This essay aims to critically discuss nurses’ role in ensuring that an

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This essay aims to critically discuss nurses’ role in ensuring that an individual living with the Human Immunodeficiency Virus (HIV) is given person-centred care (PCC). This will be examined through the theoretical framework of feminist ethics of care (Green, 2012). Gender and feminist theories encompass a broad range of perspectives, where feminism originated in a demand to break down structural inequalities between men and women, and gender theories strove to identify and recognise the socially constructed nature of gender, identity, and expression (Chapman, 2018). The feminist political economists argued that the rules governing the global political economy are inscribed with gendered meanings (Marchand and Sisson Runyan, 2000) and nursing is embedded in this gendered, cultural, and socially diverse context of relationships. The feminist ethics of care recognises and challenges the political nature of care (Gilligan, 1982; Green, 2012). The feminists critically examine the ethics of care from the standpoint of people who have been systematically marginalised and are placed in a vulnerable position (Gilligan’s 1982). Person-Centred Care (PCC) The origins of PCC could be traced to the humanistic psychotherapy. Carl Rogers (1951) viewed this as unconditional positive regard where a person is loved, valued and respected. It involves the unconditional acceptance of someone and showing compassion to a person regardless of who the person is (Bozarth, 2013). This conditional positive regard makes people see themselves the way they are, it promotes congruence which is a core condition of person-centred theory (Rogers, 1959). Caring for patients in a person-centred way within in a complex, dynamic and uncertain clinical environment require nurses to professionally prioritise the care need of the patient and make choices that will improve health outcome (Lake, Moss and Duke, 2009). Since decision-making only occurs where there is uncertainty about the choices to be made (Muir N 2004), PCC requires nurses to make regular and proactive clinical decisions, not just about patients but making decisions with the patients (Gurbutt, Russell 2006). PCC is viewed as an ethical panacea and a perceived solution to excessive paternalism in clinical medicine (Pulvirenti, Mcmillan and Lawn, 2014). It is a paradigm shift from the doctors knows best (Elwyn et al., 2017) that promotes self-determination decision making, thereby changing the power dynamics so that the person rather than the treatment is at the centre of the response (Pantelic et al., 2018). PCC is underpinned by the four themes of the Code of Professional Standards of Practice and Behaviour for Nurses and Midwives which emphasised the importance of nurses prioritising people, effective practice, preserving safety, and promoting professionalism and trust (NMC 2015). McCormack and McCance’s (2006a,b) person-centred nursing conceptual framework view human through four aspects of being: in relation, in a social world, in place, and with self. The prerequisites for person-centred nursing include the attributes of the nurse, the care environment, person-centred processes, and expected outcomes (McCormack & McCance, 2006a, b). Attributes for the nurse include professional competence (e.g., knowledge, skills, decision-making, and technical ability), interpersonal skills, commitment to providing quality care, and clarity of beliefs and views. Expected patient outcomes include satisfaction with care, involvement, subjective well-being, collaboration, and psychosocial support. From the feminist ethics of care standpoint, person-centred decision-making requires a holistic assessment that includes understanding the patient’s lifestyles, culture, beliefs, preferences and value. Person and relationship-centred care emphasised the importance of‘ knowing the person ’in order to achieve a connection with the patient (Dewing,2004). After the recognition of patients’ needs and interpretation of their illnesses, nurses are to make a decision on the best interventions that will be the most suited to each patient (V. Papathanasiou, 2015). This framework clearly fits with the recommendations for HIV nursing, which requires focusing on the whole person rather than just treating their physical symptoms (NHIVNA, 2018). Decision making is central to promoting self-management and empowerment for patients with long-term health conditions like HIV and shared decision making (SDM) has been found to help patients to take an active part in decisions that affect their care. SDM refers to the practice of giving patient informed choices on their care option and treatment and involving them as an equal partner during the process of designing their care and treatment (Stiggelbout et al. 2015). The patient‘s religion, social, ethnicity, sexual orientation and beliefs should be taken into cognisance when making a decision (Ahmad et al., 2014). Different nursing theorists have stipulated that the nurse-patient relationship is central to effective nursing care (Feo et al., 2017). Nurses are trained to take a competent decision in caring for people (NMC, 2010), and knowing the patient circumstance and preference is an important means for influencing decision‐making (Gabrielsson et al., 2014). However, this could lead to stereotyping, prejudice and wrong perception. SDM could result in conflict, where allowing patients an overwhelming influence over their care decision can compromise the patient’s recovery/well-being. Furthermore, nurses may feel that their expertise is being ignored while the patient would believe that they are in the best position to determine what is good for them. Additionally, nurses, clinical decisions can be influenced by modern ethical beliefs as a result of prior education/knowledge thereby making decisions based on their prior experience, rather than working with objective data at a given period (Thompson and Dphil, 2003, De Chesnay, Mary; Anderson, 2008). To avoid conflict in decision making which could prevent the delivery of effective and evidence-based care, nurses should give adequate consideration to patient’s choices; avoid assumption and prejudice that may influence decision-making process (Nibbelink & Brewer, 2018).