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146 Undergraduate nursing students’ experiences with supporting patients with difficult health decisions
  1. Krystina B Lewis1,2,
  2. Olivia Yeh1,
  3. Chelsea Poserio1,
  4. Michelle Reid1,
  5. Dawn Stacey1,2
  1. 1School of Nursing, University of Ottawa, Ottawa, Canada
  2. 2Centre for Implementation Research Ottawa Hospital Research Institute, Ottawa, ON, Canada


Introduction There are few opportunities in undergraduate nursing curriculum for students to acquire knowledge and skills in shared decision-making (SDM). Through a theory-based learning assignment, we aimed to explore how undergraduate nursing students understand and participate in SDM in their clinical placements.

Methods Descriptive analysis of an undergraduate nursing learning assignment. Upon completion of the Ottawa Decision Support Tutorial, undergraduate nursing students posted a virtual reflective note about a clinical experience in which they were involved in a patient’s difficult health decision. From these reflections, we inductively identified decisional needs, interventions, and outcomes, then mapped them onto the Ottawa Decision Support Framework (ODSF). We used content analysis to synthesize the factors influencing nursing students’ participation in SDM.

Results Preliminary results from 34 reflective notes showed that nursing students are most often involved in difficult medical/surgical and end-of-life decisions with their patients. Frequent decisional needs included inadequate knowledge (n=21;61.8%), and complex decisional characteristics (n=20;58.8%). Sixteen (47.1%) students raised personal and clinical characteristics as decisional needs;12 of which (75%) did not explicitly identify them as decisional needs. Decision aids were the most cited intervention (n=27;79.4%). Quality decision was commonly defined as values-based and informed, yet being informed was prioritized over personal values. Factors influencing nursing student participation in SDM included decision support knowledge, interpersonal skills, ensuring accessibility of decision aids for diverse populations (e.g., cultures), and within specific contexts (e.g., end-of-life).

Discussion As health systems are increasingly seeking ways to engage patients/families in decision- making, every effort should be made to equip future nurses with decision support knowledge, skills, and resources to support its integration into practice.

Conclusion A theory-based learning assignment permitted undergraduate nursing students to identify difficult health decisions, decisional needs, interventions to overcome them, and outcomes. Greater curricular focus is required to prepare nursing students for SDM.

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