Date of Award

Spring 5-27-2023

Document Type

Doctor of Nursing Practice Final Manuscript

Degree Name

Doctor of Nursing Practice

Department

Nursing

First Advisor

Theresa Nguyen, PhD, DNP, PMHNP-BC

Abstract

Purposes/Aims: The purpose of this Doctor of Nursing Practice (DNP) project is to implement an evidence-based SDM approach in a culturally diverse community mental health clinic in order to increase patient-provider collaboration and improve patient autonomy and engagement in decision making processes of care in a mental health setting.

Rationale/Background: According to the Substance Abuse and Mental Health Services Administration (SAMHSA), shared decision-making (SDM) is a collaborative communication approach between patient and provider that aims to help people in treatment work together to have informed, meaningful discussions about their health care decisions. SDM is an evidence-based approach to encourage and improve patient-clinician interaction in preference-based care. Mental health SDM is associated with increasing satisfaction of care, improving patient medication adherence by 9%, reporting fewer psychiatric symptoms, and decreasing hospitalizations by 20%. Existing research has identified several barriers to implementing mental health SDM into clinical practice at the provider level. These barriers include the misperceptions about the competence of patients to make treatment decisions, cultural considerations, time limitations, and lack of skill in risk communication.

Methods: The DNP-Psychiatric Mental Health Nurse Practitioner (PMHNP) student will provide an in service rooted in the Seek, Help, Assess, Reach, Evaluate (SHARE) Approach model to PMHNPs at a community based mental health clinic located in San Diego, CA. The SHARE Approach model was developed by the Agency for Healthcare Research and Quality (AHRQ) and is a systematic, five-step process for SDM which includes exploring the potential benefits, harms, and risks of treatment options through meaningful dialogue about the patient’s priorities. The DNP-PMHNP student will measure patient extent of involvement in the decision-making process from the perspective of both patient and provider during a psychiatric encounter using the Shared Decision Making Questionnaire (SDM-Q 9). The SDM-Q-9 will be measured across 20 patient-PMHNP interactions both pre and post in service. The IOWA Model for evidence-based practice will be used. Using the Iowa Model will allow the DNP-PMHNP student to clearly identify the need for clinical practice improvement and integrate empirical evidence to support this change efficiently and effectively. This model also allows for important feedback loops to cycle back when barriers present throughout the implementation process.

PICO: In a sample of 20 out-patient, community adult mental health patients in April 2023, how does implementing a structured SDM approach affect the patient’s perception of involvement in the decision-making processes during routine encounters with PMHNPs?

Assessment of findings: There was an overall increase in perceptions of involvement in SDM from both patient and provider after the SDM SHARE Approach was implemented. Patients voiced gratitude and felt more involved in their care. NPs found the training helpful, easy and efficient to incorporate, and report it gave them more structure to appointment.

Implications for Practice: This intervention will improve knowledge about SDM among PMHNPs. This will aid in standardizing and structuring SDM practice. Having a structured SDM approach in mental health care will reinforce a patient-centered treatment model as a result of making more informed and personalized treatment plans. Focusing on practices to improve SDM for PMHNPs will ensure nursing care can continue to go beyond the traditional model of health care. This intervention will continually address cultural considerations, potential barriers, uphold autonomy, provider-patient relationship, and empowerment that will lead to better outcomes in mental health care treatment.

Keywords: shared decision-making, Seek, Help, Assess, Reach, Evaluate (SHARE) Approach, mental health, Patient-Centered Care

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