171205 unique) i n PubMed) CIHNAL Participation or Person-Centred or Nurse 26 (24 5 (2 – same as 171206 unique) in PubMed) Manual Search and Articles from 7 7 Supervisor and Colleagues Total 454 (449) 66 15 Table I. Summary of search strategies used in this review. Search strategies using databases such as PubMed and CIHNAL, keywords and their combinations are listed. journal of the european wound management association 2019 vol 20 no 1 and routines in the healthcare unit, as well as obstacles and opportunities for patient participation from an organisational perspective. (See Table 3). RESULTS Obstacles - Communication Between the Nurse and Patient There was less communication with the patient when nurses did their work without involving the patient. The nurses wish to have more control over how the work should be performed with no interference, and thus, would rather provide care themselves instead of involving, instructing, or educating the patient.26 This way of working depends on the professional judgment and confidence of the nurse who is responsible for the patient’s health and safety. Thus, patient safety must be the top priority if rules are overridden so that patients can participate more actively in their own care.26,27 Other factors that affect communication include the patient’s cognition, cultural background, and language barriers.28 Lack of teamwork, large workload, and stress also reduced the patient’s ability to participate. Speaking above the patient’s comprehension can make the patient feel invisible.28 The same feeling of invisibility can arise if there is a computer screen located between the patient and nurse.29 Being informed is not the same as being involved. However, some patients see themselves as passive listeners.30 and may adopt a more traditional, compliant role as it may be a more convenient way for them to relate.29 This response might be due to a lack of understanding of how to invite them into the conversation and increase their confidence.29 Obstacles - Routine The nurse usually worked routinely, especially on days with higher stress.26 Furthermore, today’s system of rounds does not encourage teamwork or interprofessional communication, which leads to frustration and reduced nursing quality.31 For example, even though nurses wanted to invite patients to take care of their usual medication, the nurses felt bound to rules and regulations for fear that something would go wrong and affect patient safety.26, 27 Documentation was rarely collected together with the patient, which resulted in incomplete recordkeeping that did not describe the patient’s desires and needs.32 Obstacles - Organisation The advantage of person-centred care is perceived differently by different occupational categories. The physician observed little value in the need to implement a personcentred approach compared to other healthcare staff. They considered person-centred care as belonging to nursing and not medical care.33,34 The culture of an organisation has a significant impact on the implementation of personcentred care. The care is often controlled by production agreements, which can be affected when working toward person-centred care because it takes time to listen to the patient’s story.35 Implementation of person-centred care in a workplace is also affected by high staff turnover, the Table 2. Strategy employed to select the 15 articles reviewed for this study. Articles based on the titles (n=449) Articles based on the abstract (n=70) Articles based on full-texts (n=15) Rejected because abstract did not confirm the inclusion criteria (n=380) Rejected because abstract did not confirm the aim (n=55) Qualitative articles full-text (n=12) Qualitative articles full-text (n=3) 52 journal of the european wound management association 2019 vol 20 no 1 Science, Practice and Education THEME CATEGORY CODE Table. 3. Description of the data analysis themes, categories, and codes based on the 15 papers reviewed. Obstacles to patient participation Opportunities for patient participation Obstacles to communication between the nurse and the patient – for patient participation Obstacles to working methods and routines in the healthcare unit – for patient