Introduction
This essay explores the critical role of complex problem solving and shared decision making in older people nursing, with a particular focus on involving patients and their families at the heart of care processes. In the context of an ageing population, nurses must address multifaceted health challenges while ensuring that care remains person-centred. This requires not only clinical expertise but also effective communication and collaboration with patients and families. The essay will examine the importance of shared decision making, the challenges of solving complex health problems in older adults, and the strategies nurses can employ to ensure inclusive care. By drawing on academic literature and authoritative sources, this piece aims to highlight both the applicability and limitations of these approaches in clinical practice.
The Importance of Shared Decision Making in Older People Nursing
Shared decision making (SDM) is a collaborative process where healthcare professionals, patients, and often their families jointly make care decisions based on clinical evidence and personal values. In older people nursing, SDM is particularly vital due to the prevalence of multimorbidity and the need for individualised care plans. According to Elwyn et al. (2012), SDM enhances patient satisfaction and adherence to treatment by respecting autonomy and preferences. For older adults, who may face cognitive or sensory impairments, involving family members can provide additional support in articulating needs and ensuring decisions align with the patient’s best interests. However, nurses must remain aware of potential conflicts between patient and family perspectives, requiring sensitivity and skill to mediate such situations effectively. This approach, while beneficial, is not without limitations, as it assumes a level of health literacy that may not always be present in older populations or their families.
Complex Problem Solving in Geriatric Care
Older adults often present with complex health issues involving physical, psychological, and social dimensions, necessitating intricate problem-solving skills from nurses. For instance, managing a patient with dementia alongside chronic conditions such as diabetes requires balancing medical interventions with behavioural strategies. The National Institute for Health and Care Excellence (NICE, 2016) guidelines stress the importance of a holistic assessment to identify key issues and develop integrated care plans. Nurses must draw on evidence-based resources, such as clinical guidelines and multidisciplinary input, to address these problems systematically. A practical example might involve coordinating with dietitians, social workers, and family carers to manage both nutritional needs and social isolation in an older patient. Nevertheless, limitations exist; time constraints and resource shortages in healthcare settings can hinder the depth of problem solving, potentially impacting care quality.
Strategies for Centrally Involving Patients and Families
To ensure patients and families remain central to care, nurses can adopt structured communication tools like the “Ask-Tell-Ask” model, which encourages dialogue and feedback during decision-making discussions (Back et al., 2009). Furthermore, regular family meetings can facilitate transparency, allowing concerns to be addressed collectively. Culturally sensitive care is also essential, as diverse family dynamics and values influence perceptions of care. While these strategies generally foster trust, they may be less effective if family involvement oversteps patient autonomy, highlighting the need for nurses to maintain a delicate balance. Training in communication and conflict resolution, therefore, becomes a critical skill for informed application in such scenarios.
Conclusion
In conclusion, complex problem solving and shared decision making are integral to delivering high-quality care in older people nursing, with patients and families playing a central role. This essay has outlined the significance of SDM in promoting autonomy, the challenges of addressing multifaceted health issues, and the practical strategies nurses can use to enhance collaboration. While these approaches offer substantial benefits, limitations such as resource constraints and differing stakeholder perspectives must be acknowledged. Indeed, the implications for practice are clear: nurses must develop specialist skills in communication and problem solving to navigate these complexities effectively. Ultimately, prioritising patient- and family-centred care ensures that interventions are not only clinically sound but also personally meaningful, fostering better outcomes for older adults.
References
- Back, A.L., Arnold, R.M., Baile, W.F., Fryer-Edwards, K.A., Alexander, S.C., Barley, G.E., Gooley, T.A. and Tulsky, J.A. (2009) Efficacy of communication skills training for giving bad news and discussing transitions to palliative care. Archives of Internal Medicine, 167(5), pp.453-460.
- Elwyn, G., Frosch, D., Thomson, R., Joseph-Williams, N., Lloyd, A., Kinnersley, P., Cording, E., Tomson, D., Dodd, C., Rollnick, S., Edwards, A. and Barry, M. (2012) Shared decision making: A model for clinical practice. Journal of General Internal Medicine, 27(10), pp.1361-1367.
- National Institute for Health and Care Excellence (NICE) (2016) Multimorbidity: Clinical assessment and management. NICE.
