Clinical decision-making: predictors of patient participation in nursing care

J Clin Nurs. 2008 Nov;17(21):2935-44. doi: 10.1111/j.1365-2702.2008.02328.x.


Aim: To investigate predictors of patients' preferences for participation in clinical decision-making in inpatient nursing care.

Background: Patient participation in decision-making in nursing care is regarded as a prerequisite for good clinical practice regarding the person's autonomy and integrity.

Design: A cross-sectional survey of 428 persons, newly discharged from inpatient care.

Methods: The survey was conducted using the Control Preference Scale. Multiple logistic regression analysis was used for testing the association of patient characteristics with preferences for participation.

Results: Patients, in general, preferred adopting a passive role. However, predictors for adopting an active participatory role were the patient's gender (odds ratio = 1.8), education (odds ratio = 2.2), living condition (odds ratio = 1.8) and occupational status (odds ratio = 2.0). A probability of 53% was estimated, which female senior citizens with at least a high school degree and who lived alone would prefer an active role in clinical decision-making. At the same time, a working cohabiting male with less than a high school degree had a probability of 8% for active participation in clinical decision making in nursing care.

Conclusions: Patient preferences for participation differed considerably and are best elicited by assessment of the individual patient. Relevance to clinical practice. The nurses have a professional responsibility to act in such a way that patients can participate and make decisions according to their own values from an informed position. Access to knowledge of patients'basic assumptions and preferences for participation is of great value for nurses in the care process. There is a need for nurses to use structured methods and tools for eliciting individual patient preferences regarding participation in clinical decision-making.

MeSH terms

  • Female
  • Humans
  • Male
  • Nurse-Patient Relations*
  • Nursing*
  • Patient Participation*
  • Practice Patterns, Physicians'*