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

Abstract

AIM To explore patient participation in decision-making during nursing care experienced by patients with chronic diseases, family members and nurses. DESIGN Focused ethnography. METHODS This study included an 8-month fieldwork in a Chinese hospital. Fieldnotes from 90 h of participant observation and 30 semi-structured interviews (10 nurses, 13 patients, three family members, and four with both patients and family members present) were analysed using reflexive thematic analysis. RESULTS Patient participation in decision-making was facilitated in the form of co-determination, which respected patients' relational autonomy. However, participation required further development or was challenged in the form of unilateral determination, constraining relational autonomy. Interpersonal relationships among nurses, patients and family members played a significant role in promoting patient participation in decision-making. CONCLUSION A relational autonomy framework was identified to understand patient participation in decision-making within nursing care. While patient participation is encouraged and autonomy is respected in some situations, paternalistic approaches still persist in clinical practice. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE Enhancing nurses' awareness of involving patients and family members in decision-making is needed. The findings highlight the need for better integration and implementation of existing guidelines to support healthcare staff, patients and family members. They also point to the importance of developing culturally relevant frameworks to promote patient participation in decision-making in nursing care. IMPACT This research provided insight into the experiences of chronically ill patients, family members and nurses regarding patient participation in decision-making during inpatient nursing care within a non-Western context. Interpersonal dynamics are highlighted as a key element influencing patient participation. REPORTING METHODS The study is reported using the COREQ checklist. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution.