Patient participation in nursing care in a Chinese hospital: a focused ethnographic study

Abstract

BACKGROUND: Patient participation in health care refers to actively involving patients in their own care, treatment, and decision-making processes. Supporting patients to be engaged in their health care can lead to improved outcomes, better experience, and potentially more efficient healthcare systems. Within professional nursing practice, patient participation is advocated and aligned with philosophies of care such as person-centred care. Patient participation in nursing care incorporates establishing nurse-patient relationships, information and knowledge sharing, relinquishing power from nurses to patients, and mutual engagement in intellectual and, or physical activities. Yet, there remains a lack of understanding of nurses’, patients’, and family members’ experiences of patient participation in nursing care. In particular, there is a dearth of perspectives from contexts outside the Western world. China, which has different policies and cultural background, is an important context.

AIM: This focused ethnographic study aimed to explore patient participation in inpatient nursing care in China as perceived and experienced by nurses, patients with chronic illness, and their family members.

METHODOLOGY: Focused ethnography was adopted to explore patient participation in nursing care in a Chinese hospital. Nurses, chronically ill patients, and family members were recruited. Data was collected over an 8-month period of fieldwork from February to September 2021 in a Neurology Department. Fieldnotes from 90 hours of participant observation and 30 interviews were included (ten nurses, 13 patients, three family members, and four joint patient-family members). Following transcription, the data were analysed in NVivo 12 with a reflexive thematic analysis approach.

FINDINGS: Four themes were developed: the context of the Neurology Department; patient self-care; factors influencing patient participation; and minor decision making in nursing care. The Context of the Neurology Department comprised organisational and interpersonal contexts of the setting, and included nurses’ experience of role ambiguity and emotional exhaustion. Patients participated in physical, intellectual, and emotional self-care activities and many aspects of nursing care. Patients were interdependent with family members during their hospital stay, and required support from nurses. Patient participation was diverse and dynamic depending on a variety of factors, including capability, responsibility, and willingness to participate. Patients generally desired more information and communication. Capability to participate referred to patients’, family members’, and nurses’ ability to participate or provide accessible support, and resources. Responsibility in patient care included patients’ responsibility for their health, family obligations, nurses’ professional accountability, and duties in nursing care. Willingness to participate was related to nurses’ and patients’ preferences, emotional status, and nurse-patient relationships. Decision making in nursing care was related to minor issues of patient care, in contrast to treatment decisions. Patient participation and autonomy were respected where decisions were co-determined, but challenged where unilateral determination and organisational determination operated.

CONCLUSIONS: Patient participation was seen in self-care and decision-making processes in nursing care. Promoting patient autonomy and creating a caring environment could help to eliminate barriers and facilitate participation. Nurses should increase their awareness of involving patients in their own care. Family members’ contributions to care should be valued. Meanwhile, attention should be paid to paternalistic approaches from both nurses and family members causing potential hinderance for patient participation. Organisational managers and policy makers should set associated regulations and policies in place, to create a supportive environment for patient participation.