Abstract
Patient participation in nursing care is a concept which has gained prominence in recent years, with the rise of consumerism meaning patients demand better quality service, and the proliferation of the internet resulting in patients becoming more informed about their health. Patient participation has become enshrined in current policy; for example, the Nursing and Midwifery Council in the UK revised their code of conduct in 2015 to ensure the interests of patients and service users are at the forefront of nursing care (Nursing and Midwifery Council, 2015). However, despite widespread belief of the benefits of patient participation, studies suggest this may be more rhetoric than reality.
The lack of progress towards true patient participation may be in part due to the ambiguity surrounding what it actually entails. As the authors point out, despite efforts to define the concept, it remains a complex issue which causes widespread debate. Therefore this study makes an important contribution to our understanding by exploring perceptions and preferences of patient participation from the patients’ perspective.
By including both quantitative and qualitative elements in the study design, the authors are able to present a range of information. An interesting point to note is that according to the Control Preference Scale, the majority of the patients in the study stated a preference for more passive involvement in their care. However, analysis of the qualitative responses to the survey suggests patients have more reasons for being active participants in their care than for being passive recipients.
Doherty and Doherty (2005), using the Autonomy Preference Index, also found patients’ stated preferences did not always correspond with their interview data, therefore it may be that the tool does not measure preference according to what the patients perceive participation to mean. There is much focus in the literature on the importance of involving patients in research. This extends to involvement in the planning of studies as well as data collection. Therefore, perhaps involving patients in the construction of a valid tool for assessing preference would provide more valid data in future studies.
Another possibility is that patients’ preferences reflect the persistence of the paternalistic model of healthcare, where the patient is a passive recipient of their care. Culture change is often met with resistance, and as the authors point out, patient participation cannot take place without the nurse surrendering some of their power and accepting the patient as an important partner in their care. The authors identify education as key to promoting patient participation, and to this end, nurse education programmes are now heavily focussed on patient-centred care.
However, with increased patient rights come increased responsibilities. The authors state that patients in their study were aware of the positive effects of participation in their care, and were willing to take an active role. Further research is required to explore barriers and facilitators to participation from patient, nurse and organisational perspectives. Patient participation is a complex issue, and one which is not going to be realised without action on various levels. This study provides important information about what participation means to patients, and will hopefully stimulate further research on this important topic.