Patient Participation in Decision-Making During Nursing Care: A Relational Autonomy Perspective

Area of Science:

• Nursing Care
• Patient Decision-Making
• Chronic Diseases

Background:

• Patient participation in decision-making is crucial for chronic disease management.
• Understanding the dynamics of patient involvement in nursing care is essential.
• Existing frameworks may not fully capture the complexities in non-Western contexts.

Purpose of the Study:

• To explore patient participation in decision-making during nursing care.
• To understand the experiences of patients with chronic diseases, family members, and nurses.
• To identify factors influencing patient involvement in healthcare decisions.

Main Methods:

• Focused ethnography conducted over 8 months in a Chinese hospital.
• Participant observation (90 hours) and semi-structured interviews (30) with nurses, patients, and family members.
• Reflexive thematic analysis of fieldnotes and interview data.

Main Results:

• Patient participation occurred as co-determination, respecting relational autonomy.
• Participation was sometimes challenged by unilateral determination, constraining autonomy.
• Interpersonal relationships significantly promoted or hindered patient involvement in decision-making.

Conclusions:

• A relational autonomy framework helps understand patient participation in nursing care.
• Paternalistic approaches persist despite efforts to encourage participation and respect autonomy.
• Culturally relevant frameworks are needed to enhance patient involvement in decision-making.