Original article
Patient participation in the intensive care unit

https://doi.org/10.1016/j.iccn.2017.04.006Get rights and content

Summary

Objective

Patient participation in healthcare is important for optimizing treatment outcomes and for ensuring satisfaction with care. The purpose of the study wasto explore critical care nurses’ perceptions of patient participation for critically ill patients.

Design and settings

Qualitative data were collected in four separate focus group interviews with 17 nurses from two hospitals. The interviews were analyzed using qualitative content analysis.

Findings

Initially, the nurses stated that patient participation in the intensive care unit (ICU) was dependent on the patient’s health condition and consciousness. However, during the interviews three descriptive categories emerged from their experience, that is: passive patient participation, one-way communication and nurse/patient interaction.

Conclusion

In the ICU, the possibilities for patient participation in nursing care are not only dependent on the patient’s health condition but also on the nurse’s ability to include patients in various care actions despite physical and/or mental limitations. When the patient is not able to participate, nurses strive to achieve participation through relatives’ knowledge and/or other external sources of information.

Introduction

In many European countries, patients’ right to participate in healthcare have been established in laws and formal regulations (Organization, 2013). In practice though, patients have often perceived difficulties in taking an active position in their care and have sometimes been met by a paternalistic attitude by healthcare professionals (Vincent, 1998). Until relatively recently, it was not unusual that the healthcare system did not allow active patient participation or that caregivers opposed of patients being involved in their process of care (Suominen, 1992, Charles et al., 1997, Sahlsten et al., 2005a, Chewning and Sleath, 1996). However, since patient participation has been shown to be an important factor in increasing motivation for treatment adherence, inducing higher satisfaction with care and optimizing treatment outcomes (Williams et al., 1998, Sainio et al., 2001), practice is slowly changing. Most patients want to be involved in major decisions regarding their care, such as whether to undergo an operation or not, but are less concerned about minor decisions (Mansell et al., 2000). Patients state that they expect to receive competent care, but want to have knowledge about their condition and possible treatments and wish to be respectfully met by the healthcare personnel (Eldh et al., 2008, Eldh et al., 2010, Larsson et al., 2007). Information has been considered to be the key to patient participation, but often patients lack the most basic information (Organization, 2013, Sainio et al., 2001, Sahlsten et al., 2005b, Tutton, 2005). Patients are highly dependent on the caregiver to provide adequate and sufficient information to be able to give informed consent to care and treatment (Larsson et al., 2007).

Critically ill patients treated in an intensive care unit (ICU) are completely dependent on the ICU personnel. Many patients are comatose, sedated or in other ways affected by life-threating illnesses. Compared to in general health care, active participation in care and treatment may be difficult to achieve. In most countries today, the majority of patients survives the acute phase of critical illness (Vincent et al., 2014) and recovers cognitively enough to be able to participate in their process of care. Despite this, ICU patients rarely participate in decisions regarding their own care (Lautrette et al., 2008, Ferrand et al., 2001). When ICU patients were asked, they expected caregivers to make expert decisions for them, but as soon as they had recovered consciousness and vital parameters were stabilized, they wanted to participate in the process of care as much as they possibly could (Lindberg et al., 2015). Even though many factors influence the level of patient participation, there is an urgent need for ICUS to implement and practice a more person-centered care (McBrien, 2009). Today, little is known about the possibility for patient participation in the ICU (Olding et al., 2016). Therefore, this study explores critical care nurses’ perceptions of patient participation.

Section snippets

Objective

The purpose of the study was to explore critical care nurses’ perceptions of patient participation for critically ill patients.

Settings and participants

The present study used a qualitative research design that involved four focus group interviews. The study was conducted in two intensive care units, with 8 beds per unit, at two county hospitals in Stockholm, Sweden. Swedish-speaking critical care nurses who worked at the two ICUs were included in the study by using convenience sampling. The head nurse in each ICU

Findings

In the ICU context, patient participation was initially described as being conditional to patients’ health condition and consciousness. During the life-threatening phase of critical illness, patient participation was explained as passive involvement in care. Once the life-threatening phase was over and the patients’ vital parameters were stabilized, a more active patient participation could gradually be incorporated in nursing care. However, the nurses found it to be challenging to know when to

Discussion

In this study, we explored ICU nurses’ perceptions of patient participation in nursing care. The nurses found that it was possible to achieve patient participation in an ICU setting. Direct participation was conceivable for awake and cognitively alert patients. For sedated or unconscious patients, participation was interpreted by indirect means, such as through bodily expressions or discussion with relatives, or was found in documentation in medical charts.

Previous studies have shown that,

Limitations

The finding of the study should be interpreted in the light of its limitations. The interviews were conducted by two different sets of interviewers, which may have influenced the results. A more experienced interviewer may also have been able to reach deeper into the interviews. In a qualitative study, it is important that the researchers are aware of their own preconceptions. In the analysis, one researcher had vast ICU experience and the other had more experience of patient participation in

Conclusion

In the ICU, the possibilities for patient participation in nursing care are not only dependent on the patient́s health condition but also the nurse’s ability to include patients in various care actions despite physical and/or mental limitations. When the patient is not able to participate, nurses strive to achieve participation through relatives’ knowledge and/or other external sources of information. A better understanding of the core attributes for patient participation could help nurses to

Funding

The authors have no funding to report.

Conflict of interest

The authors declare no conflict of interest.

Acknowledgements

We would like to thank Anna Westring, Jonatan Malmqvist, Sara Pettersson and Liv Vannefors for conducting the focus group interviews.

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