title: Hindrance for patient participation in nursing care.
abstract: THE STUDY'S RATIONALE: Patients' influence in health care through participation, freedom of choice and information, is laid down in laws, national and local directives. In nursing care situations, the degree to which a patient participates depends on the nursing staff. Accordingly, hindrances for patient's participation during nursing care is an important question for the nursing profession.
  
  
  OBJECTIVE
  The aim was to focus on Swedish Registered Nurses opinion of hindrances for patient participation in nursing care and to uncover the informants' perspectives in depth.
  
  
  METHODS
  The study was limited to inpatient somatic care and has a qualitative approach. Data were collected through seven focus group interviews with 31 Registered Nurses from five hospitals. An analysis of the tape-recorded interview material was made, combining elements of content analysis with aspects of the Grounded Theory approach.
  
  
  METHODS
  The ethics of scientific work was followed. The participants gave informed consent. Verbal and written information was given as a guarantee that all information would be treated confidentially outside the focus group. Formal approval by ethical committee was not required according to national and local directives.
  
  
  RESULTS
  Hindrance for patient participation in nursing care comprised three themes: Competence, Influence of significant others and Organization and work environment, and their seven underlying subthemes.
  
  
  CONCLUSIONS
  The study clarified factors, which individually or combined may be hindrance for patient participation in nursing practice. Professional nurses must be able to find a balance for their patients' participation in nursing care activities through identification and coping with the hindrances. The three themes and seven subthemes here identified, can be used in patient care and its' evaluation, like also quality assurance of care and work organization and in nursing education. For further development replication studies are needed, like additional studies of patients and significant others.
authors.affiliation: Institute of Nursing, Health Care Pedagogics, The Sahlgrenska Academy at Göteborg University, Göteborg, Sweden. monika.sahlsten@swipnet.se
authors.forename: Monika J M
authors.initials: MJ
authors.lastname: Sahlsten
authors.forename: Inga E
authors.initials: IE
authors.lastname: Larsson
authors.forename: Kaety A E
authors.initials: KA
authors.lastname: Plos
authors.forename: Catharina S C
authors.initials: CS
authors.lastname: Lindencrona
mesh_terms: D000223:Adaptation, Psychological; D001291:Attitude of Health Personnel; D002983:Clinical Competence / Q000592:standards; D017144:Focus Groups; D007722:Health Knowledge, Attitudes, Practice; D006769:Hospitals, General; D006785:Hospitals, University; D006801:Humans; D020380:Needs Assessment; D009723:Nurse-Patient Relations; D009732:Nursing Care / Q000379:methods* / Q000523:psychology; D015404:Nursing Methodology Research; D009741:Nursing Staff, Hospital / Q000193:education / Q000523:psychology*; D015279:Organizational Culture; D026706:Paternalism; D010353:Patient Education as Topic / Q000592:standards; D010358:Patient Participation / Q000331:legislation & jurisprudence / Q000379:methods* / Q000523:psychology; D036301:Qualitative Research; D012944:Social Support; D011795:Surveys and Questionnaires; D013548:Sweden; D035502:Trust; D017132:Workplace / Q000458:organization & administration / Q000523:psychology