This study aimed to describe inpatients with myocardial infarction and their participation in care as documented in the nursing records when standardized care plans are used in care. The use of standardized care plans not only has increased the quality of medical treatment but has also overlooked patients' opportunities to participate in their own care. There is a lack of knowledge about how standardized care plans influence patients' participation in nursing care. Data were collected from thirteen patients' records with diagnoses of myocardial infarction. Participation in the decision-making process and participation associated with “sharing with others” were searched for in the analysis. The analytical process was guided by content analysis. The findings were grouped into two categories: patients' intermediary participation and patients' active participation. The main results indicated that patients' intermediary participation depended on healthcare professionals' power to rule the nursing care situation. 1. Introduction Standardized care plans have been in place since the middle of the 1980s and are used in several countries with the objective of achieving a quality-assured standard of care [1–3]. Standardized care plans make it possible to give good care to everyone regardless of who is caring, and standardized care plans are particularly important for quality of care [4]. Standardized care plans are both health and cost effective [5, 6] although there are few studies that show how standardized care plans affect patients’ participation and their influence on health care. Which conditions are required of the patients in order to participate in nursing care and treatment, if care is already planned before the patient’s admission to hospital? This study presents the findings of patients with myocardial infarction and their participation in care, as it appears in the nursing documentation. When standardized care plans are used in nursing care, the care plans are designed in advance for a specific patient group. The standard care plan lists the treatment steps to be performed as well as the times [4, 7–10]. The effect of standardized care plans on different outcomes is wide and has been used in care of patients with different diagnoses. For example, patients with heart failure who received medical care with guidance of a standardized care plan showed a decrease in mortality from 14% to 7% [11]; for patients with pneumonia, mortality decreased from 10% to 5% [12]. Another outcome using standardized care plans is that fewer postoperative complications
References
[1]
L. De Bleser, R. Depreitere, K. De Waele, K. Vanhaecht, J. Vlayen, and W. Sermeus, “Defining pathways,” Journal of Nursing Management, vol. 14, no. 7, pp. 553–563, 2006.
[2]
K. Vanhaecht, M. Bollmann, K. Bower et al., “Prevalence and use of clinical pathways in 23 countries—an international survey by the European Pathway Association,” Journal of Integrated Care Pathways, vol. 10, no. 1, pp. 28–34, 2006.
[3]
K. Zander, “Integrated care pathways: eleven international trends,” Journal of Integrated Care Pathways, vol. 6, no. 3, pp. 101–107, 2002.
[4]
A. Forsberg and K. Edlund, Standardv？rdplaner: ett instrument f？r h？gkvalitativ v？rd, Studentlitteratur, Lund, Sweden, 2003.
[5]
J. C. Corbelli, D. M. Janicke, M. J. Cziraky, T. A. Hoy, and J. A. Corbelli, “Acute coronary syndrome emergency treatment strategies: improved treatment and reduced mortality in patients with acute coronary syndrome using guideline-based critical care pathways,” American Heart Journal, vol. 157, no. 1, pp. 61–68, 2009.
[6]
M. Panella, S. Marchisio, and F. Di Stanislao, “Reducing clinical variations with clinical pathways: do pathways work?” International Journal for Quality in Health Care, vol. 15, no. 6, pp. 509–521, 2003.
[7]
C. Bj？rvell, Sjuksk？terskans journalf？ring: en praktisk handbok, Studentlitteratur, Lund, Sweden, 2001.
[8]
L. J. Carpenito-Moyet, Nursing Care Plans and Documentation: Nursing Diagnoses and Collaborative Problems, Lippincott Williams & Wilkins, Philadelphia, Pa, USA, 2004.
[9]
T. T. Lee, “Nurses' perceptions of their documentation experiences in a computerized nursing care planning system,” Journal of Clinical Nursing, vol. 15, no. 11, pp. 1376–1382, 2006.
[10]
J. Main, C. Whittle, J. Treml, J. Woolley, and A. Main, “The development of an Integrated Care Pathway for all patients with advanced life-limiting illness—the Supportive Care Pathway,” Journal of Nursing Management, vol. 14, no. 7, pp. 521–528, 2006.
[11]
E. K. Kasper, G. Gerstenblith, G. Hefter et al., “A randomized trial of the efficacy of multidisciplinary care in heart failure outpatients at high risk of hospital readmission,” Journal of the American College of Cardiology, vol. 39, no. 3, pp. 471–480, 2002.
[12]
R. Benenson, A. Magalski, S. Cavanaugh, and E. Williams, “Effects of a pneumonia clinical pathway on time to antibiotic treatment, length of stay, and mortality,” Academic Emergency Medicine, vol. 6, no. 12, pp. 1243–1248, 1999.
[13]
M. M. Dowsey, M. L. Kilgour, N. M. Santamaria, and P. F. M. Choong, “Clinical pathways in hip and knee arthroplasty: a prospective randomised controlled study,” Medical Journal of Australia, vol. 170, no. 2, pp. 59–62, 1999.
[14]
K. B. Johnson, C. J. Blaisdell, A. Walker, and P. Eggleston, “Effectiveness of a clinical pathway for inpatient asthma management,” Pediatrics, vol. 106, no. 5, pp. 1006–1012, 2000.
[15]
T. J. Marrie, C. Y. Lau, S. L. Wheeler, C. J. Wong, M. K. Vandervoort, and B. G. Feagan, “A controlled trial of a critical pathway for treatment of community-acquired pneumonia,” Journal of the American Medical Association, vol. 283, no. 6, pp. 749–755, 2000.
[16]
WHO, A Declaration on the Promotion of Patients' Rights in Europe, WHO, 1994.
[17]
A. Coulter and H. Magee, The European Patient of the Future, Open University Press, Maidenhead, UK, 2003.
[18]
SFS, H？lso-och sjukv？rdslagen, Svensk f？rfattningssamling, Stockholm, Sweden, 1982.
SOSFS, Informationshantering och journalf？ring i h？lso-och sjukv？rden, Socialstyrelsen, Stockholm, Sweden, 2008.
[21]
M. Ehnfors, A. Ehrenberg, and I. Thorell-Ekstrand, VIPS-boken: om en forskningsbaserad modell f？r dokumentation av omv？rdnad i patientjournalen, V？rdf？rbundet, SHSTF, Stockholm, Sweden, 1998.
[22]
A. C. Eldh, I. Ekman, and M. Ehnfors, “A comparison of the concept of patient participation and patients' descriptions as related to healthcare definitions,” International Journal of Nursing Terminologies and Classifications, vol. 21, no. 1, pp. 21–32, 2010.
[23]
J. E. Arnetz, U. Winblad, B. B. Arnetz, and A. T. H？glund, “Physicians' and nurses' perceptions of patient involvement in myocardial infarction care,” European Journal of Cardiovascular Nursing, vol. 7, no. 2, pp. 113–120, 2008.
[24]
M. J. M. Sahlsten, I. E. Larsson, C. S. C. Lindencrona, and K. A. E. Plos, “Patient participation in nursing care: an interpretation by Swedish Registered Nurses,” Journal of Clinical Nursing, vol. 14, no. 1, pp. 35–42, 2005.
[25]
M. S？derb？ck, Encountering parents: professional action styles among nurses in pediatric care, Doctoral thesis, Acta Universitatis Gothoburgensis, G？teborg, Sweden, 1999.
[26]
A. C. Eldh, I. Ekman, and M. Ehnfors, “Conditions for patient participation and non-participation in health care,” Nursing Ethics, vol. 13, no. 5, pp. 503–514, 2006.
[27]
T. Kiessling and K.-I. Kjellgren, “Patienters delaktighet i v？rden,” V？rd i Norden, vol. 24, no. 74, pp. 31–35, 2004.
[28]
L. Nordgren, M. Asp, and I. Fagerberg, “An exploration of the phenomenon of formal care from the perspective of middle-aged heart failure patients,” European Journal of Cardiovascular Nursing, vol. 6, no. 2, pp. 121–129, 2007.
[29]
I. Larsson, Patient och medakt？r: studier av patientdelaktighet och hur s？dan stimuleras och hindras, Doctoral thesis, Institutionen f？r v？rdvetenskap och h？lsa, G？teborgs Universitet, G？teborg, Sweden, 2008.
[30]
T. A. Hanssen, J. E. Nordrehaug, and B. R. Hanestad, “A qualitative study of the information needs of acute myocardial infarction patients, and their preferences for follow-up contact after discharge,” European Journal of Cardiovascular Nursing, vol. 4, no. 1, pp. 37–44, 2005.
[31]
K. Oterhals, B. R. Hanestad, G. E. Eide, and T. A. Hanssen, “The relationship between in-hospital information and patient satisfaction after acute myocardial infarction,” European Journal of Cardiovascular Nursing, vol. 5, no. 4, pp. 303–310, 2006.
[32]
R. Suhonen, M. V？lim？ki, and H. Leino-Kilpi, “Individualized care, quality of life and satisfaction with nursing care,” Journal of Advanced Nursing, vol. 50, no. 3, pp. 283–292, 2005.
[33]
A. Johansson, K. Dahlberg, and M. Ekebergh, “Living with experiences following a myocardial infarction,” European Journal of Cardiovascular Nursing, vol. 2, no. 3, pp. 229–236, 2003.
[34]
Datainspektionen, “Personuppgifter i forskningen – vilka regler g？ller?” August 2010, http://www.datainspektionen.se/Documents/faktabroschyr-pul-forskning.pdf.
[35]
U. H. Graneheim and B. Lundman, “Qualitative content analysis in nursing research: concepts, procedures and measures to achieve trustworthiness,” Nurse Education Today, vol. 24, no. 2, pp. 105–112, 2004.
[36]
D. F. Polit and C. T. Beck, Nursing Research: Generating and Assessing Evidence for Nursing Practice, Lippincott Williams & Wilkins, Philadelphia, Pa, USA, 2008.
[37]
SFS, Patientdatalag, Svensk f？rfattningssamling, Stockholm, Sweden, 2008.
[38]
A. C. Eldh, M. Ehnfors, and I. Ekman, “The meaning of patient participation for patients and nurses at a nurse-led clinic for chronic heart failure,” European Journal of Cardiovascular Nursing, vol. 5, no. 1, pp. 45–53, 2006.
[39]
V. Zoffmann, I. Harder, and M. Kirkevold, “A person-centered communication and reflection model: sharing decision-making in chronic care,” Qualitative Health Research, vol. 18, no. 5, pp. 670–685, 2008.
[40]
M. J. M. Sahlsten, I. E. Larsson, K. A. E. Plos, and C. S. C. Lindencrona, “Hindrance for patient participation in nursing care,” Scandinavian Journal of Caring Sciences, vol. 19, no. 3, pp. 223–229, 2005.
[41]
H. Grimen, “Power, trust, and risk: some reflections on an absent issue,” Medical Anthropology Quarterly, vol. 23, no. 1, pp. 16–33, 2009.
[42]
C. Condon and G. McCarthy, “Lifestyle changes following acute myocardial infarction: patients perspectives,” European Journal of Cardiovascular Nursing, vol. 5, no. 1, pp. 37–44, 2006.
[43]
SOSFS, Ledningssystem f？r kvalitet och patients？kerhet i h？lso-och sjukv？rden, Socialstyrelsen, Stockholm, Sweden, 2005.
[44]
A. W. Ekdahl, L. Andersson, and M. Friedrichsen, ““They do what they think is the best for me.” Frail elderly patients' preferences for participation in their care during hospitalization,” Patient Education and Counseling, vol. 80, no. 2, pp. 233–240, 2010.
[45]
H. H？t？nen, L. Kuosmanen, H. Malkavaara, and M. V？lim？ki, “Mental health: patients' experiences of patient education during inpatient care,” Journal of Clinical Nursing, vol. 17, no. 6, pp. 752–762, 2008.
[46]
C. McCabe, “Nurse-patient communication: an exploration of patients' experiences,” Journal of Clinical Nursing, vol. 13, no. 1, pp. 41–49, 2004.
[47]
E. Walldal, I. Anund, and C. Furaker, “Quality of care and development of a critical pathway,” Journal of Nursing Management, vol. 10, no. 2, pp. 115–122, 2002.
[48]
K. Pollock, K. Cox, P. Howard, E. Wilson, and N. Moghaddam, “Service user experiences of information delivery after a diagnosis of cancer: a qualitative study,” Supportive Care in Cancer, vol. 16, no. 8, pp. 963–973, 2008.
[49]
P. Benner, L. Rooke, and T. Grundberg, Fr？n novis till expert: m？sterskap och talang i omv？rdnadsarbetet, Studentlitteratur, Lund, Sweden, 1993.
[50]
M. F. Dahm and B. Wadensten, “Nurses' experiences of and opinions about using standardised care plans in electronic health records—a questionnaire study,” Journal of Clinical Nursing, vol. 17, no. 16, pp. 2137–2145, 2008.
[51]
A. Nakano, J. Mainz, and K. Lomborg, “Patient perception and assessment of admission to acute cardiac care unit,” European Journal of Cardiovascular Nursing, vol. 7, no. 1, pp. 10–15, 2008.
