Patient participation in clinical decision-making in nursing: a comparative study of nurses’ and patients’ perceptions


  • Jan Florin MSN, RN,

  • Anna Ehrenberg PhD, RN,

  • Margareta Ehnfors PhD, RNT

Jan Florin
Department of Health and Social Sciences
Högskolan Dalarna
791 81 Falun
Telephone: 46 23 778446


Aims and objectives.  The aim of this study was to compare the degree of concordance between patients and Registered Nurses’ perceptions of the patients’ preferences for participation in clinical decision-making in nursing care. A further aim was to compare patients’ experienced participation with their preferred participatory role.

Background.  Patient participation in clinical decision-making is valuable and has an effect on quality of care. However, there is limited knowledge about patient preferences for participation and how nurses perceive their patients’ preferences.

Methods.  A comparative design was adopted with a convenient sample of 80 nurse–patient dyads. A modified version of the Control Preference Scale was used in conjunction with a questionnaire developed to elicit the experienced participation of the patient.

Results.  A majority of the Registered Nurses perceived that their patients preferred a higher degree of participation in decision-making than did the patients. Differences in patient preferences were found in relation to age and social status but not to gender. Patients often experienced having a different role than what was initially preferred, e.g. a more passive role concerning needs related to communication, breathing and pain and a more active role related to activity and emotions/roles.

Conclusions.  Registered Nurses are not always aware of their patients’ perspective and tend to overestimate patients’ willingness to assume an active role. Registered Nurses do not successfully involve patients in clinical decision-making in nursing care according to their own perceptions and not even to the patients’ more moderate preferences of participation.

Relevance to clinical practice.  A thorough assessment of the individual's preferences for participation in decision-making seems to be the most appropriate approach to ascertain patient's involvement to the preferred level of participation. The categorization of patients as preferring a passive role, collaborative role or active role is seen as valuable information for Registered Nurses to tailor nursing care.