Shared Decision Making and Appreciative Inquiry In Nursing Practice

The Shared Decision Making and Appreciative Inquiry In Nursing Practice. The patient’s preferences and values ​​are considered in the decision-making process to ensure that the patient feels heard and respected.

What Is Shared Decision Making and Appreciative Inquiry In Nursing Practice

Shared Decision-Making (SDM) and Appreciative Inquiry (AI) are two approaches that can significantly improve nursing practice by fostering collaboration, patient engagement, and positive change. SDM focuses on involving patients in healthcare decisions, while AI seeks to leverage the strengths and positive aspects of a situation to drive improvement.

Shared Decision Making

The role of the nurse leader and manager is shifting from making all unit-related decisions to designing effective shared decision-making processes. Shared decision making is the inclusion of staff nurses in decision making related to patient care and work methods at the unit and organizational levels. Shared decision making re quires nurse leaders and managers to involve staff nurses in decisions about hiring, scheduling, and performance evaluations (appraisals), as well as include them in general unit discussions (Graham-Dickerson et al., 2013).

Nurses engaged in shared decision making are empowered to provide effective, efficient, safe, and compassion ate quality care and have opportunities for ongoing professional growth and development (ANA, 2015b). Unit cultures with shared decision making foster a healthy work environment and promote safe and quality patient care. Moreover, shared decision making is a positive factor in job satisfaction and nurse recruitment and retention (Houser et al., 2012; Scherb, Specht, Loes, & Reed, 2011; Shiparski, 2005).

Although not yet the norm in all organizations, shared decision making is a standard in Magnet-recognized organizations and has been shown to have a positive impact on nurse satisfaction, nurse recruitment and retention, patient satisfaction, and reduction of adverse events (Houser et al., 2012). The ANA’s Code of Ethics for Nurses With Interpretive Statements suggests that nurse leaders and managers are responsible to ensure that nurses are included on teams at the unit and organizational level and in decision-making processes that affect the quality and safety of patient care (ANA, 2015b).

According to the ANA’s Nursing Administration: Scope and Standards of Practice, nurse leaders and managers are encouraged to develop skills in shared decision making (ANA, 2016). Shared decision making is identified by the American Organization of Nurse Executives (AONE) as a communication and relationship-building competency and states that nurse leaders and managers should “engage staff and others in decision-making; promote decisions that are patient-centered; and provide an environment conducive to opinion sharing” (AONE, 2007, p. 4).

Appreciative Inquiry

In many cases, part of the decision-making process involves problem solving. Problem solving consists of the act of identifying a problem and implementing an active systematic process to solve that problem. Problem solving requires looking closely at problems, failures, and negative outcomes and then finding a solution. One possible approach to problem solving is appreciative inquiry. Appreciative inquiry is a problem-solving strategy that capitalizes on the positive characteristics of an outcome by valuing and building on them. The end product of appreciative inquiry is a culture change or the development of a vision or plan (Manion, 2011).

Appreciative inquiry is based on the belief that there is something similar in the organization somewhere that is already working, and it focuses on recognizing and finding a positive attribute and studying that element to gain insight into handling the current issue (Manion, 2011; Meline & Brehm, 2015). Appreciative inquiry is a collaborative process that engages staff in a healthy exchange of knowledge to solve problems and innovate change. It avoids focusing on the negatives by shifting the perspective to what works best in the organization.

There are four stages of appreciate inquiry, commonly referred to as the four Ds. Stage one is discovery, or the discovery phase, and it involves storytelling. The question answered in this phase is “What gives life?” The goal in this first phase is to identify what works best. The next stage is dreaming, or the envisioning phase, during which the question to be answered is “What might be?” Staff members think ahead and imagine a future based on the positives identified during the discovery phase.

Stage three is design, or the co-constructing phase, because the focus during this stage is to design the ideal and to identify the structures and processes necessary to make the dream a reality. The question asked at this stage is “What should be?” The final stage is destiny, or the sustaining phase. The goal of the last phase is to determine how to actualize, sustain, or create the identified characteristics. During the last stage, the focus is on the positive and on empowering everyone to sustain the vision.

Summary

All nurses, regardless of their role, must develop critical thinking and decision making skills. Providing safe and quality patient care involves effective critical thinking skills, and nurse leaders and managers must encourage staff members to be critical thinkers. Critical thinking involves thinking in a systematic and logical way and generating, implementing, and evaluating approaches to promoting positive patient and nurse outcomes. Reflective thinking and intuitive thinking are elements of critical thinking, and they are based on well-established experiences and provide valuable insight into decision making.

Critical thinking is interrelated with decision making and the nursing process. Nurse leaders and managers achieve outcomes by building on the nursing process when making patient care and unit decisions. Effective nurse leaders and managers model sound critical thinking and decision making skills as well as foster open communication and give voice to staff by encouraging shared decision making. In turn, nurses find meaning in their work and share a commitment to patient safety and quality (ANA, 2016).

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