Patient participation in nursing care from a patient perspective: a Grounded Theory study.

UNLABELLED: the study's rationale: Patients' active participation in their own care is expected to contribute to increased motivation to improve their own condition, better treatment results and greater satisfaction with received care. Knowledge of patients' understanding of participation is of great importance for nurses in their efforts to meet patient expectations and for quality of nursing care. AIM: The aim was to explore the meaning of patient participation in nursing care from a patient point of view. METHODOLOGICAL DESIGN AND JUSTIFICATION: Six tape-recorded focus group interviews with 26 Swedish informants described opinions on and experiences of patient participation. The informants consisted of patients in somatic inpatient care as well as discharged patients from such a setting. The Grounded Theory method was used and the data were analysed using constant comparative analysis. ETHICAL ISSUES AND APPROVAL: The ethics of scientific work was followed. Each study participant gave informed consent after verbal and written information. The Ethics Committee of Göteborg University approved the study. FINDINGS: The patients emphasised the importance of collaboration to improve participation. The core category, Insight through consideration, was generated from four inter-related categories: (i) Obliging atmosphere; (ii) Emotional response; (iii) Concordance; and (iv) Rights and their 15 subcategories. CONCLUSIONS: The meaning structures of patient participation in nursing care revealed from a patient point of view, seemed to mainly consist of not only external factors presented by the institutions -- by the professionals -- but also internal patient factors. The patients' view of participation should be considered to a greater degree in nursing practice and education, as should also further development of nursing care policy programmes, evaluation and quality assurance criteria. For further development, studies are needed in similar and other settings.

Patient participation in nursing care: towards a concept clarification from a nurse perspective.

AIM: The aim of this study was to investigate the meanings of the concept of patient participation in nursing care from a nurse perspective. BACKGROUND: Participation is essential and increases patients' motivation and satisfaction with received care. Studies of patient participation in nursing care are not congruent regarding definition, elements and processes. This lack of clarity is amplified by several terms used; patient/client/consumer involvement or collaboration, partnership and influence. Despite the fact that several nursing theories have emphasized the importance of patient participation, an empirically grounded theory has yet to be published. METHODS: Seven focus group interviews were held with nurses providing inpatient physical care at five hospitals in West Sweden. The focus groups consisted of Registered Swedish nurses (n = 31) who described the meaning and implementation of patient participation in nursing care. A Grounded Theory approach has been applied to tape-recorded data. Constant comparative analysis was used and saturation was achieved. RESULTS: Mutuality in negotiation emerged as the core category for explaining nurses' perspectives on patient participation in nursing care. It is characterized by four interrelated sub-core categories: interpersonal procedure, therapeutic approach, focus on resources and opportunities for influence. Mutuality in negotiation constitutes the dynamic nurse-patient interaction process. CONCLUSIONS: The study clarifies that patient participation can be explained as an interactional process identified as mutuality in negotiation based on four components. RELEVANCE TO CLINICAL PRACTICE: The results are important and can be used in nursing practice and education. Application in a clinical context means nursing care organized to include all the components presented. The results can also be used in quality assurance to improve and evaluate patient participation.

Hindrance for patient participation in nursing care.

UNLABELLED: THE STUDY'S RATIONALE: Patients' influence in health care through participation, freedom of choice and information, is laid down in laws, national and local directives. In nursing care situations, the degree to which a patient participates depends on the nursing staff. Accordingly, hindrances for patient's participation during nursing care is an important question for the nursing profession. AIMS AND OBJECTIVES: The aim was to focus on Swedish Registered Nurses opinion of hindrances for patient participation in nursing care and to uncover the informants' perspectives in depth. METHODOLOGICAL DESIGN AND JUSTIFICATION: The study was limited to inpatient somatic care and has a qualitative approach. Data were collected through seven focus group interviews with 31 Registered Nurses from five hospitals. An analysis of the tape-recorded interview material was made, combining elements of content analysis with aspects of the Grounded Theory approach. ETHICAL ISSUES AND APPROVAL: The ethics of scientific work was followed. The participants gave informed consent. Verbal and written information was given as a guarantee that all information would be treated confidentially outside the focus group. Formal approval by ethical committee was not required according to national and local directives. RESULTS: Hindrance for patient participation in nursing care comprised three themes: Competence, Influence of significant others and Organization and work environment, and their seven underlying subthemes. CONCLUSIONS: The study clarified factors, which individually or combined may be hindrance for patient participation in nursing practice. Professional nurses must be able to find a balance for their patients' participation in nursing care activities through identification and coping with the hindrances. The three themes and seven subthemes here identified, can be used in patient care and its' evaluation, like also quality assurance of care and work organization and in nursing education. For further development replication studies are needed, like additional studies of patients and significant others.

Patient participation in nursing care: an interpretation by Swedish registered nurses.

AIMS AND OBJECTIVES: The aim of this study was to clarify Registered Nurses' understanding of patient participation in nursing care. Objectives were to investigate ward nurses' interpretation of the elements of patient participation and its implementation. BACKGROUND: One goal of health care is patient participation. Registered Nurses must encourage the participation of their patients in nursing care situations. A right for patients to make their own informed choices is laid down in Swedish laws and national and local directives. The concept of patient participation can be interpreted differently and is thus difficult to implement and evaluate. Current nursing literature provides little clarity of the elements and processes of patient participation and conceptual definitions differ. DESIGN AND METHODS: A qualitative approach was applied and the Grounded Theory method used. Thirty-one Registered Swedish Nurses described the meaning of patient participation and its implementation in nursing care. Seven focus group interviews with nurses providing inpatient somatic care were carried out in five hospitals in west Sweden. RESULTS: Four properties, describing nurses' approaches and procedures, constitute patient participation. The properties are: interpersonal procedure, therapeutic approach, focus on resources, opportunities for influence. These properties were considered crucial for patient participation in a nursing care context. CONCLUSIONS AND RELEVANCE TO CLINICAL PRACTICE: The results clarify the concept of patient participation from a nursing perspective. A comprehensive description of important factors for patient participation could be made on the basis of nursing experience. This comprehensive description can be used in nursing care practice and its evaluation. The developed categories can be used in nursing care documentation of how patient participation is realized.