Patient participation in nurse-patient interactions about medication
University of Southampton, School of Nursing and Midwifery,
Restricted to Repository staff only
The dominant political ideology emphasises the patient as a consumer and partner in health care.
Correspondingly, the move towards patient-centred nursing, based on the principles of humanism and
individualism, emphasise the central role patients' should play in the nurse-patient encounter.
Additionally, changing social and demographic trends highlight the importance of medication as a
health care issue. Thus, current health care policy and practice contexts highlight the importance of
patients' participation in health care as consumers and partners and, nurses' ability to make an
effective contribution to educating patients about medication as part of their role in health education
and promotion. However, despite the significance of this context, little is known about the extent and
manner of patient participation, or the contribution that nurses make to this important health
promotion activity. Therefore the purpose of this study is to extend knowledge in this area by
describing and explaining patient participation in medication interactions, as it occurs within the
reality of the clinical context.
In order to study patient participation in medication interactions in the reality of the clinical context,
a case study approach was adopted. Three case sites were sampled and included: 1) an acute medical
ward, 2) a community hospital rehabilitation unit, and 3) a community mental health service. Data
collection methods employed to explore and describe patient participation in medication interactions
included: non-participant observation, audio-recording of nurse-patient interactions, nurse interviews,
patient interviews, reflective field notes, focus groups and documentation. The data analysis
framework included the use of conversation analysis for nurse-patient interaction data and content
analysis for other qualitative data.
The findings indicate that patient participation can be understood at least in part by the
communicative practices and choices that nurse and patients/clients make. More specifically a range
of conversational strategies were employed by nurses to initiate and control conversations and by
doing so inhibited patients' participation. However a comparison of findings across sites indicates
that there were both differences and similarities in the extent to which nurses facilitated and inhibited
patient participation. A number of influencing factors were identified that helped to explain these
findings. These include: power, nurses' communicative style, knowledge, skills and experience,
patients' age, acuity of illness and level of knowledge, and the organisation and philosophy of care.
The findings from the study make a unique contribution to the body of knowledge in a number of
ways. First, as the only study to describe patient participation in medication interactions between
nurses and patients, it identifies that participation can occur at an interactional level, as well as a
more practical level via, for example, the potential to self medicate and independently manage
medications. Related to this, it has also contributed to the conceptual clarity and development of the
concept of patient participation. This study has highlighted that patient participation may be realised
and understood more fundamentally, at the level of the nurse-patient interaction, in contrast to
previous research that conceptualises participation as making choices and involvement in decisionmaking.
Furthermore, by the successful use of conversation analysis, this study has also advanced
knowledge about potential ways to investigate patient participation at the level of nurse-patient
discourse. Finally, this study provides a contribution to advancing theoretical explanations of patient
participation through the construction of a framework of explanatory factors influencing patient
A framework for enabling participation has been developed based on the specific conclusions and
principles for action drawn from the findings and from the philosophy of Freire (1972; 1983), which
acknowledges an individual's potential to be empowered and assume control. The framework
proposes that addressing attitudinal, interactional, relational, educational and contextual issues, might
facilitate patient participation. Implications and recommendations reflect the practice and education
requirements needed to implement such a framework.
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