Approach to Shared Decision-Making in Nursing - Literature review Example

Approach to Shared Decision-Making in Nursing Introduction Medical articles can be well analyzed based on the content, the reputation of the authors among other useful information. However, it is paramount that evidence based practice (EBP) be adopted when analyzing an article. According to Sackett et al (1996, pg 71-72) “Evidence based medicine is the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients”. The best available and current research is utilized in making a judgment about the article in question (Drisko and Grady 2012). The research article, Healthcare Providers’ Intentions to Engage in an Interprofessional Approach to Shared Decision-Making in Home Care Programs: A Mixed Methods Study by Legare et al., presents views of the healthcare providers in the implementation of the interprofessional approach to shared decision-making (IP-SDM). In addition, it evaluates their intention for engaging in the program. The IP-SDM program has been gaining popularity in Canada but it is yet to be incorporated into the healthcare system (Reeves et al., 2008) Interprofessional approach entails the engagement of different professionals within the healthcare system, where all contribute towards the achievement of a common method of patient care. In addition, the aspect of shared decision-making entails the development of a system that involves the patients in determining the type of treatment that is given to them. The research concludes that the health professionals are not in any way opposed to the program (Legare et al. 2013, pg 221). The research objective is clearly defined by establishing the two main items under analysis, the intentions, and the factors behind the intentions of the health workers. The methodology was also defined and this article attempts to analyze it further by pointing out some of its strengths and weaknesses. The participants were healthcare providers with home care programs, majority of who were women. Data was collected through filling of questionnaires, which were later analyzed and deductions made. The target group was not inclusively used in the analysis of the final data due to various reasons. The Research was well conducted and gave representative results but there are areas of the research that could have been done in a better way (Saint Joseph College Connecticut 2001). The Title The title is a very important component of a research article. It should be capable of capturing the articles’ major variables concepts and the methods involved (Kaplan 2012). A careful look at the research article under focus, the authors have captured diverse aspects of the study in the title. Firstly, the program under consideration is very clearly defined, IP-SDM. Secondly, it goes further to specify on the particular area under investigation, which happens to be the intentions of the healthcare providers as they engage in the program. These two aspects make the title accurate and specific on the issue being discussed in the article. It is also clear the type of participants that are involved in the study from the title, those health workers in home care programs. However, the authors take a global perspective in the methodology used. The title mentions in broad terms that the research uses mixed methods without a clear definition of what are those ‘mixed methods’. The length of the title is desirable; this is because it carries diverse aspects under investigation that cannot be assumed. It is descriptive and informative, just from a first look it is likely that one is capable of capturing the parameters under investigations and the variable involved. Largely the title is the best impression that gives a view of what to expect in the main body of the article, and sure enough, Legare et al. successfully captures most of the aspects. The Athors The authors of the article comprises of a highly professional team drawn from various institutions across Canada and one from the United States. Professor France Legare is a distinguished academician and a researcher. She is a professor at the Department of Family Medicine and Emergency Medicine at Université Laval, Quebec. In addition, she has done research in various capacities, including her well-known research titled, Health Professionals in Primary Care: From Knowledge Brokers to Decision Brokers among others. Apart from research she has held various responsibilities including being the chairperson of the Implementation of Shared Decision Making in Primary Care. Together with her colleagues in this research, they have engaged in various activities that have focused on the interprofessional approach especially in the clinical setup (Université Laval 2013). Dawn Stacey is an associate professor at University of Ottawa, School of Nursing. She has specialized in clinical epidemiology and acts as the Director of the Patient Decision Aids Research Group. Her research has a major bias towards patient participation in the health decisions. She has focused on knowledge transmission to the patients, decision coaching, helping in decision development, evaluation and its appraisal (Ottawa Hospital Research Institute 2013). Nathalie Briere is from CSSS de la Vielle-Capitale that is based in Quebec. Kimberly Fraser is another researcher in the group from the University of Alberta with a specialization in home care, community health, and outpost nursing. She is a teacher for both graduate and undergraduate programs in the institution. Besides, she has engaged in intensive research on allocation of resources, policies in homecare and decision making in the health sector (University of Alberta 2013). Other key contributors of this research include Université Laval lecturers and researchers including Sophie Desroches from the Department of Food and Nutrition Sciences and Serge Dumont from the School of Social work. Anne Sales comes from the United States’ University of Michigan. She has engaged in extensive research in patient care among other health services research (School of Nursing University of Michigan 2013). Carole Puma is based at the Research Center of the Center Hospitalier Universitaire de Quebec, and lastly Denise Aube is part of the Health and Social Services Systems Unit at INSPQ. All these authors complement each other in several ways as evident in the research article. Their wealth of experience and the training they have received gives their work a credible outlook. The abstract features the main concerns that are being addressed in the study. The research article under analysis here has an abstract despite the fact that it is not labeled. It has captured the research question under study by presenting the global picture under study concisely Pellerin, et al., 2011). It has identified the essence of the study, which is to determine the intention of the health professionals in engaging with the IP-SDM. In addition, they have put it clear that they are establishing the relationship between the two variables, health professionals’ intention against the program. This brings forth the research question clearly and precisely. It is also apparent that the abstract captures the sample under study, 272 participants, as well as the strategy that was used in the study, which was the use of questionnaires. In addition, descriptive statistics together with multivariate analysis were used to analyze the data that was acquired through the survey. It describes the process of analysis and the criterion that was applicable when designing the questionnaires. The challenges experienced in the study and the factors that promoted it feature in the abstract and provide potential ways of developing the program. The hypothesis of the study is featured in the abstract. The research article indicates the findings according to the analysis, which showed that the mean intention of the health professionals was positive 1.42 when analyzed in a range of -3 to +3. However, the abstract does not provide many details about the sample that has been used in the study. It has only mentioned in passing the number of participants in the study. The Introduction The introduction provides the background information about the topic under study. The IP-SDM has been explicitly explained in the introduction. It is comprehensive, explanatory and captures diverse aspects of the research including a review of the existing literature. The authors have cited not only their previous works but also other peer-reviewed materials; for example, in Dagone (2009) is quoted having hypothesized that interprofessional care can be viewed in the light of providing superior quality and cost friendly services. It gives details about how the interprofessional approach works and demonstrates the situation in Canada. They further review literature on the facilitators of the program; they have mentioned that home care services are expected to increase with a significant margin. The last sentence captures the entire picture of the research paper, which is “to evaluate healthcare providers’ intentions to engage in IP-SDM and to identify factors associated with their intentions” (Legare et al.2013). Most of the study requirements have been developed in the introduction hence making it one of that captures the methodology of the study. The study’s objectivity and specificity is defined, its scope ranges from the intention of the health professionals concerning the IP-SDM to the factors behind their intentions. This means that the study is limited to provision of specific information that is useful to the users. The research has carried a wide view of the entire topic in the introduction but it goes beyond to describe aspects that are beyond the scope of study. Inadequate related studies pose a challenge for a more concise introduction. Literature Review Research is synergistic in nature and requires the input of various researchers to make it complete. A trending topic, one that does not have much material poses a challenge for the researchers, to elucidate their own findings they will need some background information from a credible source. In addition, the sources should have the latest information for the topic under research. Most of the material that has been referred to by Legare et al. in this article is recent as it pertains the home care studies. However, some of the older sources have been used to complement the works of the recent authors; for example, the works of Ajzen (1988) has featured in the discussion because of its significance in the research. This early literature is quoted because of its significance during the data collection procedures. In fact, the literature talks about the theory of planned behavior that developed way back in 1988. Unfortunately, the article takes a narrow scope of literature review that is captured in the introduction. However, much of the information given in this section is relevant and relates directly to the IP-SDM program, but also it narrows down its attention more to the health professionals. The article’s literature is crosscutting; it captures both the positive and negative ends of the IP-SDM program and its development. Levinson et al., (2005) has been referred for their input in establishing that there are factors that hinders effective decision making, that includes, cognitive impairments, and cultural origin. The research is backed by the keen interest of the authors on the area of home care; they have adversely quoted their previous work. This means that experience and the understanding of the authors support the literature under review. However, they have somehow gone overboard in citing their own works, the best strategy would have been having one or two citations from their works and then use additional external sources. The information that they have concluded in the course of their research can be used as common knowledge that would help them gather more information from research that is not theirs. In the literature review, the research has identified the underlying need for the research by analyzing the all its components. Finally, the literature review carries the current operationalization of the home care programs in Canada. Consequently, the model used in this research had been developed and tested earlier. Hypothesis and Research Question An experimental study should capture a research question and a hypothesis that can be tested. The research question is meant to guide the research, if the research question is answered through an experimental methodology, then it means that the research is concluded (Tzeng, Duffy and Low 2008, pg 3). In the research article under review, the authors have not cited the clear question that should be answered. However, from the literature provided, it is easy to deduce the question under focus, which would be, ‘what are the intentions of the healthcare providers in engaging with the IP-SDM in home care programs and what are the factors that motivate such intentions?’ Such a question would capture the two main aspects of healthcare providers under study. In addition to a good research question, a testable hypothesis is very important. They have failed to define their hypothesis in the research article but again it is easy to deduce how the hypothesis would look like based on the abstract and the literature review. It is mandatory that the hypothesis will provide a position. This is because during its testing it can either be proven wrong or right. Methodology A research without a clear methodology is deficient and cannot satisfactorily be regarded as scientific. The methodology sets out clear the mechanism of achieving the necessary results and the interventions that are required in the process (Kaplan 2012). The design of this research article is one that has mixed methods of getting to the results. The researchers opted to apply focus groups, administration of questionnaires and interviews. They have set out clear the essence of engaging in the mixed methods approach, which is to be able to get both qualitative and quantitative data that can be useful in elucidating the intentions of the healthcare providers. The methods used are complementary to each other hence the results obtained are consistent. However, at times mixed methods may bring different results that can present challenges in the final analysis. When setting the research it is always important to minimize the placebo effect in order to get results that are not biased on grounds of sensitization. In this methodology, the research approach has been clearly defined. It was done in three main ways, all that facilitated the establishment whether healthcare providers what is the intention why health providers would choose to embrace the IP-SDM in home care programs. The three methods are very appropriate for the research since they provide different viewpoints from different medical practitioners. If a section is used then it might not be possible to triangulate the findings. The participants were representative of all the health practitioners; they included the unlicensed home support workers, nurses, social workers, physiotherapists, occupational therapists, activity coordinators, dietitians, physicians and other workers offering social support and rehabilitation. These diverse groups are highly representative of the individuals that are directly involved in home care programs. Therefore, it is apparent that the choice of participants was done diligently and adhered to research requirements. The mixed method approach helped the researchers reach out to different groups in different ways, for example the focus groups involved the healthcare exclusively professionals. In choosing the homecare team under investigations some careful considerations were made, they tried to capture diversity as well as those dealing with highly prevalent clinical issues. The methodology provides a clear way of achieving results (Coughlan, Cronin, and Ryan 2007, pg 661). However, its weaknesses are not exposed, it is likely that the different groups under study may have a big difference in opinions. When concluding the results, biasness may ensue where the extreme results are averaged. Sample Selection and Data Collection This research article is based on data that has been collected through the mixed methods that were adopted in the study design. It was obtained through a survey that was intended for 428 participants but it ended up having 272 participants whose questionnaires were analyzed. The large scope of participants provided an assurance for participation. However, the strategy of the administration of the questionnaires was flawed; this is because up to 147 participants failed to return their questionnaires. The data obtained was representative and presented a clear picture on the ground, this was contributed by the fact that the participants whose data was analyzed were willing to participate in the study. In order to keep track of the participants as well as maintain their confidentiality the researchers diligently established a coding method. The questionnaires were professionally done taking into account the theory of planned behavior; they had been used previously in a similar study involving the implementation of Shared Decision-Making in clinical practice (Stacey et al., 2012). In laying a level playfield for all the participants, the researchers provided a comprehensive definition of IP-SDM as it is used in home care, this was a positive development given that majority of the participants were the unlicensed home support workers. The focused group discussions included individuals at three levels, which could have acted as a communication barrier. It is likely that some of the group members would not give their opinions perfectly in presence of their seniors. The one on one interview with the managers was likely to produce a personal view, which is very important in elucidating their intentions. Ethical Considerations The study observes adherence to ethical considerations. Ethics is a vital component of every research for it to meet the threshold of being acceptable for publication (Stockhausen and Conrick 2002, pg 41). The article states that the research had been approved and given a clean bill of health before it began. Most of the professional requirements for a scientific research were met. The data was collected using scientific methods, which included the administration of questionnaires, interviews, and focused group discussion. The ethical considerations of the participants were also taken care of. Their confidentiality was protected by developing a coding system that involved the participant’s mother initials and their birthdates. However, this coding method can reveal the identity of an individual when a person with ill motives wants to determine their opinion. Such an occurrence can compromise anonymity of the participants. The coordinators did not coerce or persuade the participants, this is why the questionnaires were to be mailed. There are those who chose not to take part in the study, there was liberty to do so. The participants were fully aware of their involvement in the research as well as having a clear understanding of what the research entailed. Results and Data Analysis The results present the information presented by the participants that needs to be analyzed. The article has presented the results in accordance to the method used. This is a very important aspect since it helps in the identification of the specific results of a certain group of health workers. Inconsistencies across the methods can be easily be identified, an aspect that will help in the analysis of the results (The Joint Center for Nursing Research at Ochsner Medical Center. n.d, 10). The article presents statistics relating to the participants in the ‘results’ section instead of focusing on the findings of the study. Ultimately, the study established a positive intention among the healthcare providers that participated. A Review of the Article’s Conclusion According to the results of the analysis, there was a significant correlation between their profession and the intention, other factors such as gender, age and job experience did not have a major input. It is important the research entailed both bivariate and multivariate analysis; this is because they have played a key role in the establishment of the relationship with different variables. The multivariate analysis established that the intention to engage in IP-SDM by the healthcare practitioners was facilitated by cognitive attitude, perceived behavioral control, and individual norms. The tabulation of the results gives the first impression of the findings and helps the reader to get a fast glimpse of what to expect in the conclusion. The research article has discussed the findings at length making appropriate inferences from the results. In addition, the article gets further to have concluding remarks that brings out the entire view of the research. Conclusion In conclusion, Healthcare Providers’ Intentions to Engage in an Interprofessional Approach to Shared Decision-Making in Home Care Programs: A Mixed Methods Study by Legare et al., stands out as a well-researched and analyzed research article. This is because the article is capable of meeting the requirements of a good title, hypothesis, introduction, literature review, methodology, research question, and the conclusion. However, the mode of presentation of the results is contentious since it fails to capture the findings in a manner that a lay man can understand them at the first glance. The title is very relevant to the understanding of the research question being addressed, which happens to be the reasoning behind the intentions by healthcare providers (Drisko and Grady 2012). It is very possible to deduce what to expect in the article by having a keen look of the title. The individuals that have composed the research are professionals with years of experience in research and practice as demonstrated by the contribution of Legare, Stacey among the other authors. The introduction has been merged with literature review and has captured recent and past research about home care and the research about interprofessionalism and Shared Decision Making especially in the health sector. The literature is precise and addresses the relationship between the healthcare providers and IP-SDM as developed in the Canadian healthcare system. The review of literature is well articulated and features not only works from these authors but also different authors both recent and past. It is worth appreciating the extensive work by the authors in the advancing homecare systems through their personal research, collaborative research and institutional research. The sources that have been cited are up to date and reflect the most recent developments in the different areas discussed. Research as recent as 2013 publications have featured while some of the instrumental and relevant literature have been used but to a small extent. The methodology is developed through three main strategies that facilitated the attainment of inclusive results. It has captured the following methodologies; these are the focused group discussions, conducting interviews, and the filling of questionnaires. The results were tabulated and analyzed in a systematic way, hence enabling the reader to have a fast view of the findings. However, the presentation of the results section was missing; instead the statistics about the group under investigation were given. The conclusion is descriptive and features the ultimate findings of the research. This makes it possible to elucidate that there is a positive intention by the healthcare providers concerning the adoption of interprofessional coupled with shared decision making. References Coughlan, M., Cronin, P. and Ryan, F (2007), Step by Step Guide to Critiquing Research. Part 1: Quantitative Research, British Journal of Nursing. Vol 16 No.11. Retrieved on 27 December, 2013 from http://www.olemiss.edu/celi/Files/step-by-step-guide-to-criti-research-part-1-quantitative-reseawrch.pdf Dagone, T (2009), For patient’s sake: Patient First review commissioner’s report to the Saskatchewan Minister of Health. Drisko, J. and Grady, M (2012), Evidence-based practice in clinical social work. New York:  Springer-Verlag. Kaplan, L (2012), Reading and Critiquing a Research Article. American Nurse Today. Vol 7 No. 10. Retrieved on 27 December, 2013 from http://www.americannursetoday.com/article.aspx?id=9568&fid=9534 Légaré, F. and Stacey, D (2010), IP-SDM Model Concepts Defined. Retrieved on 27 December, 2013 from http://www.decision.chaire.fmed.ulaval.ca/index.php?eID=tx_nawsecuredl&u=0&file=fileadmin/documents_utilisateurs/recherche/IPSDM/IP-SDMconceptsdefined_edit.pdf&t=1388174542&hash=15fe7b469ca358470617ce401a2ac8aa Légaré, F. et al., (2013), Healthcare Providers’ Intentions to Engage In an Interprofessional Approach to Shared Decision-Making in Home Care Programs: A Mixed Methods Study. Journal of Interprofessional Care, 27:214-222. Ottawa Hospital Research Institute (2013), Dawn Stacey RN, PhD. Retrieved on 27 December, 2013 from http://www.ohri.ca/profiles/dstacey.asp Pellerin, M. A, et al., (2011), Toward shared decision making: Using the OPTION scale to analyze resident-patient consultations in family medicine. Academic Medicine. Reeves, S, et al., (2008). Interprofessional education: Effects on professional practice and health care outcomes. Cochrane Database of Systematic Reviews. Sackett, D., Rosenberg, W., Muir Gray, J., Haynes, R. 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Retrieved on 27 December, 2013 from https://open.umich.edu/sites/default/files/Topic8Assignment-CritiqueArticle.pdf Université Laval (2013), Dr. France Légaré, MD, PhD, CCFP,FCFP. Retrieved on 27 December, 2013 from http://www.decision.chaire.fmed.ulaval.ca/index.php?id=81&L=2 University of Alberta (2013), Dr. Kimberley Fraser. Retrieved on 27 December, 2013 from http://www.nursing.ualberta.ca/en/staff/faculty/kfraser.aspx University of Michigan (2013), Anne E. Sales. Retrieved on 27 December, 2013 from http://nursing.umich.edu/faculty-staff/anne-e-sales Read More