In perspective of individual care. Antecedents The role

In recent years,
the term of ‘patient participation’ is increasingly used in many different perspectives,
such as decision-making on healthcare and treatment, administration of the
treatment, and patient safety management. In particular, patient participation
is one important factor for improving patient safety. In a recent World Health
Organization report for patient safety, patient participation is emphasized to sustain
the patient safety (World Health Organization, 2016). Patients and their
families could actively engage in decision-making process and treatment, even
in the formation of health policy. However, the concept of patient participation
is not well defined, and the meaning of patient participation is often vague.     

Definitions

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Patient
participation is defined in the Medical Subjects Headings (MeSH), which is the
National Library of Medicine’s controlled vocabulary thesaurus, as patient
involvement in the decision-making process in matters pertaining to health (Patient
Participation, n.d.). Other terms including patient involvement, patient collaboration,
and patient empowerment seem to be interchangeably used as patient
participation (Cahill, 1996; Castro, Van Regenmortel, Vanhaecht, Sermeus, &
Van Hecke, 2016; Longtin et al., 2010). The concept of patient participation could
be applied to different perspectives: individual care, service development, and
formation of health policy. In this concept analysis for patient participation,
I mainly focus on the perspective of individual care.

Antecedents

The role of the patient
in healthcare has been evolved from traditionally being a passive spectator to requiring
patients being actively involved in their healthcare (Emanuel & Emanuel,
1992; Longtin et al., 2010). Patient participation in individual care begins
with providing essential information that includes patient’s health conditions,
treatments, and prognosis by healthcare providers. To provide the essential
information, education and training for healthcare providers are crucial.
Moreover, adequate education for patients should be preceded through the
interaction between patients and healthcare providers.

To promote
patient participation, supportive environments are also important that include
social supports and sufficient resources (Cahill, 1996; Castro, Van
Regenmortel, Vanhaecht, Sermeus, & Van Hecke, 2016; Sahlsten, Larsson, Sjostrom,
& Plos, 2008). In addition, healthcare provider should respect patients, in
terms of patients’ attributes, thoughts, beliefs, and emotions. Healthcare
providers need to consider patients as having equal and valuable power and
responsibility. Patients’ willingness to make a decision in individual care is
also essential for the patient participation.  

Consequences

Several studies demonstrated
benefits of patient participation in the management of acute and chronic
illness (Allen & Dennison, 2010; Coulter & Ellins, 2007).  In particular, nursing interventions with
patient participation have shown the significant effects on the improvement of
health outcomes as a primary and secondary prevention for cardiovascular disease
(Allen & Dennison, 2010; Lin et al., 2014). Furthermore, in a systematic
review (Coulter & Ellins, 2007), they showed the effect of patient
participation on the improvement of patients’ satisfaction, quality of life,
healthcare provider-patient communication, patient safety, and better clinical
outcomes.

Model, Borderline, and Contrary Cases

First, I will show
a model case. A 65-years old male was newly diagnosed with ischemic heart
disease. He got all information about ischemic heart disease including etiologies,
treatment options, and prognosis, by his healthcare provider with open-ended
questions. Moreover, his healthcare provider showed respect by exploring his expectation
and letting him make a decision on his care. They worked together and reached
the final decision for his treatment, and this patient fully understood his health
condition and actively engaged to change his bad lifestyle for preventing the
progression of his condition. He satisfied his care with a sense of controlling
his own condition by himself.

An example of borderline
cases would be the following: The patient described in the above was not
willing to stop smoking despite his knowledge about bad outcomes of smoking. After
healthcare provider pushed him to attend smoking cessation class, this patient
finally agreed to put his efforts on the cessation of smoking. A contrary case
of patient participation: An elderly woman was admitted to the hospital for the
treatment of heart failure. She met several healthcare providers including
nurses but did not get any information about her care. During her
hospitalization, the healthcare providers just did provide care in their own
way without consulting her.                        

Empirical Referents

Regarding the empirical
referents of patient participation, which refers to demonstrate the existence of
the concept by Walker & Avant (2011), several studies developed tools for measuring
patient participation in healthcare (Frank, Asp, Fridlund, & Baigi, 2011;
Mockford, Staniszewska, Griffiths, & Herron-Marx, 2012; Phillips, Street,
& Haesler, 2016). In a recent systematic review (Phillips, Street, &
Haesler, 2016), they found that few tools were reliable and valid to measure
patient participation and suggested the dyadic-Observing Patient Involvement in
Decision Making (OPTION) tool as the most promising tool. The dyadic-OPTION
tool is comprised of 12 items that include providing adequate information to patients
and patient involvement in decision-making and promoting self-care and autonomy
(Melbourne, Sinclair, Durand, Legare, & Elwyn, 2010).         

Conclusions

In conclusion,
the concept of patient participation at the individual level is widely accepted
in the healthcare setting, and several tools have been developed to measure
patient participation in different practice. Based on this brief concept
analysis for patient participation, patient participation could be considered
as one of the most crucial factors to establish the patient-healthcare provider
in patient-centered care and to provide the most reliable healthcare for
patients.   

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