Table 3.

Overview of Themes

Themes	Enabling factors	Inhibiting factors	Environmental issues
A positive culture of collaborative and reciprocal relationships	Trust and communication Existing culture of relationship-centred care Role of the Registered Nurse: knowing the personhood of the resident & being able to adapt & respond with careful regard to each resident as an individual.	Time pressure, low staffing levels, inadequate skill mix and knowledge levels of staff	Management support and participation are necessary conditions for SDM
Willingness to engage and a willingness to become engaged	Suggested strategies to facilitate SDM: for example, developing the skills of staff in relation to SDM, and assigning a key worker for each resident to support SDM	Lack of competence & confidence by staff in how to apply SDM in their conversations Residents and families’ unpreparedness for SDM	Staff assume that people with dementia are no longer able to talk about their preferences. Residents & families acquiesce, deferring decision-making to the staff
Communicating with intent to share and support rather than inform and direct	Balancing an appropriate level of independence with an appropriate level of risk Seeing decision-making as a supportive process rather than a once off event	Paternalistic practices of staff	Top-down approach versus a bottom-up approach

SDM shared decision making