title: Patient participation in nursing care on medical wards: An integrative review.
abstract: BACKGROUND
  Patient participation is a way for patients to engage in their nursing care. In view of the possible link between patient participation and safety, there is a need for an updated review to assess patient participation in nursing care.
  
  
  OBJECTIVE
  To investigate patients' and nurses' perceptions of and behaviours towards patient participation in nursing care in the context of hospital medical wards.
  
  
  METHODS
  Integrative review.
  
  
  METHODS
  Three search strategies were employed in August 2013; a computerised database search of Cumulative Index of Nursing and Allied Health Literature, Cochrane Library, Medline and PsychINFO; reference lists were hand-searched; and forward citation searching was executed.
  
  
  METHODS
  After reviewing the studies, extracting study data and completing summary tables the methodological quality was assessed using the Mixed-Methods Assessment Tool by two reviewers. Reviewers met then to discuss discrepancies as well as the overall strengths and limitations of the studies. Discrepancies were overcome through consensus or a third reviewer adjudicated the issue. Within and across study analysis and synthesis of the findings sections was undertaken using thematic synthesis.
  
  
  RESULTS
  Eight studies met inclusion criteria. Four themes were identified - enacting participation, challenges to participation, promoting participation and types of participation. Most studies included were conducted in Europe. The majority of studies used qualitative methodologies, with all studies sampling patients; nurses were included in three studies. Data were largely collected using self-reported perceptions; two studies included observational data. Methodological issues included a lack of reflexivity, un-validated data collection tools, sampling issues and low response rates.
  
  
  CONCLUSIONS
  On medical wards, patients and nurses desire, perceive or enact patient participation passively. Challenging factors for patient participation include patients' willingness, nurses' approach and confusion around expectations and roles. Information-sharing was identified as an activity that promotes patient participation, suggesting nurses encourage active communication with patients in practice. Involving patients in assessment and care planning may also enhance patient participation. For education, enhancing nurses' understanding of the attributes of patient participation, as well as patient-centred care approaches may be beneficial for medical ward nurses. From here, researchers need to examine ways to overcome the barriers to patient participation; further nurse participants and observational data is required on medical wards.
authors.affiliation: Centre for Health Practice Innovation, Menzies Health Institute Queensland, Griffith University, Gold Coast Campus, Queensland, Australia. Electronic address: g.tobiano@griffith.edu.au.
authors.forename: Georgia
authors.initials: G
authors.lastname: Tobiano
authors.affiliation: Centre for Health Practice Innovation, Menzies Health Institute Queensland, Griffith University, Gold Coast Campus, Queensland, Australia; The Gold Coast University Hospital, Queensland, Australia.
authors.forename: Andrea
authors.initials: A
authors.lastname: Marshall
authors.affiliation: School of Nursing and Midwifery, Deakin University, Victoria, Australia; Alfred Health, Victoria, Australia.
authors.forename: Tracey
authors.initials: T
authors.lastname: Bucknall
authors.affiliation: Centre for Health Practice Innovation, Menzies Health Institute Queensland, Griffith University, Gold Coast Campus, Queensland, Australia; National Centre of Research Excellence in Nursing Interventions for Hospitalised Patients, Menzies Health Institute Queensland, Griffith University, Queensland, Australia.
authors.forename: Wendy
authors.initials: W
authors.lastname: Chaboyer
mesh_terms: D006801:Humans; D009732:Nursing Care; D009741:Nursing Staff, Hospital; D010358:Patient Participation
keywords: Communication; Consumer participation; Cooperative behaviour; Nurse–patient relations; Patient engagement; Patient involvement; Patient participation; Patient-centred care; Review; Shared decision-making