The patient's agenda: nurses’ experience of learning and using guided self‐determination

Abstract

Objectives: Health care has seen a shift towards person-centred care to encompass the entirety of a person's needs and preferences, but research is sparse on healthcare professionals learning and using person-centred care. Aim: To investigate nurses' experiences of learning and using the person-centred method guided self-determination (GSD) in three different gynaecological settings and to determine whether, and potentially, how new tasks introduced by the GSD method influence their professional identity. Design: A qualitative interview study conducted between January 2019 and January 2020. Method: We conducted 16 semi-structured interviews with nurses educated in using GSD. Applying inductive and deductive reasoning, we analysed the interviews using thematic analysis. The study was registered with the Danish Data Protection Agency (file no.: VD-2018-445, I-Suite no.: 6700). Results: The analysis generated three main themes with two subthemes each: (a) prerequisites and barriers to learning and using GSD in terms of personal factors and organisational and method-related factors; (b) new knowledge and understanding of illness with the subthemes expanded understanding of illness and a different relationship; and (c) nursing undergoing change with the subthemes, a new role and a professional self shaped through interaction with other professions. Conclusions: Although other professionals may have either supported or challenged the use of GSD, most nurses indicated that it supplemented their professional role and identity as they gained new knowledge about person-centred challenges and felt more confident. When introducing GSD in nursing, the organisation must not only consider individual characteristics, multidisciplinary collaboration and communication but also plan individual education and supervision. This is necessary because all these factors affect how a new professional role is constructed and adopted, not to mention how it influences the nurses' perception of their professional identity and use of GSD. Establishing a helpful person-centred environment must also be considered.

Impact of the person‐centred intervention guided self‐determination across healthcare settings—An integrated review

“…This was denoted as ‘in open waters’ [38] ‘groping in the dark’ [40] or hesitation in starting out with the first patient [37]. When entering the new role, some HCPs found they had to unlearn behaviour such as informing and advising [41], and coming up with solutions [36, 56]. The change of approach made some question own professional competence [56] as traditional practice was built on a ‘safe, professional and disease‐specific platform’ [38].…”

“…The altered role also changed the professional relationship with the patients towards a more collaborative approach [36], a change that was mentioned by several HCPs as a positive mean of GSD [35, 37, 40, 56], except when GSD was delivered as pure eHealth with written communication, then a ‘more fragile relationship’ with patients was experienced due to no face‐to‐face contact [39].…”

“…Some HCPs participated in follow‐up training [38], and some expressed a need for further follow‐up training [56], and that continuous use of GSD in clinical practice was of great necessity to improve their skills [39].…”

“…Most important, they were considered a tool facilitating collaboration and keeping focus on the patient's perspective [35–39, 41, 56]. Additionally, saved online reflection sheets created opportunity for the HCPs to revisit previous conversations to ensure personalised plans [36].…”

“…Furthermore, the HCPs valued and recognised the patients' knowledge and experiences, ‘it is the whole patient now’ [56]. This entailed a shift in power to be more equal [36, 38, 40], but also an opportunity to discover the patients' real challenges in living with their condition [35–38, 40, 55–57], which contributed to a mutual generation of new insights.…”