• autonomy;
  • communication;
  • knowledge;
  • patients;
  • perceptions;
  • rights;
  • phenomenography;
  • power;
  • professional;
  • qualitative method;
  • self-determination

Patients’ perceptions of self-determination as expressed in the context of care

Aim. The aim of this study was to describe patients’ perceptions of how self-determination finds expression in the context of care.

Background. Self-determination is an important concept within health care as well as an important patient right. New legislation on patient rights in Sweden and Europe is aimed at increased patient self-determination.

Design and method. Data were collected through semi-structured, tape-recorded interviews with 17 strategically chosen patients within somatic care and analysed using a method inspired by phenomenography.

Results. The analysis found three descriptive categories of the informants’ perceptions: trusting, accepting and a feeling of powerlessness. The patients expressed a great sense of trust and confidence in the care provided and they accepted the health care procedures. At the same time, they expressed a feeling of powerlessness because of not being part of decision-making, as well as lacking knowledge and information about treatment strategies. The patients wished to have the right of more self-determination but lacked the strength and knowledge to be able to influence their own care.

Conclusions. Patients’ perceptions of self-determination suggest that, in their encounters with the professional care, knowledge is expressed as power. The feeling of a lack of self-determination can be reduced by help and support from a nurse who allocates time for communication in order to learn the patient’s needs and reach a mutual understanding.