Factors That Create Obstacles and Opportunity for Patient Participation

Science, Practice and Education DOI: 10.35279 / jewma201905.06 Factors that create Obstacles and Opportunity for Patient Participation

Susanne Stålenhag in Orthopaedic Nursing Care RN, BSc, Trauma and Reparative Medicine Theme, Karolinska University Hospital. Stockholm, The nurse plays an essential role in enabling the patient’s sense of Sweden. participation, but patient’s involvement is essential and wound healing often requires patient involvement. The aim of this study was to highlight factors that hinder patient care and provide opportunities for patient- centred care from a nursing perspective.

Eila Sterner ABSTRACT RN, PhD, Head of nursing Background development, Inst. dividual training in groups are needed. To increase Molecular medicine and The nurse plays an essential role in enabling the surgery, Trauma and patient’s sense of participation. Although it has patient participation through person-centred care, Reparative Medicine Theme, organisational change and the resultant develop- Karolinska University been several years since patient law was enacted, Hospital. Stockholm, the patient’s involvement in their own care is still ment of new routines are also important. This ap- Sweden. poorly understood in several areas. In many areas, proach to healthcare can also reduce stress. wounds occur in various forms. Wound healing often requires patient involvement. Implications for Clinical Practice A participating patient can lead to faster recovery, Aim higher quality of life, lower cost, and higher quality The aim of this study was to highlight factors that for health care. To achieve this, active leadership, hinder patient care and provide opportunities for a positive attitude from staff, encouragement, and patient participation in orthopaedic care from a support are needed for the patient. The work en- nursing perspective. vironment should be reviewed because it affects everyone in the healthcare sector. Methods Electronic databases, such as PubMed and Cinahl, BACKGROUND were searched using keywords from 2007-2017. Today patients have higher demands to participa- Fifteen articles were reviewed, both qualitatively tion in and influence healthcare. Access to infor- and quantitatively, and included in the content mation and the opportunity to express their ex- analysis. pectations before a scheduled operation have been shown to produce a more realistic expectation of 1,2 Results patient experience and self-reported health. As Our results show the importance of open commu- we live longer, the cost of healthcare increases. nication between nurses and patients, the routine Complicated operations can now be performed on and working methods used in healthcare facilities, ill, elderly, or physically weak patients. The care as well as the fact that an organisation which sup- period in the hospital is short and day surgery is ports a working person-centred approach is needed. often possible. For example, five to ten years ago Nurses and all members of the team need time for in Sweden, it was standard for patients undergoing reflection and guidance to accomplish the person- knee replacement surgery to stay in the hospital centred approach. for seven to ten days. Today, some patients can recover at home starting the day after this type Correspondence: [email protected] Conclusions of surgery. These developments place greater de- Person-centred care needs a new mindset to allow mands on the nurses and the multidisciplinary Conflicts of Interest: the patient to play a more active role. Skills and in-  None

journal of the european wound management association 2019 vol 20 no 1 49 team. Once home the patient’s task is to watch over the It is important to ask patients open-ended questions, lis- wound. They need to know when to contact their health- ten carefully, and allow time for the patient to express care team if something is not right, such as when they have himself.2,15,17 Improved communication, individualised a fever, the wound dressing leaks, they notice a smell, or care, shared decision-making, and patient education are when other problems related to the wound occur. other factors that lead to increased patient involvement and independence.15 Nursing involves both surgical and non-surgical care. Excellent nursing requires theoretical knowledge and an In one of the first literature reviews on person-centred care, ability to perform with an ethical approach.3 The patient person-centring is defined as an approach with four central is a specialist in his/herself and a valuable resource, but concepts: being in a relationship, being in a social world, they do not always feel like an equal partner in their own being in a place, and being yourself.18 Within person- healthcare.4 They are entitled to, and responsible for, de- centred care, the perspective is shifted from describing cisions that concern their own lives. The nurse can both “what” a patient is about to telling “who” a person is based facilitate the healing process and support the patient in on three parts: the patient’s story, forming a partnership increasing the feeling of well-being that can lead to an (i.e., the team’s collective knowledge of the patient), and improved quality of life.5-8 having a documented planned agreement.19 Placing the patient as the focal point, which is based on relationships For patients to become more involved in their wellness, and the need for a patient story, is actually not a new they need information, support, and knowledge about concept; one can read it already in Travelbee’s interaction medical treatments. Laws and regulations shape healthcare theory.20 Communication between nurse and patient is in Sweden just as in other countries. Swedish law states fundamental to good care. There are several touch points that health and medical care must be conducted in such a between Travelbee’s theory and person-centred care. She way that it meets the requirements for good care and that describes it as essential that all people have equal value, it must be based on respect for the patient’s self-determi- and that one should see each patient as a human being nation and integrity.9-11 Systematic quality work must also and not someone who is “sick.” With person-centred care, be performed in parallel12 to continuously develop and nurses are aware that suffering is subjective. Regardless of secure the quality of care. However, the goal of achieving the disease or diagnosis, the patient may experience illness high quality patient-centred care has proven difficult. differently, and the experience of health-related illness is therefore unique. The patient is always at the centre and Participation it is important to build a relationship from the beginning Patient participation is a vague and ambiguous concept. to meet the patient’s needs. Travelbee and person-centred The nurse plays a crucial role in encouraging and engaging care are thus aligned on the need for the patient story. The the patient, which in turn increases his or her self-esteem. nurse must be committed to taking the time to understand 13 To achieve this goal, collaboration based on communi- the needs of the patient. An important part of nursing cation and understanding of the situation is required.14 care is effective communication to increase the interaction Health and medical care have evolved from being tra- between nurse and patient.20 ditional and paternalistic to starting from the patient’s personal preferences.15 If the nurse has a positive attitude The key to following and finding meaning in the patient’s plus gives encouragement and support to the patient, it is story is understanding both verbal and non-verbal com- of great importance for participation and patient safety. 2 munication.21 All people are unique and have the right Being seen is of great importance to the patient’s sense of to good health regardless of their abilities and resources. participation.16 Patients are often satisfied with the treat- Therefore, it is essential to study the obstacles and op- ment, but less satisfied with information and participation. portunities that can affect the patient’s involvement from A well-informed and engaged patient is more likely to fol- a nursing perspective in the field of orthopaedics. low treatment plans and experience increased well-being.13 METHODS A person-centred approach requires participation from the Student papers can make differences and contribute to whole healthcare team. Person-centred care also requires the implementation of more in-depth research within the becoming familiar with another person’s perspective, and chosen area. To cover the current research field, online the ability to adapt working methods based on the pa- databases such as PubMed and Cinahl were used. Both tient’s needs and wishes. For the nurse, this means having qualitative and quantitative research were included in a holistic perspective, being honest and committed, and the content analysis22 to help answer the research ques- willing to show respect for the individual patient’s story.3 tion. Research articles in languages other than English

50 journal of the european wound management association 2019 vol 20 no 1 Science, Practice and Education and Swedish were excluded due to translation issues. The ened to acute care. Each phase of the systematic review was search strategy did not impose any language limitations. conducted by the author. The first step involved selecting the papers to include in the review. The second step was Data Gathering appraising the methodological quality of the included pa- The literature research began with a manual search strategy pers followed by extracting data from the papers. Finally, to obtain an understanding of the current area. The review a synthesis of the papers was prepared for presenting the question was identified using keywords and a combination findings. These different steps were described in the litera- of keywords with AND, OR, and NOT. The keywords ture by Caldwell.22 The articles were checked for quality Patient participation, Patient-centred care, Nurse-patient using criteria developed on a scorecard as published previ- relations, Nurse’s role, and Orthopaedics were combined ously.23,24 Fifteen papers met the quality criteria and were with Communication barriers and obstacles. The search included in the final analysis. was conducted with the consultation of an expert librarian, and papers published from 2007 to 2017 were collected. ANALYSIS The search strategy and results of different phases and To create the summary, the selected articles were tabulated combinations of the systematic review are presented in to facilitate overview and formulate conclusions.22, 25 Data Tables 1 and 2. were classified, and significant information was marked in color to organise the data into groups. Then the simi- Inclusion criteria were focused on articles where the survey larities and differences were identified and grouped into group consisted of people over 18 years of age and when different themes, categories, and codes.22,25 Two themes patient engagement was combined with orthopaedic care were identified: obstacles and opportunities for patient and nursing involvement. Unfortunately, orthopaedic care participation. Three categories were identified: commu- did not give any relevant results, so the search was broad- nication between the nurse and patient, working methods 

Table I. Summary of search strategies used in this review. Search strategies using databases such as PubMed and CIHNAL, keywords and their combinations are listed.

DATABASE KEYWORDS HITS ABSTRACTS ARTICLE(S) DATE AND COMBINATIONS READ INCLUDED

PubMed Patient Participation and Patient-Centred Care 99 20 7 171129 AND Nurse-Patient Relations AND/OR Nurse’s Role

PubMed Patient Participation AND Patient-Centred Care 88 10 0 171129 AND Nurse’s Role

PubMed Patient Participation and Patient-Centred Care 25 4 1 171129 AND Nurse-Patient Relations AND/OR Nurse’s Role AND/OR Communication Barriers AND/ OR Hinders

CIHNAL Participation and Orthopaedics and Patient 127 (126 10 (1 – same as 171205 unique) in Pubmed)

CIHNAL Participation and Person-Centred and Patient 82 (80 10 (2 – same as 171205 unique) i n PubMed)

CIHNAL Participation or Person-Centred or Nurse 26 (24 5 (2 – same as 171206 unique) in PubMed)

Manual Search and Articles from 7 7 Supervisor and Colleagues

Total 454 (449) 66 15

journal of the european wound management association 2019 vol 20 no 1 Table 2. Strategy employed to select the 15 articles reviewed for this study.

Articles based on the titles (n=449)

Rejected because abstract did not confirm the inclusion criteria (n=380)

Articles based on the abstract (n=70)

Rejected because abstract did not confirm the aim (n=55)

Articles based on full-texts (n=15)

Qualitative articles Qualitative articles full-text (n=12) full-text (n=3)

and routines in the healthcare unit, as well as obstacles and more convenient way for them to relate.29 This response opportunities for patient participation from an organisa- might be due to a lack of understanding of how to invite tional perspective. (See Table 3). them into the conversation and increase their confidence.29

RESULTS Obstacles - Routine Obstacles - Communication Between the Nurse and The nurse usually worked routinely, especially on days Patient with higher stress.26 Furthermore, today’s system of rounds does not encourage teamwork or interprofessional com- There was less communication with the patient when munication, which leads to frustration and reduced nurs- nurses did their work without involving the patient. The ing quality.31 For example, even though nurses wanted to nurses wish to have more control over how the work should invite patients to take care of their usual medication, the be performed with no interference, and thus, would rather nurses felt bound to rules and regulations for fear that provide care themselves instead of involving, instructing, something would go wrong and affect patient safety.26, or educating the patient.26 This way of working depends 27 Documentation was rarely collected together with the on the professional judgment and confidence of the nurse patient, which resulted in incomplete recordkeeping that who is responsible for the patient’s health and safety. Thus, did not describe the patient’s desires and needs.32 patient safety must be the top priority if rules are overridden so that patients can participate more actively in their Obstacles - Organisation own care.26,27 Other factors that affect communication The advantage of person-centred care is perceived differ- include the patient’s cognition, cultural background, and ently by different occupational categories. The physician language barriers.28 observed little value in the need to implement a person- centred approach compared to other healthcare staff. They Lack of teamwork, large workload, and stress also reduced considered person-centred care as belonging to nursing the patient’s ability to participate. Speaking above the pa- and not medical care.33,34 The culture of an organisation tient’s comprehension can make the patient feel invisible.28 has a significant impact on the implementation of person- The same feeling of invisibility can arise if there is a com- centred care. The care is often controlled by production puter screen located between the patient and nurse.29 Be- agreements, which can be affected when working toward ing informed is not the same as being involved. However, person-centred care because it takes time to listen to the some patients see themselves as passive listeners.30 and may patient’s story.35 Implementation of person-centred care adopt a more traditional, compliant role as it may be a in a workplace is also affected by high staff turnover, the

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Table. 3. Description of the data analysis themes, categories, and codes based on the 15 papers reviewed.

THEME CATEGORY CODE

Obstacles to patient Obstacles to communication between the nurse The relationship between nurse and patient participation and the patient – for patient participation The importance of communication Passivity of the patient Attitudes Cultural factors for nurses and patients

Obstacles to working methods and routines in Routines the healthcare unit – for patient participation Standardisation Patient safety Secrecy Documentation

Obstacles from an organisational perspective – Skills shortage (knowledge) for patient participation Difficulties with implementation Lack of team work Jargon Leadership Hierarchical structures Stress High workload High staff turnover Inexperienced nurses

Opportunities for patient Communication between the nurse and the Commitment participation patient that can support Communication Attitudes Autonomy Empowerment

Working methods and routines in the health- Partnerships care unit – that can support patient participa- Person-centred care tion Rounds Reports (between shifts, patient records) Documentation

From an organisational perspective – to support Teamwork patient participation Interprofessional work Leadership Organisation Reflection Learn from each other Training

hiring of nurses without person-centred care experience, time, this is a challenging task. The nurse must identify lack of experience in the staff overall, as well as a stressful each patient’s specific needs and a find balance between work environment.36 The existing paternalistic healthcare assessing the patient’s condition and the need for nursing. system requires educational skills when implementing a Studies show that when the nurse asks open-ended ques- patient-centred care approach where patients are seen as tions and inquires about the current situation, the patient’s partners.35 ability to participate actively in their care is encouraged and strengthened.37 By deliberately handing over respon- Possibilities - Communication sibilities in various nursing activities, the patient feels en- The nurse plays a crucial role in promoting the patient’s couraged to understand, participate in, and increase their 36 opportunity to participate in their care. At the same  journal of the european wound management association 2019 vol 20 no 1 53 commitment to healing.28,29 When professionals listened cess factor in achieving a person-centred approach. The to the patient and focused on them as a person rather review of work routines is required to increase active par- than on their disease, they felt secure.29 Listening to the ticipation by the patient. The nurses felt bound to rules patient is also an attribute that demonstrates empathy and regulations. Nurses should not fear scrutiny if rules by the nurse. Patients experienced something more than are overridden or routines changed when the patient par- just being taken care of; they experienced hope, which, in ticipates more actively.26,27 turn, created a catalyst for empowerment and participation.38 Listening and encouraging participation without Orthopaedics was a criterion included in our database the patient feeling pressure to take a decision is a winning searches. Unfortunately, this term did not provide any concept.39 When the patient’s role is strengthened with in- relevant hits together with or without the wound healing creased participation, improved patient safety is observed, process. This finding reveals that patient involvement in leading to independence and confidence.36 orthopaedic nursing care could be interesting to study. The literature review method was chosen for this bach- Possibilities - Routine elor’s thesis to obtain more knowledge about the field of The interaction between a patient and their nurse increases patient-centred care and to facilitate planning of follow-up the patient’s sense of participation and leads to safer care. studies at a later stage. Literature review with a systematic Patients who felt they were treated respectfully were more approach gives readers the opportunity to decide whether willing to speak up and felt that they could correct any in- the conclusions are credible. accuracies, leading to increased patient safety.27,30 Having time for reflection and supervision also plays an important This literature review has both strengths and weaknesses. role in the nurses’ ability to implement person-centred.34 One of the strengths was that nine of the 15 selected articles were written after 2013, which should increase the Patient-centred rounds have a positive impact on the nurs- reliability of the results obtained. A possible weakness is es’ work situation and have contributed to better teamwork that this review was written by only one author which, due and reduced hierarchy between different healthcare profes- to a lack of collaboration, may limit processing of the col- sionals.31 When working in a person-centred environment, lected material and the opportunity to include all papers documentation is performed together with the patient in the review. One’s understanding can also affect and and their relatives, which prevents misunderstandings and shape the outcome. It is difficult to generalise the results clarifies communication.32 presented in this paper, but it can be used as a basis for discussion in one’s healthcare unit. Writing a review also requires different biases to be considered. For example, Possibilities - Organisation the studies discussed in these articles were performed in The development of nursing skills in communication different countries, six from Sweden, five from Australia, strategies and person-centred care as a measure of patient one from Canada, USA, and Ireland, and one from Is- safety would promote patient participation.26 However, rael. Thus, further discussion could be conducted about attention should be paid to nurses’ concerns about main- whether the healthcare systems in these countries differs taining confidentiality in connection with the patient.30 and how any differences may affect the results.

The workplace culture, (i.e., the employees’ perception The concept of person-centred care is based on the patient of methods, procedures, and behaviours) affects patient being an equal partner. This partnership is only achieved participation. The need for a strong relationship between if the patient is invited to participate and is given the op- the work environment and person-centred care has been portunity to influence their own care. The intention is not presented.40 A positive workplace culture is a prerequisite for the staff to create something for the patient. Instead the for person-centred care and, thus, patient participation. staff should identify and strengthen the resources that ex- Nurses should have opportunities to continue their edu- ist in the patient.19 Participation, the patient’s autonomy, cation, so that they can further develop their skills. The communication, and the role of the nurse are the basis for work environment affects both the nurses’ commitment person-centred care, which in turn leads to patient involve- and motivation, especially in times when a full workload ment. There may be different perceptions between the is carried.40 patient and the nurse regarding the extent of participation, and this may be the reason why the patient sometimes feels DISCUSSION dissatisfied with the nursing care received.4 Open communication between everyone on the patient’s team (including the patient themselves) is an essential suc-

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The department’s routines and the nurse’s attitude, com- prerequisite for nurses to implement new approaches for munication, and sometimes controlling function reduce increased patient participation.37 the patient’s ability to participate.26,41 Existing routines and the absence of them can both impede a patient’s CONCLUSION willingness to participate.26,41,42 Short care times and a Person-centred care requires a new mindset to let the shortage of experienced staff can make it difficult to pro- patient play a more active role. There are many factors vide individualized care as it is easier to follow standard that influence the opportunity for patient participation routines. Today’s rounds system can also prevent patient in daily care, from the healthcare organisation in the ward participation.31 The difficulty of nurses handling confi- and its leadership to the work environment for nurses in dentiality and sharing confidential information during the healthcare sector. Both verbal and non-verbal com- bedside conversation was highlighted in several articles.28, munication between patients and nurses are as important 30,41 At the same time, conducting bedside conversation as communication between all healthcare professionals. provides opportunity to amend any inaccuracies in the pa- However, the fear that nurses feel when overriding rules tient information.30 This could be remedied by providing or adjusting routines to allow patients to participate can more private rooms in the healthcare units and changing hinder person-centred care from being fully implemented. work methods. This student essay can make a difference by helping to Lack of experienced staff, continuity, and a large work- elucidate the fact that in-depth research is needed within load can lead to less patient participation.36,39 One study a specific area of orthopaedic patient care. It also shows the also observed that time restrictions limit the possibility importance of taking a critical approach when evaluating of patient participation, which ultimately affects patient published studies. Equally important is the fact that care safety.42 The same study also showed that the patient’s must rest on the best scientific research available. Wounds respect for authority can serve as an obstacle to many pa- are treated in all fields of healthcare, especially in ortho- tients’ involvement in their care and treatment. Involving paedic care. It is not only surgical wounds but also hard- the patient at a round creates opportunities for improved to-heal wounds after trauma and infections. Diabetic foot communication, teamwork, and reduced hierarchy.31 ulcers also occur. Those in need of wound healing are both young and old. Because wounds and people vary greatly, Creating opportunities within the healthcare organisa- it is even more important to find working methods that tion for professionals to work toward a person-centred involve the patient in an optimal and natural way. The approach by educating nurses in communication strategies wound healing process often requires patient involvement. will promote participation.26 Discussing person-centred They need to know when to contact their healthcare team care at all levels of the organisation as a measure of patient if something is not right with the healing process. m safety30 can be a winning concept for increased participa-  tion and opportunities. The importance of partnership and competent staff in creating security, and therefore patient participation, is important.39 An educational, sup- portive working model with reflection and supervision is a

Table 4/1. Framework for the review, including quality control.

AUTHORS AIM TITLE METHODS RESULTS QUALITY/ YEAR TYPE OF COUNTRY STUDY

Tobiano, Bucknall, To explore nurses’ Nurses’ view of Interpretive study Five categories emerged I/K Marshall, Guinane, views on patient patient participating In-depth semi- from the nurses’ views. Chaboyer participation in nursing in nursing care structured interviews Nurses play a crucial role in 2015 care. The objectives were conducted and promoting patient participa- Australia of this study were to analysed using content tion. Nurses felt limited by investigate nurses’ un- analysis. rules, perceptions of main- derstanding of patient taining safety, and patient participation, and the characteristics when attempt- barriers and facilitators ing to enact participation. to it.

journal of the european wound management association 2019 vol 20 no 1 55 Table 4/1. Framework for the review, including quality control.

AUTHORS AIM TITLE METHODS RESULTS QUALITY/ YEAR TYPE OF COUNTRY STUDY

Svanström, To describe experi- Moving from theory Data were collected The participants described I/K Andersson, Rosén, ences of implementing to practice: experi- through interviews, challenges when patients Berglund a process based on a ence of implementing notes, and written became involved in their 2016 learning support model a learning support stories, and then ana- care and took charge of Sverige designed to increase model designed lysed using herme- their lives. The participants’ patient involvement to increase patient neutic analysis with a experience led to increased and autonomy in care. involvement and focus on meanings. self-confidence and feelings autonomy in care of improved competence in dialogue with patients.

Sharp, McAllister, To examine and The vital blend of Semi-structured in- Clinically competent care, II/K Broadbent understand the clinical competence terviews with patients delivered compassionately 2016 unique and particular and compassion: how were examined via through a positive nurse- Australia experiences of a group patients experience thematic analysis patient relationship, resulted of former patients’ person-centred care to understand how in personal, emotional, participating in person- patients identify ways or spiritual responses that centred care. to enhance and sup- were the catalyst for patient port compassionate empowerment and participa- person-centred care tion in care, and a positive in everyday nursing outlook toward recovery. practice.

Abdelhadi, Drach- To test a model that Promoting patient A nested cross- The findings: service climate II/RCT Zahavy suggests the ward’s care: work engage- sectional research proved to be a link to nurses’ 2011 climate of service ment as a mediator design was adopted, work engagement and Israel facilitates nurses’ between ward service with three parameters patient-centred care behav- patient-centred care climate and patient- to measure the be- iours. Nurses’ work engage- behaviours through centred care haviour of nurses by ment mediated the service its effect on nurses’ questionnaires: work climate patient-centred care engagement. engagement, ward’s behaviours. climate for service, and control variables. Patient-centred care behaviours were as- sessed by structured observations.

Alharbi, Carlström, To investigate whether Experiences of Sixteen participants Patients felt listened to and I/K Ekman, Jarneborn, patients did in fact person-centred care- were interviewed. that their own perception of Olsson perceive the intentions patients´ perceptions: the situation had been noted. 2014 of partnership in the qualitative study Patients expressed that they Sweden new care model 1 year felt the staff saw them as after its implementa- persons and did not solely tion. focus on their disease.

Bolster, Manias To examine how Person-centred A qualitative ap- The results of the study I/K 2010 nurses and patients interactions between proach was used generated insights into Australia interact with each oth- nurses and patients comprising natu- the nature of interactions er during medication during medication ralistic observations between nurses and patients activities in an acute activities in an acute and semi-structured where person-centred care care environment with hospital setting: quali- interviews. is the underlying philosophy an underlying philoso- tative observation and of care. Three major themes phy of person-centred interview study were found: provision of care. individualised care, patient participation, and contextual barriers to providing person- centred care.

56 journal of the european wound management association 2019 vol 20 no 1 Science, Practice and Education

Table 4/2. Framework for the review, including quality control.

AUTHORS AIM TITLE METHODS RESULTS QUALITY/ YEAR TYPE OF COUNTRY STUDY

Jangland, Gun- To evaluate the imple- Improving patient Study is a descriptive Improving patient participa- I/RTC ningberg mentation of a project participation in a design using quantita- tion in a busy environment is 2017 on patient participa- challenging context: tive and qualitative challenging. Sweden tion, using two specific a 2-year evaluation methods. Although the long-term research questions for study of an implemen- implementation project patients and nurses. tation project did not improve patient participation in the units, the nurse managers described a changing culture in which staff grew to accept patients’ involvement in their own care. Several barriers to change and sustainability were acknowledged.

Tobiano, Marshall, To describe and under- Activities Patient and Field notes were col- Nurse–patient interactions II/K Bucknall stand the activities that Nurses Undertake lected and were ana- promoted patient participa- 2016 patients and nurses to Promote Patient lysed both inductively tion through dialogue and Australia undertake to enact Participation and deductively. knowledge sharing. Less patient participation in evident was patient involve- nursing care. ment in planning or self-care. Nurses exerted control over patient care, which influenced the extent of patient participation.

Oxelmark, Ulin, To describe registered Registered Nurses‘ Interviews were Five themes emerged: listen- I/K Chaboyer, Bucknall, nurses’ experiences experiences of patient conducted with 20 ing to the patient, engaging Ringdal with patient participa- participation in hos- registered nurses. the patient, relinquishing 2017 tion in nursing care, pital care: supporting Thematic data analy- some responsibility, sharing Sweden including their barriers and hindering factors sis was used to ana- power, and partnering with and facilitators for patient participation lyse the transcribed patients. In addition, hinder- participation. in care interview data. ing and facilitating factors to participation were identified, including patient desire to take on a passive role and lack of teamwork, which participants understood would enhance patient safety. Patient participation was hindered by medical jargon during the ward round; there was a risk of staff talking above patient comprehension, which was sometimes inevitable at the patient’s bedside.

Sharma, Klocke To study and improve Attitudes of nursing We surveyed attitudes Compared with baseline pre- II/K 2014 the perceived commu- staff toward interpro- of nursing staff before rounding data, nursing staff USA nication and interprofessional in-patient- and after four-month satisfaction related to the fessional care provided centred rounding implementation of communication and round- by medical providers a patient-centred ing by hospitalist providers and nursing staff. physician–nurse significantly improved after rounding process for the patient-centred in-patient in-patients. rounding model was implemented. Nursing workflow, nurses’ perceptions of value as a team member, and their job satisfaction were also positively impacted.

 journal of the european wound management association 2019 vol 20 no 1 57 Table 4/3. Framework for the review, including quality control.

AUTHORS AIM TITLE METHODS RESULTS QUALITY/ YEAR TYPE OF COUNTRY STUDY

Wolf, Moore, To explore the reali- The realities of part- Qualitative study Our findings identified I/K Lydahl, Naldemirci, ties of partnership as nership in person-cen- employing a thematic both informal and formal Elam, Britten perceived by patients tred care: a qualitative analysis of semi-struc- aspects of partnership that 2017 and health profession- interview study with tured interviews with patients felt listened to and Sweden als in everyday PCC patients and profes- professionals and informed. They were content practice. sionals patients. to ask questions and felt less involved in care planning, documentation, or exploring lifestyle goals.

Alharbi, Olsson, To measure the The impact of A quantitative study The results tentatively indi- II/P Ekman, Carlström effect of organisa- organisational culture using Organisational cated an association between 2014 tional culture on on the outcome of Values Questionnaire an organisational culture and Sweden health outcomes of hospital care: after (OVQ) and a health- patients’ health-related qual- patients 3 months after the implementation of related quality of life ity of life. Our results showed discharge. person-centred care instrument (EQ-5D). that it could be hindering instead of helping the new health care model achieve its objectives.

Gachoud, Albert, To explore how Meanings and percep- Semi-structured inter- The analysis generated three II/K Kuper, Stroud, “patient-centredness” tion of patient-centred- views were employed main themes: “Definition of Reeves is operationalised in ness in social work, because they gener- PCP”; “Value given to PCP”; 2012 the work life of those nursing and medicine: ate understanding of and “PCP and collabora- Canada professionals. a comparative study the meanings differ- tion”. All the themes gave ent individuals have of a specific perspective on their real-life world. patient-centred in practice (PCP) and are presented below.

McMurray, Chaboy- To examine patients’ Patients´perspec-tives A descriptive case Four themes emerged from I/K er, Wallis, Johnson, perspectives of of bedside nursing study was conducted. the analysis: patients appre- Gehrke participation in shift-to- handover Data were analysed ciated being acknowledged 2011 shift bedside nursing using thematic con- as partners in their care; they Australia handover. tent analysis. viewed bedside handover as an opportunity to amend any inaccuracies in the information being communicated; some preferred passive engagement rather than being fully engaged in the handover; most patients appreci- ated the inclusive approach of handover as nurse-patient interaction.

Broderick, Coffey To explore nursing Person-centred care A qualitative descrip- Findings indicated that I/K 2012 documentation in in nursing documen- tive study using the many nursing records were Ireland long-term care, to tation. PCN framework as incomplete, and documenta- determine whether it the context through tion of information regarding reflected a person- which nursing assess- psychosocial aspects of centred approach to ments and care plans care was infrequent. There care, and to describe were explored. was evidence that nurses aspects of PCC as engaged with residents and they appeared in worked with their beliefs and nursing records. values. Nursing documentation was not completed in consultation with the patient, and there was little to suggest that patients were involved in decisions related to their care.

58 journal of the european wound management association 2019 vol 20 no 1 Science, Practice and Education

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