Engage patient in the therapeutic relationship. Demonstrate an attitude of respect, patience, and acceptance. Persons who feel cared for, understood, and respected in health care situations are better motivated to collaboratively participate in their care.- Continually assess for readiness to make a health care choice to promote timely decision-making.
- Ensure privacy for one-to-one interaction between patient and nurse. Patient's status in relationships with family/loved ones may inhibit frank discussion in their presence.
- Ensure that communications and information provided are at a level consistent with patient's cognitive abilities to ensure understanding.
- Avoid limiting choices based on health care provider preference, values, or beliefs and avoid encouraging one choice over another. The health care team is accountable to patient to provide appropriate information on all available options and to promote autonomous decision-making.
- Explore with patient the meaning of experience of making a health care decision. Ask what meanings the current health care situation and having to make a health care decision have for the patient. The health care need and necessity to make a health care decision may represent a crisis for the patient. Understanding patient's experience of this can direct the identification of other necessary assessments and interventions.
- Discuss patient's emotional experience of needing to make a health care choice. Patient may feel anger, fear, anxiety, pressured, or overwhelmed by the need to choose or the choices offered.
- Validate patient's experience, and ask permission to discuss patient's thoughts and feelings about own choices. Identify any anxiety or fear related to making a decision. Fear and anxiety can lead to anger, feeling pressured or overwhelmed, procrastination, and/or excessive seeing of reassurance or opinions from others.
- If fear or anxiety is present, validate patient's experience to promote self-esteem, strengthen the therapeutic relationship, and promote autonomous decision-making.
Provide clarifying information about choices if needed. Misinterpretations of information may lead to difficulty making a decision.
Refer to professional support to address anxious distorted thoughts if needed. Counseling may be required to assist patient to work through distorted thoughts and determine own best course of action.- Share with patient observation of distress when hearing other's opinion. Ask patient to share thoughts that are leading to distress. Sharing thoughts that lead to distress regarding others' opinions may reveal relationship barriers to decision-making. Indecision may arise from dissonance between patient's own values, beliefs, and preferences and those of loved ones or health care providers. Validate those thoughts. Validation of patient's distressing thoughts promotes self-esteem, builds the therapeutic relationship, and promotes autonomous decision-making.
- If needed, clarify perceptions of health care team decisional preference. Patient may feel pressured to make an unwanted choice by a perceived power differential within the therapeutic relationship.
- Engage patient to use a problem-solving framework to identify and to evaluate the possible available choices. Ask patient to list the advantages and drawbacks to each choice, as well as personal values, goals, and preferences related to each choice. Encourage patient to identify personal and social barriers to enacting any of the choices. Then ask patient to rate the suitability of each choice based on appraisal of each one. Use of a problem-solving framework in consideration of health care choices encourages patient to consider health care options from the context of own experience and to identify own best choices given patient's life situation.
Suggested NIC Interventions
Active Listening; Assertiveness Training; Decision-Making Support; Learning Facilitation; Mutual Goal Setting |