The roles of critical care nurses in shared decision-making.

Note. This chart illustrates the six themes associated with the critical care nurses’ roles in shared decision-making and the relationships among these situations. Unidirectional arrows between the labels indicate the order in which things occurred and the direction of their influence. Bidirectional arrows indicate the complementary relationships between them. The vertices of the two triangles facing each other indicate a paired relationship between the contents on both sides.</p

Additional quotes about patients’ difficult situations in decision-making.

CCNS, certified nurse specialist(s) in critical care nursing; CRRT, continuous renal replacement therapy; ECMO, extracorporeal membrane oxygenation; HTx, heart transplantation; ICU, intensive care unit; VAD, ventricular assist device. (DOCX)</p

Flow of analysis by affinity diagramming.

Note. 1) Label making: The qualitative data are divided into units that contain a single semantic content, and an original label is created for each unit. The original labels of Inagaki’s previous study [19] revealed “the actual situation of nurse participation in shared decision-making for patients with severe heart failure.” In this study, original labels were created for each patient’s difficult situations and nurses’ roles. 2) Label grouping: In the label grouping process, all cards are shuffled and arranged; the cards are repeatedly read to grasp the meaning and grouped according to affinity or similarity rather than preconceived notions into labels that denote the common theme of the group in a single sentence. Subsequently, the labels are further grouped. This step of labeling the top groups is repeated until the final group comprises five to seven labels. 3) Chart making: The logical relationships among the final labels are explored until a consensus is reached among the researchers and is diagrammatically presented.</p

Difficult situations in decision-making for patients with severe heart failure.

Note. This chart illustrates the six themes related to difficult situations in decision-making for patients with severe heart failure and the relationships at play in these situations. Unidirectional arrows between the labels indicate the order in which things occurred and/or the direction of influence. The vertices of the two triangles facing each other indicate a pairwise relationship between the content on both sides.</p

Additional quotes regarding the roles of critical care nurses in shared decision-making.

CCNS, certified nurse specialist(s) in critical care nursing; HTx, heart transplantation; ICU, intensive care unit; VAD, ventricular assist device. (DOCX)</p

An overview of patient decision-making, as described in interviews.

An overview of patient decision-making, as described in interviews.</p

Participant characteristics.

AimPatients with severe heart failure undergo highly invasive and advanced therapies with uncertain treatment outcomes. For these patients, shared decision-making is necessary. To date, the nursing perspective of the decision-making process for patients facing difficulties and how nurses can support patients in this process have not been fully elucidated. This study aimed to clarify the perceptions of critical care nurses regarding situations with patients with severe heart failure that require difficult decision-making, and their role in supporting these patients.MethodsIndividual semi-structured interviews were conducted with 10 certified nurse specialists in critical care nursing at nine hospitals in Japan. A qualitative inductive method was used and the derived relationships among the themes were visually structured and represented.ResultsThe nurses’ perceptions on patients’ difficult situations in decision-making were identified as follows: painful decisions under uncertainties; tense relationships; wavering emotions during decision-making; difficulties in coping with worsening medical conditions; patients’ wishes that are difficult to realize or estimate; and difficulties in transitioning from advanced medical care. Critical care nurses’ roles were summarized into six themes and performed collaboratively within the nursing team. Of these, the search for meaning and value was fundamental. Two positions underpin the role of critical care nurses. The first aims to provide direct support and includes partnerships and rights advocacy. The second aims to provide a holistic perspective to enable necessary adjustments, as indicated by situation assessments and mediation. By crossing various boundaries, co-creating, and forming a good circular relationship in the search for meaning and values, the possibility of expanding treatment and recuperation options may be considered.ConclusionsPatients with severe heart failure have difficulty participating in shared decision-making. Critical care nurses should collaborate within the nursing team to improve interprofessional shared decision-making by providing decisional support to patients that focuses on values and meaning.</div

Independent variables for loss to follow-up in HIV care.

<p>^a Odds ratio</p><p>^b Mantel-Haenszel method for binominal variables and conditional logistic regression for ordinal variables</p><p>^c Confidence interval</p><p>^d Stepwise, multivariate-adjusted conditional logistic regression</p

Simple linear regression.

<p>Risk difference (y-axis) was plotted as a function of the mean follow-up period in the interventional and control groups of each study (x-axis), and a simple linear regression line was fitted using the least squares method. The point at which the risk of cancer occurrence in the interventional group exceeds that in the control group was calculated to be approximately 12 years. rd, risk difference.</p

Publication bias of trials reporting gastric cancer in patients with <i>Helicobacter pylori</i> infection.

<p>OR, Odds Ratio.</p