Person-centered shared decision-making and data-informed district nursing care to enhance independence: Protocol for a feasibility study.

For nursing students

Study summary

This article describes a research study designed to explore how combining two specific nursing strategies—person-centered shared decision-making and data-informed care—can help older adults maintain their independence. The main goal of this feasibility study is not yet known, as the researchers are still in the planning phase; they haven't collected or analyzed any results yet.

The problem being addressed is that many older people want to stay independent, meaning they can manage daily tasks and live on their own for as long as possible. District nurses (who provide care at home) often use these two strategies separately: talking with patients about what matters most to them in decisions about their care, and using information from electronic records to understand how well a patient is doing over time. However, the researchers want to see if putting these together into one approach—the 'Data Nurse intervention'—is practical for nurses to use and helpful for older adults.

The study will take place across four different district nursing organizations in the Netherlands, covering both urban (city) and rural (country) areas. A total of 14 teams of district nurses will participate; eight teams will try out the new Data Nurse intervention, while six teams will continue with their usual care methods as a comparison group.

The 'Data Nurse intervention' has two main parts: 1. **Person-centered shared decision-making:** This involves nurses working closely with older adults to understand their personal goals and preferences when making decisions about their health and care. A special tool called the Patient Preparatory Tool for Shared Decision-Making will be used to help guide these conversations. 2. **Data-informed care using a digital dashboard:** Nurses will use a computer screen (a 'dashboard') that shows information from electronic nursing records over time, specifically about how well older adults are managing their independence in daily activities. This data helps nurses see patterns and plan interventions better. The process is continuous: they look at the data, discuss it with patients during team meetings or one-on-one, try new ways to support independence, document what happens, check if these new approaches work by looking at more data, and then adjust their plans as needed.

To understand how well this intervention works in practice before a large-scale study is done (which is why it's called a 'feasibility' study), the researchers will look at several things: * **Feasibility:** Is it easy for nurses to use? Can they fit it into their busy work? * **Acceptability:** Do patients and nurses like using this new approach? * **Fidelity:** Are nurses actually doing what is planned in the intervention as described? * **Experiences, Barriers, and Facilitators:** What do participants find good or difficult about it? What helps make it work well?

They will also look at some early signs of whether this approach might help older adults become more independent. This will be measured using a questionnaire called TOPIC-SF (which asks about daily activities) and by looking at information already recorded in electronic nursing records.

The study is designed to gather these initial insights so that the researchers can improve the Data Nurse intervention before testing it on a larger scale with many more participants. The first person was enrolled in this study around June 2025, and results are expected sometime after that. This research could help nurses find better ways to support older adults' independence by thoughtfully combining talking directly with patients about their care goals and using data from electronic records.

For educators

Teaching and appraisal notes

This protocol outlines a multicenter non-randomized feasibility study investigating the Data Nurse intervention—a novel complex intervention integrating person-centered shared decision-making (PCSDM) with data-informed district nursing care—to enhance older adults' independence. The primary aim is to assess the feasibility, acceptability, fidelity, experiences, and barriers/facilitators of this combined approach among Dutch district nursing teams and their older adult clients. A secondary aim explores preliminary effectiveness on independent functioning.

The study involves four district nursing organizations across urban and rural Netherlands, with 14 teams (8 intervention, 6 control) comprising approximately 84-109 nursing professionals and 210-294 older adults. The Data Nurse intervention has two core components: (1) PCSDM supported by a patient preparatory tool for shared decision-making; and (2) learning from data via a digital dashboard visualizing longitudinal independence data from electronic nursing records. This creates a continuous cycle of planning, documenting interventions to support independent functioning, discussing data during team reflection sessions with patients, evaluating outcomes, and adjusting strategies.

Primary feasibility/acceptability/fidelity measures include validated questionnaires (Feasibility of Intervention Measure, Theoretical Framework of Acceptability questionnaire), self-developed tools for fidelity monitoring through monthly meetings, focus groups, and interviews. Secondary preliminary effectiveness on independent functioning will be measured using selected domains of the TOPIC-SF questionnaire and electronic nursing record data. Patient perceived involvement in shared decision-making is assessed with CollaboRATE.

Data analysis will employ descriptive statistics and thematic analysis. This protocol aims to generate evidence for intervention refinement before a definitive trial, as no results are available at submission. The study is registered on ISRCTN (14972807), first participant recruited June 4, 2025.