Ömsesidighet i förhandling. Sjuksköterskors förutsättningar för och erfarenheter av att främja patientdelaktighet.

Abstract

The overall aim of this thesis was to find theoretical structures in order to explain the phenomenon of patient participation as it is described by nurses. Data collection were obtained from focus groups (10) with nurses (47) providing inpatient somatic care at five hospitals in West Sweden and by a systematic analysis of published research literature (30) between 1996-2005. This thesis includes five papers.

Grounded Theory has been described and used to clarify the meaning of patient participation in nursing care. “Mutuality in negotiation” emerged as an explanation of nurses’ perspectives on patient participation in nursing care. It is characterised by four interrelated dimensions: Interpersonal procedure, Therapeutic approach, Focus on resources and Opportunities for influence. A thematic content analysis has been described and used to illustrate nurses opinion of hindrances for patient participation in nursing care. Hindrances in nurses’ work situation were identified: Competence, Influence of significant others and Organisation and work environment. A qualitative, inductive content analysis has been described and used to illuminate nurses’ strategies in order to stimulate and optimise patient participation in nursing care. The strategies were identified as: Building close cooperation, Getting to know the person and Reinforcing self-care capacity. Concept analysis according to Walker and Avant has been described and used in order to identify and explore the attributes of the concept of patient participation, to clarify and elucidate the meaning within the context of nursing practice, as it is described in empirical studies. Patient participation in nursing practice can be defined as an established relationship between nurse and patient, a surrendering of some power or control by the nurse, shared information and knowledge, and active engagement together in intellectual and/or physical activities.

The results of this thesis have been summarised in a preliminary theoretical structure. To promote and stimulate optimum patient participation, a nurse needs to utilise deliberate guidance strategies in order to achieve mutuality in negotiation with the patient as an equal partner. A nurse should also be able to balance hindrances to patient participation in her work situation so that the patient is not unfairly treated. It is of vital importance for a nurse to integrate reflection as a pedagogical strategy for developing self-knowledge and personal knowledge. The nurse needs to continuously reflect on her own approach and the effects of her behaviour on the patient and vice versa. In order to fulfil expected obligations to promote optimum patient participation, adequate resources and support for nurses’ implementation of participation need to be provided by leaders at all levels of the health care system as well as by health care politicians.