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Patient och medaktör.: Studier av patientdelaktighet och hur sådan stimuleras och hindras,
University West, Department of Nursing, Health and Culture, Division of Nursing.
2008 (Swedish)Doctoral thesis, comprehensive summary (Other academic)Alternative title
Patient and co-actor : Studies of patient participation and how this  is stimulated and hindered (English)
Abstract [en]

Original title: Patient och medaktör. Studier av patientdelaktighet och hur sådan stimuleras och hindras. Title in English: Patient and Co-actor. Studies of patient participation and how this is stimulated and hindered. Language: Swedish with summary in English. Keywords: behaviour, Co-actor, Critical Incident Technique, barriers, focus group, Grounded Theory, nurse-patient relationships, nursing, patient participation. ISBN: 978-91-628-7410-0 The overall aim of this thesis was to contribute to the development of knowledge of what could strengthen patients’ participation in their own care by clarifying the phenomenon patient participation and describe how it is stimulated or hindered, respectively. Data collection were obtained from focus groups (13); with patients (26) and with nurses (31) and interviews; with patients (17) within inpatient somatic care at five hospitals in West Sweden. This thesis includes four papers. Grounded Theory has been described and used to explore the meaning of patient participation in nursing care from a patient point of view. “Insight through consideration” was generated from four interrelated categories: Obliging atmosphere, Emotional response, Concordance and Rights. Grounded Theory has also been used to clarify Registered Nurses’ understanding of patient participation in nursing care. Four properties emerged: Interpersonal procedure, Therapeutic approach, Focus on resources and Opportunities for influence. A thematic content analysis has been described and used to explore barriers for patient participation in nursing care with a special focus on adult patients identified as: Facing own inability, Meeting ignorance, Meeting a paternalistic attitude and Sensing structural barriers. A qualitative approach, using the Critical Incident Technique has been described and used to identify incidents and nurses’ behaviours that influence patients’ participation in nursing care based on patients’ experiences from inpatient somatic care, identified as: Regarded as a person, Engaged through information, Acknowledged as competent, Abandoned without backup, Belittled verbally, Ignored without influence. This thesis has clarified the fact that patient participation is something that needs to be worked on and further developed in health and medical care. This requires nurses as well as leaders at all levels to become aware of the rights and expectations patients have. To achieve optimum patient participation, patients need to be encouraged and supported by knowledgeable and dedicated nurses in order to increase their own control. In order to improve patient participation, traditional structures as well as attitudes of the caregivers need to be questioned and replaced.

Place, publisher, year, edition, pages
Göteborg: Institutionen för vårdvetenskap och hälsa, Göteborgs Universitet, Sahlgrenska Akademin vid Göteborgs Universitet , 2008. , 67 p.
Keyword [en]
Co-actor, Critical Incident Technique, barriers, focus group, Grounded Theory, nurse-patient relationships, nursing, patient participation
National Category
Nursing
Research subject
NURSING AND PUBLIC HEALTH SCIENCE, Nursing science
Identifiers
URN: urn:nbn:se:hv:diva-1911ISBN: 978-91-628-7410-0 (print)OAI: oai:DiVA.org:hv-1911DiVA: diva2:275673
Public defence
Hörsal 2119, Arvid Wallgrens backe, hus 2., Göteborg (English)
Supervisors
Note
Doctor of Philosophy (Health Care Sciences)Available from: 2010-03-03 Created: 2009-11-06 Last updated: 2010-03-03Bibliographically approved
List of papers
1. Patient participation in nursing care from a patient perspective: a Grounded Theory study
Open this publication in new window or tab >>Patient participation in nursing care from a patient perspective: a Grounded Theory study
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2007 (English)In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, Vol. 21, no 3, 313-320 p.Article in journal (Refereed) Published
Place, publisher, year, edition, pages
Wiley-Blackwell, 2007
National Category
Nursing
Research subject
NURSING AND PUBLIC HEALTH SCIENCE, Nursing science
Identifiers
urn:nbn:se:hv:diva-107 (URN)10.1111/j.1471-6712.2007.00471.x (DOI)
Available from: 2009-04-06 Created: 2009-04-06 Last updated: 2009-11-11Bibliographically approved
2. Patient participation in nursing care: an interpretation by Swedish registered nurses.
Open this publication in new window or tab >>Patient participation in nursing care: an interpretation by Swedish registered nurses.
2005 (English)In: Journal of Clinical Nursing, ISSN 0962-1067, Vol. 14, no 1, 35-42 p.Article in journal (Refereed) Published
Abstract [en]

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.

Keyword
concept, nursing care, nurse–patient relationship, patient participation
National Category
Nursing
Research subject
Nursing and public health science , Nursing science
Identifiers
urn:nbn:se:hv:diva-1782 (URN)10.1111/j.1365-2702.2004.00957.x (DOI)15656846 (PubMedID)
Available from: 2009-10-06 Created: 2009-10-02 Last updated: 2009-10-14Bibliographically approved
3. Nurses´behaviours that influence patients´ participation in nursing care: A critical incident analysis study
Open this publication in new window or tab >>Nurses´behaviours that influence patients´ participation in nursing care: A critical incident analysis study
(English)Article in journal (Refereed) In press
Keyword
Critical incident technique, nurse behaviour, nurse-patient interaction, patient participation, patient responses
National Category
Nursing
Research subject
NURSING AND PUBLIC HEALTH SCIENCE, Nursing science
Identifiers
urn:nbn:se:hv:diva-1924 (URN)
Available from: 2009-11-06 Created: 2009-11-06 Last updated: 2010-01-14Bibliographically approved
4. Patients perceptions of barriers for participation in nursing care
Open this publication in new window or tab >>Patients perceptions of barriers for participation in nursing care
2011 (English)In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 25, no 3, 575-582 p.Article in journal (Refereed) Published
Abstract [en]

Background: In many Western countries as in Sweden, patients have legal right to participate in own care individually adjusted to each patient's wishes and abilities. There are still few empirical studies of patients' perceptions of barriers for participation. Accordingly, there is a need to identify what may prevent patients from playing an active role in own nursing care. Such knowledge is highly valuable for the nursing profession when it comes to implementation of individual patient participation. Aim and objective: To explore barriers for patient participation in nursing care with a special focus on adult patients with experience of inpatient physical care. Methodological design and justification: Data were collected through 6 focus groups with 26 Swedish informants recruited from physical inpatient care as well as discharged patients from such a setting. A content analysis with qualitative approach of the tape-recorded interview material was made. Ethical issues and approval: The ethics of scientific work was adhered to. Each study participant gave informed consent after verbal and written information. The Ethics Committee of Göteborg University approved the study. Results: The barriers for patient participation were identified as four categories: Facing own inability, meeting lack of empathy, meeting a paternalistic attitude and sensing structural barriers, and their 10 underlying subcategories. Conclusions: Our study contributes knowledge and understanding of patients' experiences ofbarriers for participation. The findings point to remaining structures and nurse attitudes that are of disadvantage for patients' participation. The findings may increase the understanding of patient participation and may serve as an incentive in practice and nursing education to meet and eliminate these barriers, in quality assurance of care, work organization and further research. © 2011 The Authors. Scandinavian Journal of Caring Sciences © 2011 Nordic College of Caring Science

Keyword
Focus groups, barriers, hindrance, nursing care, patient participation
National Category
Nursing
Research subject
NURSING AND PUBLIC HEALTH SCIENCE, Nursing science
Identifiers
urn:nbn:se:hv:diva-1922 (URN)10.1111/j.1471-6712.2010.00866.x (DOI)
Available from: 2009-11-06 Created: 2009-11-06 Last updated: 2012-01-09Bibliographically approved

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