An Exploration of the Nature of Patient Participation Within the Context of the Acute Surgical Care Setting - a Grounded Theory Study

Abstract

Patient participation is a central theme in health care policy in the United Kingdom (U.K.). Indeed, there is a trend in health care policy and practice towards encouraging patients to participate actively in their care, treatment and the services they use (Department of Health, 1989, 2003; 2004; 2005; 2006; 2008; 2009; 2010; 2011; 2012). Despite the current popularity surrounding such an approach to care, the concept remains elusive. Patient participation in nursing care specifically has not been examined adequately and remains one of the least understood ideas in clinical practice. The contribution that nurses make to this important activity has also not been explored. Furthermore, only a few studies have examined the nature of patient participation in nursing care from the frame of reference of the acute surgical patient (Henderson, 1997; Sahlston et al., 2008 and Larsson et al., 2011). Most studies have targeted clinically distinct patient groups and discrete aspects of patient participation within the context of chronic illness or medical and primary care practice. They are therefore limited by their precision and narrow focus (Cassileth et al., 1980; Haug & Levin, 1981; Vertinsky et al., 1984; Caress et al., 2005; Entwhistle et al., 2004; Collins et al., 2007; S. Parsons et al., 2010). Most have also drawn on positivist epistemologies and derived data from self-completed fixed choice questionnaires. An empirically grounded theory that explains the process of patient participation in surgical nursing care within the empirical world has yet to be published.

The purpose of this grounded theory study was to explore the nature of patient participation in nursing care within the context of the acute surgical care setting. Ultimately the aim was to generate a substantive theory that could account for, and explain, the process by which patients’ participate in their surgical nursing care. A qualitative, inductive design, based on the classic grounded theory approach to data collection and data analysis (Glaser & Strauss, 1967; Glaser, 1978) was employed to examine the complex nature or natural history of patient participation within the context of contemporary surgical nursing practice.

The informants of the research were patients and nurses on three acute surgical wards in an NHS Trust Hospital. Data were collected through 61 unstructured, audiotaped interviews (47 patients and 14 nurses) and 72 hours of participant observation. The interview and observational data were analysed using the constant comparative method of analysis (Glaser & Strauss, 1967; Glaser, 1978). The analytic process generated a substantive theory, labelled Engaging in Nursing Care. The theory explains how patient participation in nursing care within the acute surgical setting is established, developed, maintained or inhibited. It reveals an evolutionary context-sensitive process, which describes the complex and challenging nature of patient participation in nursing care as experienced by patients and nurses in the pre and post-operative period.

Three dynamic phases: Establishing Readiness, Shaping Work and Incurring Rewards and Costs describe how patients engage in their nursing care prior to and after surgery. The phase Establishing Readiness describes the structural, organisational and environmental antecedents of patient participation within the context of the surgical care setting. Shaping Work describes the range and variation in participatory behaviour and the levels at which patients participate in their own nursing care throughout their surgical experience. The phase Incurring Rewards and Costs explains the varied effects of patient participation in surgical nursing care on the individual patient, the nurse and surgical ward performance and resources. A number of recommendations are made to enable nurses, educationalists, health care managers and policy makers to develop substantiated strategies and initiatives for the effective implementation of patient participation in modern surgical nursing practice.