encourage patient participation during Fundamentals of care in the hospital: a qualitative study

Abstract

SUMMARY Rationale: In response to population ageing, healthcare policy emphasises the importance of encouraging older patients to participate in their care. The importance and positive effects of patient participation (PP) are clear but it is still not known how nurses can stimulate this participation. Such knowledge would be highly valuable for the nursing profession as it would help to optimize PP and improve quality of care. Aim: To gain insight into how nurses can encourage patients to participate during fundamental care delivery. Method: An ethnography study using participatory observations and content data analysis was conducted. Nurses who provide fundamental care to patients in the geriatric ward of a general hospital in the Netherlands were observed. Results: The nurses’ (n = 10) behaviour with regard to PP reflects four major themes: an established relationship; surrendering of some power/control; shared information and knowledge; and active mutual engagement in intellectual and physical activities. Conclusion: The care seems to be task-oriented, whereby the nurses maintain control and rarely take into account the needs of the patient. Within this task-oriented care, all nurses show that they value building a nurse-patient relationship. The nurses stimulated self-care by giving patients orders. However, these orders do not arise from consultation with the patient and sometimes information is not shared. Identified hindering factors for participation were the patient characteristics’ and time constraints. Recommendations: The findings provide new and useful insights into facilitating PP in the geriatric patient population and are relevant to the problems facing “greying societies”. Follow-up research, should focus specifically on this growing demographic group and try to identify and implement methodologies to enable PP. In this implementation, training for the nurses is an important precondition for increasing their knowledge and ability to enable PP. Keywords: Ethnography, Observations, Patient participation, Fundamental care