Some determinants that effect patient participation in decision-making about nursing care

Until recently patients were expected to be the passive recipients of nursing care. This passive role has been changing, and nurses are now being actively encouraged to promote the inclusion of patients in decision-making. However, this stance is being taken with very little empirical evidence to support it, and the evidence that does exist appears to indicate that patients do not always welcome this more active role. A modified grounded theory approach was utilized in order to discover how patients feel about participating in decision-making about nursing care. Eight informants were interviewed informally, 7-10 days following discharge from hospital after undergoing surgical intervention. A state of category saturation was not achieved and the analysis of the data can only tentatively suggest the existence of three 'second order' categories that describe situations that effect patient choice and participation in decision-making about their nursing care. The first category, 'If I am well enough...', describes the states of 'Being too ill' to be involved in decision-making to 'Being well' which allows greater involvement. The second category, 'If I know enough...', describes situations that, first, require technical knowledge, 'Nurse knows best', where patients prefer to take a passive role in decision-making; secondly, less technical matters about which patients require information but still prefer to be passive; and finally an 'I know best' situation where patients prefer to be actively involved in activities of living. The third category, 'If I can...', describes the organizational constraints or freedom that can either restrict or encourage choice and participation in decision-making. Limitations and recommendations that arise from the study are discussed.