title: Challenges in achieving patient participation: A review of how patient participation is addressed in empirical studies.
abstract: BACKGROUND
  For decades, it has been an ideal in western countries that individuals should participate in society as self-governing and autonomous subjects; however, this ideal does not always correspond to the actual experiences of individuals in their encounters with health professionals.
  
  
  OBJECTIVE
  This review identifies how empirical studies address challenges in achieving patient participation in clinical nursing.
  
  
  METHODS
  We conducted a literature search for studies of patient participation in PubMed, Cinahl, PsychInfo and Scopus. In a systematic review using Garrard's matrix method, we selected empirical studies that focused on patients' participation in health services.
  
  
  RESULTS
  The empirical studies we investigated addressed the relationship between patient and nurse, knowledge, contact time with the patient, severity of illness and the effect of age on the degree of patient involvement. Every study thus investigated assessed patient participation as being achievable. None of the studies questioned the foundation for patient participation, which has been described in theoretical articles. The main explanation for difficulties in achieving patient participation was that expectations concerning the extent and quality of participation could be unrealistic and lead to dissatisfaction.
  
  
  CONCLUSIONS
  Studies on patient participation identify challenges due to the nature of the relationship between laypersons and professionals, and the embedded difference in situation and knowledge. This difference may be reduced by time and a mutually positive attitude. But participation in its ideal form cannot be achieved because of this fundamental difference. Therefore, the optimal level of patient participation can only be achieved within a framework which provides both patients and health professionals with adequate time to build relationships and shared knowledge.
authors.affiliation: Section of Nursing Science, Institute of Public Health, Aarhus University, Hoegh-Guldbergs Gade 6 A, 8000 Aarhus C, Denmark. Electronic address: angel@ph.au.dk.
authors.forename: Sanne
authors.initials: S
authors.lastname: Angel
authors.affiliation: Section of Nursing Science, Institute of Public Health, Aarhus University, Hoegh-Guldbergs Gade 6 A, 8000 Aarhus C, Denmark. Electronic address: kf@ph.au.dk.
authors.forename: Kirsten Norup
authors.initials: KN
authors.lastname: Frederiksen
mesh_terms: D036262:Empirical Research; D006801:Humans; D010358:Patient Participation
keywords: Matrix method; Nurse–patient relationship; Patient participation; Review