Nursing Dissertation: Shared Decision Making and Patient Satisfaction

This dissertation examines the impact of shared decision-making on patient satisfaction within a healthcare context. The introduction establishes the importance of patient-centered care and the role of nurses and other medical personnel in influencing patient perceptions. It highlights the significance of shared decision-making, where patients actively participate in their treatment plans, and the benefits of this approach. The dissertation then delves into the problem, emphasizing the reduction of patient involvement in decision-making and its adverse effects on satisfaction, recovery rates, and mortality. It outlines the project's purpose: to analyze the positive impact of shared decision-making and to develop effective implementation processes. The literature review provides a comprehensive overview of existing research on the topic. The project description details the research design, data collection methods, and ethical considerations. The findings and conclusion section discusses the impact of shared decision-making on patient satisfaction, and provides suggestions and limitations. The project aims to provide a framework for healthcare organizations to improve patient outcomes through increased involvement in treatment decisions.

Running Head: NURSING 0
PATIENT SATISFACTION AND SHARED decision MAKING: DISSERTATION
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Contents
Chapter 1....................................................................................................................................2
Introduction............................................................................................................................2
Background.............................................................................................................................3
Rationale.................................................................................................................................4
Chapter 2....................................................................................................................................5
Description of the problem.....................................................................................................5
Purpose of the project.............................................................................................................6
Chapter 3....................................................................................................................................9
Literature review....................................................................................................................9
Chapter 4..................................................................................................................................15
Project Description...............................................................................................................15
Introduction-.......................................................................................................................15
Research problem.................................................................................................................15
Research design-...................................................................................................................16
Data collection-....................................................................................................................16
Data analysis-.......................................................................................................................18
Ethical consideration-...........................................................................................................19
Chapter 5..................................................................................................................................20
Conclusion and lesson learned.............................................................................................20
Findings-...............................................................................................................................20
Conclusion............................................................................................................................21
Suggestions...........................................................................................................................22
Limitations............................................................................................................................23
References................................................................................................................................24

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Chapter 1
Introduction
The medical world is primarily comprised of doctors, nurses, and patients. The most
important element is the patient as the whole story from the diagnosis to the treatment then
finally to discharge revolves around the patient (Banfield & Kay, 2012). The patient is
considered to be the first priority in the professional life of a doctor and nurse, where any
small problem faced by him or her is of the highest concerns. Most of the renowned hospitals
in the world are revered because their patients are of highest concern. These hospitals believe
in the motto of serving the patients in the best possible manner. These patients’ friendly
hospitals ensure that the needs of the patients are met in an effective manner. A patient visits
the hospital when he or she thinks that the self-heal process is not sufficient to cure himself or
herself of the disease.
The need for immediate medical attention for diseases or disorder makes the patient
visit the hospital. The doctors ensure that care is patient centered and effective. In the
hospital, it is not the doctors who are responsible for ensuring the greatest satisfaction to the
clients by providing the certain medications that can cure him of the disease but various
policies or strategies that are responsible for initiating the change in the organization (Barry,
2012).
Every employee interaction impacts overall patient satisfaction. Even, the security
guard who directs patients and family affect patient perception towards the working of a
hospital. In the hospital premises, the nurses, nursing assistants, transporters, and other
medicine personnel affects the perception of the patient towards the hospital.
Researchers reported that a patient never forgets how he was treated by the nurse or a
storekeeper that affects his decision-making capabilities towards the hospitals (Bazzoli,
2015). The reason behind this is that patients are emotionally lowest at such a point and
remember about every episode they encountered at the healthcare organization. The best
hospitals that were listed in the Forbes list had the well-trained staff to cater to the needs of
the patients in the best possible manner (cremdas, 2019).
Recently healthcare, CEOs recognize the importance of quality treatment of the
patients. Quality care involves being concerned about the core needs and requirements of the

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client and responding accordingly (Bethell, Newacheck, Hawes, & Halfon, 2014). The CEO’s
of the hospitals have changed their goals and objectives to focus for their organization to take
an empathetic approach.
Background
Shared decision-making is essential, as patients’ opinions and needs must be taken
into consideration. Shared decisions improve the patient and doctor relationship . These
decisions have the power to channelize the actions in a particular area.. In many of the
surveys, it was claimed that it is essential to take the decision of effective treatment by
communicating with the patients (Bhargava, 2018). In one of the popular surveys, it was
reported that around sixty-five percent of the patients claim the need to involve themselves in
the decision-making process (Boucaut & Cusack, 2016).
. Although, shared decision-making is important. A majority of the hospitals do not
actively practice it.. Some of the reasons behind this are lack of awareness of the patients,
non-willingness of doctors, and high risk involved in it. Most of the patients are not aware of
their rights and they can freely entertain their opinions with the doctors regarding their
treatment (Borghuis, 2016).
The lack of awareness makes patients hesitant to discuss their opinions in the
treatment and in the end, they merely defer to their doctors. The other reasons include the
unwillingness of the doctors to entertain the opinions of the patients in the treatment as they
find it quite tedious to completely satisfy patients (Boucaut & Cusack, 2016). Moreover, the
doctors often believe that their opinions are the best and that they do not need to take into
account the opinions of their patients. Some physicians consider it the waste of time in the
decision making process.
More recently, the concept of shared decision making have gained importance in the
healthcare . The reason for gaining the importance of the patients’ rights are being taken care
of. When shared decision-making is applied, all the pros and cons can be addressed, And the
patient feels quite safe with the treatment (Coulter, 2016)... There are some of the changes
that are being deployed in some of the hospitals, these changes are related to the shared
decision making are important for the hospitals to get into the top-ranking category
(Connelly, 2014).

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Rationale
The project is intended to address the impact of shared decision making on patient’s
satisfaction. Shared decision making is important in achieving the higher degree of
understanding among the patients and hospital staff. As one of the greatest challenges in the
health care is achieving the highest satisfaction level among patients as there are various
instances where the high level of conflicts between the hospital staff and patients that be only
be overcome if the steps are taken to achieve the highest level of patient satisfaction among
the patients through various programs and initiatives.
Chapter 2
Description of the problem
The decisions of the patients play an important part in the treatment. It is one of the
important components of the patient’ssatisfaction. In today’s scenario, the role of the patients
in taking decisions have reduced while the doctor’s role in directing them towards certain
medication has increased. This culture has led to decreased satisfaction of the patient’s in
their treatment. Sometimes, there decreased satisfaction is contributed to the low rate of
recovery where it becomes difficult for the patients to recover effectively as it affects their
psyche. The following project will accomplish the correct rationale behind how shared

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decision making affects the patient’s satisfaction positively. The project will be helpful in
developing the right processes and models to ensure greater patient satisfaction at hospitals.
The project comprises of great benefits for the community as it will result in greater
patient involvement, high recovery rate, decreased mortality rate, better coordination, and
innovative methods of treating patients. The first benefit for the target community would be
greater patient involvement where the patient will have the say in the treatment provided to
him which would ensure greater transparency in the medical procedures. The patient would
be in the position to say no to treatment if he or she does not find it suitable according to the
body. He can even guide the doctor towards the right way of getting operated in the best
manner effective manner.
The second important benefit to the community would be high recovery rate where
the patient would be quite positive that he or she will be able to gain the best health after the
treatment as his or decisions are involved in the recovery rate. It is considered that the
recovery of the patient depends upon the mindset he or she has regarding the particular
disease (Doenges, Moorhouse, & Murr, 2016). The high involvement of the patients in their
treatment will result in better satisfaction thus resulting in fast recovery. The third important
benefit for the community is decreased mortality rate, the low involvement of the patients in
taking the decisions concerning their treatment, sometimes make the doctors ignore the
important facts related to the patient’s health (Doenges, Moorhouse, & Murr, 2016).
The doctors’ approach in treating the patient becomes adamant where an individual
has to simply listen to the doctor prescription and to act accordingly. The patient’s right
towards their recovery gets affected and he finds himself in the fearful position to act in a
certain way. The shared decisions making approach opens the doorway for the patient to
freely put the views on his treatment Infront of the doctors. The fourth important benefit is
better coordination, the shared decisions making approach leads to better coordination
between the patient and the doctor where the doctor is in the position to provide the
customized treatment to the patient. The patient is able to get the right treatment according to
the needs mentioned thus leading to a high degree of coordination and understanding between
the two. It also ensures long term understanding and client building.
The last important benefit to the community is the development of innovative
methods for treating patients, the good level of interaction of the patient and the doctor leads

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to a high degree of exchange of the information related to the medical issues. The exchange
of the valued information is quite beneficial for the doctors and hospital administration to
come up with the innovative ways of doing things (Dranove & Garthwaite, 2016). These
innovative procedures are helpful in achieving the stated goals of the medicine where they are
helpful in completely satisfying the needs of the patients. The interaction of the doctor with
the patients develops their understanding of the needs of the patients thus leading to the
formulation of procedures (Li, Guthridge, Lawton, & Burgess, 2019).
As a nursing professional, the project will be highly beneficial as it would result in a
high degree of understanding with the patients. It will be helpful for the nurses to successfully
be able to implement the procedures in its place after discussing with the people in the
organization. the nurses will be able to come up with the procedures to get the things done in
an effective manner. The other important aspect would be that they will be able to implement
atherapeutic relationship with the patients. As the patients will be involved in taking the
decisions that will be helpful in building a strong connection with them thus leading to a high
level of understanding with the patients (Lieberman, 2018).
Purpose of the project
The following project is made on judging the impact of patient satisfaction on the
shared decision making in the hospital. The objectives of the following project are-
 To analyze the positive impact of shared decision making on patient satisfaction.
 To develop effective processes to initiate shared decision making at the hospital.
The objectives of the project are to analyze the positive impact of shared decisions
making on patient satisfaction. According to various studies, it was analyzed that patient
satisfaction can be achieved when there is involvement in the decisions making process. The
patients feel highly satisfied as they have the notion that their decisions are welcomed and the
doctors will provide them with the safe treatment. The psychology of the patients gets
affected positively and their conditions will result in effective outcomes. According to
various studies it was estimated that there is a high level of understanding with the people
where they have to get these things or various operations done.
The patients start feeling the bonding with the hospital and they become the hardcore
loyal client of the hospital. The shared decisions making results in great achievement among
the people. In one of the studies also it was reported that the highest recovery rate of the
patients can be achieved when the patients are involved in the decision-making process as

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they direct the medical staff towards the right treatment based on their needs and
requirements.
It also contributes to the openness of the patient where they can easily offer suggestions
to the hospital administration regarding their treatment or the medication to be provided to
them. The step is highly helpful in providing the customized services to the patients that
results in a high degree of customer satisfaction leading to hardcore loyal employees of the
hospital. Moreover, in one of the surveys that were conducted, it was reported that around
seventy percent of the respondents who were patients wanted the process of shared decisions
making in the organizational culture.
The development of effective processes to initiate shared decisions making is important
because, without it, the patient satisfaction cannot be achieved. In the past, various decision-
making processes have come up that has resulted in greater patient satisfaction (Macklin,
2015). These models and process have been of great help for the easy implementation of the
processes where the high level of understanding led to better projects in the hospital
administration.
Many doctors and medical researchers have come up with the motto to get the things
done in an effective manner. There were various programs in which many patients in the
hospital participated where they put forth their views and arguments in favour of involving
them in the process of decisions making process. In past, in some of the hospitals, various
educational programs were organized where patients were told regarding the high level of
involvement in meeting their requirements and personal goals (Paediatric Nursing).
These models have been of great help where they have achieved alow mortality rate and
high functioning in the areas of great expertise where it became easy to achieve the goals and
tasks in the hospital. The patients have become less fearful about asking the question or
counteracting the doctor’s decisions. They have become more mindful of the rights of asking
for help in the hospital in the best manner possible. the techniques have given patients the
reason to achieve the goals and objectives of the people in an effective manner (Fitch,
Fliedner, & O’Connor, 2015).
In recent times, the doctors and the hospital staff of the administration are trying to
research various means where the right way of doing things are helpful in achieving the
goals. These areas have been of great helpwhere its hospital objectives in the best possible

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manner. The other important reason is the growing patient awareness regarding their rights
and duties as a patient in the hospital.
The patients have become mindful of the goals and rights at the hospital thus leading to a
high degree of understanding and things among the target group of the people where the
patients have used the best way of doing the things in an effective manner. The doctors and
the other medical staff have tried a number of ways of achieving things and the goalsof the
highest satisfaction of the patients in the area of the study in the best possible manner.
Chapter 3
Literature review
In the recent study by the American academy of orthopaedic Surgeons where it has
conducted a survey on 550 patients in the orthopaedic department (Hegarty, Amoore, &
Blackett, Healthcare Technology Management A SYSTEMATIC APPROACH, 2017). The
patients were suffering from various orthopaedic conditions that included slipped discs, and
osteoarthritis. A survey was conducted where the measurement of the patient’s knowledge
regarding their condition and their quality of life with the disease was analyzed. The survey

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was initially conducted before the surgery and after six months of the surgery. The objective
of doing the survey was to be aware that how the patient-centric decision affects the outcome.
After the analyzation of the result, it was found out that the highly knowledgeable
patients who were minutely aware of the diseases they are plagued with, were able to take the
well-informed decisions. Moreover, quality of life was also good. Around 71 percent of the
patients were far more satisfied than the rest of the group. It could be concluded the
shareddecisions making is quite helpful in getting the things done in an effective manner
(S.Deacon, 2012). The other results of the survey included that the patient who was permitted
to take the shared decisions were in the position to manage their pain in the better manner and
were in the position to make the informed choices. In the university of Wisconsin school of
medicine, who have taken the initiatives to involve the surgical patients in taking the
decisions related to the surgical treatments. According toROBERT, the directed set of
questions were helpful in keeping the patients of the hospital informed thus improving their
customer satisfaction (ROBERT, 2016).
The process of asking questions before beginning the surgical procedure was recorded
in the journal of JAMA Surgery. The article in the journal reviewed the patient engagement at
the hospital in their treatment. The procedure was done to ensure how the effective outcome
comes after deploying the questionnaire. The questions that were asked should I have
surgery?” what should I expect if everything goes well?” “What happens if things go
wrong?” (S.Deacon, 2012). In this way, around eleven questions were asked where the
patients were able to achieve the right outcome after the surgery (Mackey & Bassendowski,
2017). The right set of questioning hada great effect on the patient’s health. Shared decision
making led to ahigh percentage of successful surgical operations. After a year, the hike in the
successful surgical operations was recorded in the hospital.
In the past various surveys and the studies were conducted to analyze the health
literacy among the people it was found that among the European countries, Germany is the
country where more than half of the population had limited literacy level. The result of
Germany came out after the analyzation when it was recorded that the respondents who were
involved in the shared decisions making process were 4.02 times more satisfied than the
respondents who were not involved with the satisfaction level of 2.06 times (Valdovinos &
Le, 2015). The respondents were the patients in different European countries who were
evaluated on the treatment rendered to them by their GP.

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According to Franklin, the main reason for the lack of the process of shared decisions
making is due to the capitalistic nature of various hospitals in European countries (Franklin,
2018). Many hospitals in the country are of the view that involving patients in the decision-
making process involves high cost and time leading to the delay in the decision-making
processat the hospital. Although many hospitals have claimed that there is lack of shared
decision process at various hospitals but the momentum of involving the decision making is
gaining as people are getting aware of the situation (Giluk, 2015).
One of the research papers on informed decision making was published in the
Elsevier journal with an objective to justify the role of the shared decision-making process in
the satisfaction of the patients. The research design included 130 patients who were suffering
from various disabilities and were suffering from extreme pain. Their medical condition was
recorded in the audio and was coded by independent coders (Olfson, 2016). In the study,
around eight ISDM elements were evaluated with ISDM score.
In the study, the various questionnaire was used that included the disabilities of the
arm, hand and shoulder questionnaire, and the patient health questionnaires’. There was
another index that was used, one such index was whitely index which was helpful in
assessing the satisfaction among patients. In the results, the lees health anxiety was reported
among the female gender (Dries, 2013). The reason for the less anxiety among the female
patients was due to the incorporation of shared decision-making technique. The study was
concluded with the importance of the various psychologic factors that are achievable with the
shared decision making thus leading to a high level of patient satisfaction.
According toDurey, Wynaden, Thompson, Davidson, & Bessarabia,the informed
shared decisions making process has been of great help in treating the patients with various
diseases (Durey, Wynaden, Thompson, Davidson, & Bessarab, 2012). Some of the other
authors claimed that it is very helpful in treating patients suffering from depressive disorders.
The reason behind the reduction in the depressive disorder is that depressed patients feel that
their opinions are welcomed and they have the say in their treatment (Fowler, Kirkham, &
Sawatzky, 2011). The acknowledgement given to the depressed patients helps them in curing
them of the negative thought process.
The process of shared decisions making is also helpful in supporting psychiatric
patients who are abused by various substances as shared decision making is helpful in
effective decisions making. Except for these, mental disorders, the shared decision-

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makingtechnique has been of great help in treating the high level of diseases that require a
high level of medication to treat it. Some of the deadliest diseases include inflammatory
bowel syndrome and chronic liver disorders. These disorders hamper the normal lifestyle of
the patients that affect normal working.
According toFeltham,the informed shared decisions making helps the patients to
overcome the fearful conditions of the diseases (Feltham, 2015). Among the Japanese
patients, the shared decision making was used so that the patients can discuss the insecurities
and problems with the doctors and nurses. The patients will be able to get effective advice
from their doctors or nurses as they would guide them towards the better life-related
adjustments as per the diseases suffered by them.
The shared decisions making process is the most important to achieve the greatest
patient satisfaction. The decision-making process is affected by various factors that include
Costs, choice, and efficiency. The cost is another important factor for the patientto consider
obtaining the services of shared decision making. According to Elwyn,patients usually care
less about the cost of care as the cost is usually paid by the insurance company (Elwyn,
2012). It can be concluded that patients are ready to invest to obtain the services of shared
decision making.
The other important factor is choice, every patient has different choices some like
obtaining the services of the shared decision making while some do not. According
toNational learning consortium,patients are prone to obtaining the advice in the form of
shared decision making as it would result in better outcomes for their health (National
learning consortium , 2018). In the study conducted, it was also reported around fifty percent
of patients like shared decision option (Donnelly & Martin, 2016). The other important
factor is of efficiency of the care process that explains the relationship between patient
satisfaction and shared decisions making.
Some of the patients are already of the view that the care process system of their
hospital is already efficient so they would demand the shared decision making at the hospital
(Haimi & Lerner, 2016). Secondly, the patients already have enough knowledge about the
diseases and its consequences so there is no need forshared decisions making for them.
Thirdly, there are patients who are fearful when their opinions are not welcomed in the
hospital so it becomes really essential from them to welcome the opinions thus leading to the
need for shared decisionsmaking (Hatzenbuehler, O'Cleirigh, & Grasso, 2012).