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It's my life, don't you forget ...


Student nurse Elena Ivany believes patients should be allowed to participate in the clinical decision making process

So far I have spent most of my holiday reading up on patient participation. It seems that modern nursing policy and theory both welcome the idea that patients should be involved in their treatment. From my own experience as a patient, I realise that someone who wants to heal is more likely to take an active role in the healing process, and vice versa.

For inpatients, all levels of involvement are a valuable step towards positive recovery. This can range from individuals performing their own personal care to gathering information about medical conditions and procedures.

As a nurse, I can only welcome such active participation from my patients. If all goes well, seeing a client become independent is proof that they are well on the way to recovery or that they have successfully adjusted to living with their condition. On a ward, where time and man-power are scarce, independent patients are a godsend because they allow nurses and HCAs to concentrate on those individuals who require extensive support with personal needs. Equally, well-informed patients are less likely to be anxious and more likely to recover sucessfully from a variety of procedures.

All in all, patient participation in the process of care is the way to go.  

Yet what of patient participation in the decision-making process? The general shift towards client-focused care encourages nurses to place patients’ needs at the centre of nursing care. The NMC code talks of ensuring a prompt response to calls for assistance, of upholding the values of dignity and privacy when it comes to personal care, of allowing clients the right to chose.

These are all vital patient rights and nursing obligations. But what of the patients’ right to be involved in the process of creating a care plan? When nurses talk of patient choice, do we mean that the patient should be able to exercise choice from the very moment that they enter into contact with the healthcare service?

If so, then nursing still has some way to go. The age old distinction between the knowing nurse and the passive patient may be disappearing but I still believe that not all patients are given the opportunity to truly voice their preferences when it comes to making clinical decisions.

Please do not think that I am advocating for a complete system overhaul, whereby patients would dictate their own care plans to passive nurses. What I am advocating, however, is a situation where nurses embrace the fact that patients wish to play an active role in making decisions. The notion of the expert patient is not a theory or an ideal, it is a reality that is all too often ignored despite the many benefits that it can bring to the nurse-patient relationship and to the process of nursing care. If nurses believe in patient choice, then patient involvement in the decision-making process should be a priority for all of us.

Elena Ivany is a mature student nurse at King’s College London.


Readers' comments (3)

  • A good and well expressed article but what a quaint old fashioned attitude. It is not the role of nurses in the first place to make decisions for their patients that they, as autonomous human beings, are competent of make themselves or to do for them what they are able to do for themselves and it goes without saying that their knowledge, participation in their care, expressing their needs and wishes, and their own professionally guided decision making is naturally important in the healing process or in learning to live with and successfully manage a disease or disorder for which they may not be a cure.

    Furthermore, patient centered care is not a new concept and has already been practiced
    by several generations of nurses.

    All clinical care is, and must of necessity, be delivered in partnership with all competent and conscious patients, except in emergencies, and only with their informed consent.

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  • michael stone

    I get confused by this (I'm not a clinician, but I am involved in a debate with some).

    This should be - but somehow, isn't for many clinicians - very simple.

    Clinicians offer treatment, and predict outcomes with or without various proposed treatments.

    Mentally capable patients, then decide whether to accept any of the offered treatments (and they do not need to explain why an offered treatment is being refused, and it is not a negotiation - the treatment is offered, the patient decides whether to accept: full stop).

    For some reason, the fact that treating an unwilling patient is an assault, seems to disappear (especially if one reads some of the stuff, in EoLC protocols and literature).

    I don't know why it disappears - it isn't hard to grasp !

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  • Being a mental health nursing student, I would say that within this branch of nursing the emphasis on person centred care and self directed recovery is major. As a nurse I feel I am there to provide care and guidance, but not dictation as I do strongly believe that in the vast majorty of cases people are able to decide for themselves what they feel will help their own recovery. Even with dementia patients it is important to remember that within a care plan there should be information that allows us, as nurses to care for the person in the most person centred way.

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