized users.

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Section: Discussionsupporting

confidence: 60%

“…With no single route to optimum shared decision making, remaining flexible in approach and being open to new ideas is critical [72]. …”

Section: Discussionmentioning

confidence: 99%

Achieving Good Outcomes for Asthma Living (GOAL): mixed methods feasibility and pilot cluster randomised controlled trial of a practical intervention for eliciting, setting and achieving goals for adults with asthma

Hoskins

Williams

Abhyankar

et al. 2016

Trials

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“…It is easier to increase autonomy for persons with sound cognitive abilities and verbal communication skills, because it is simpler for them to express how they want their assistance performed. This aspect was also pointed out by Meyer et al 43 Moser et al 44 found in their review that the empirical literature on patients' perception of autonomy is sparse. In the present study the interviewees clearly described their perception of autonomy and indicated that they strove to maintain their personal autonomy when receiving assistance.…”

Section: Discussionmentioning

confidence: 88%

The Struggle for Dignity by People with Severe Functional Disabilities

Wadensten

Ahlström

2009

Nurs Ethics

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The purpose of this study was to investigate what strategies people with severe functional disabilities who receive personal assistance in their homes use in their daily life to achieve autonomy, integrity, influence and participation. Qualitative interviews were carried out and subjected to qualitative latent content analysis. The main finding was expressed in terms of six subthemes: trying to keep a private sphere; striving to communicate; searching for possibilities; taking the initiative; striving to gain insight; and using one's temperament. These generated the overall theme: maintaining dignity in close relationships. This study contributes an understanding of the strategies used by people who are dependent on personal assistance. Future efforts in nursing must focus on supporting personal assistants with ethical knowledge and guidance in order that people with severe functional disabilities are empowered to achieve autonomy, integrity, influence and participation in their daily lives.

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“…An overview of theoretical and empirical literature showed that various concepts of autonomy exist and that autonomy in long-term care is difficult to understand (Moser et al 2007). People with diabetes are a good example for studying autonomy because of the high prevalence, complexity (co-morbidity and secondary long-term complications), large care demand, and the amount of responsibility that is placed on the patient.…”

Section: Discussionmentioning

confidence: 99%

Realizing autonomy in responsive relationships

Moser

Houtepen

Spreeuwenberg

et al. 2010

Med Health Care and Philos

Self Cite

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The goal of this article is to augment the ethical discussion among nurses with the findings from empirical research on autonomy of older adults with type 2 diabetes mellitus. There are many factors influencing autonomy. These include: health conditions, treatment, knowledge, experience and skills, personal approach as well as familial patterns, type of relationship, life history and social context. Fifteen older adults with type 2 diabetes mellitus were interviewed in a nurse-led diabetes clinic. These participants perceive three processes which support autonomy in responsive relationships: preserving patterns of concern and interaction, nurturing collaborative responsibilities and being closely engaged in trustful and helpful family relations. People with diabetes realize autonomy in various responsive relationships in their unique life context. Next, we performed a literature review of care ethics and caring in nursing with regard to relational autonomy. We classified the literature in five strands of care: attitude-oriented, dialogue-oriented, activity-oriented, relationship-oriented and life-oriented. According to our respondents, autonomy in responsive relationships is fostered when patient, nurses, professionals of the health team and family members carry out care activities supported by a relational attitude of care. They can best realize autonomy in relationships with others when several essential aspects of care and caring are present in their lives. Therefore, we advocate a comprehensive approach to care and caring.

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Patient autonomy in nurse‐led shared care: a review of theoretical and empirical literature

Abstract: Nurses cannot rely exclusively on one model of autonomy to foster patient autonomy. Rather, it requires in-depth knowledge of, and interaction with, patients in the context of each particular nursing encounter because people express their autonomy through particular courses of action.

Cited by 40 publications

References 21 publications

Achieving Good Outcomes for Asthma Living (GOAL): mixed methods feasibility and pilot cluster randomised controlled trial of a practical intervention for eliciting, setting and achieving goals for adults with asthma

Achieving Good Outcomes for Asthma Living (GOAL): mixed methods feasibility and pilot cluster randomised controlled trial of a practical intervention for eliciting, setting and achieving goals for adults with asthma

The Struggle for Dignity by People with Severe Functional Disabilities

Realizing autonomy in responsive relationships

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