Person-centered shared decision-making in district nursing care on interventions to support independence in older adults with multiple chronic conditions: a video observation study

Older adults with multiple chronic conditions often have care needs who are complex, diverse, and intertwined with personal values and goals for independent functioning. Healthcare professionals achieve person-centered decision-making by aligning interventions with prioritized personal and care-related goals. Within the context of district nursing care (home-based nursing care), person-centered shared decision-making plays a critical role in supporting older adults to maintain their independence. However, there is limited insight into how person-centered shared decision-making about interventions to support independence is applied in district nursing practice. This study explored how district nurses engage in person-centered shared decision-making with older adults with multiple chronic conditions during discussions about interventions to support independent functioning at home. It examined how verbal and non-verbal communication contributes to the decision-making process and how these practices align with existing person-centered shared decision-making models. A non-participatory video observation design was used. Sixteen video recordings of intakes and care evaluations were collected across four district nursing organizations in the Netherlands. Verbal communication was reported using the Consolidated Criteria for Reporting Qualitative Research checklist, while non-verbal communication was analyzed using the guideline of Systematic Coding of Observed human Behaviour. Analysis of verbal and non-verbal communication showed that district nurses appeared friendly, interested, and encouraged older adults to speak. In addition, verbal communication analysis revealed that independent functioning was not assessed or decided upon in a structured, goal-oriented way. Independence was mainly discussed when raised by older adults or related to the referrer's care request. Eight verbal communication themes emerged: being informed at start of the conversation; initiating the conversation; exploring care needs; demonstrating attentiveness to the older adult; identifying care problems and care goals; presenting and discussing options; agreeing on district nursing care, and concluding the conversation. A person-centered shared decision-making model is crucial in district nursing care to support informed and collaborative decisions about interventions that promote independent functioning in older adults with multiple chronic conditions. This model should include preparatory and introductory phases, emphasize trust-building, and be co-developed with both district nurses and older adults. Effective implementation requires integration into professional education and training, as well as the development of a holistic geriatric assessment framework and communication skills training tailored to the context of district nursing care. Not applicable for this study.