participation Communication between the nurse and the patient that can support Working methods and routines in the healthcare unit – that can support patient participation From an organisational perspective – to support patient participation Obstacles from an organisational perspective – for patient participation The relationship between nurse and patient The importance of communication Passivity of the patient Attitudes Cultural factors for nurses and patients Routines Standardisation Patient safety Secrecy Documentation Commitment Communication Attitudes Autonomy Empowerment Partnerships Person-centred care Rounds Reports (between shifts, patient records) Documentation Teamwork Interprofessional work Leadership Organisation Reflection Learn from each other Training Skills shortage (knowledge) Difficulties with implementation Lack of team work Jargon Leadership Hierarchical structures Stress High workload High staff turnover Inexperienced nurses hiring of nurses without person-centred care experience, lack of experience in the staff overall, as well as a stressful work environment.36 The existing paternalistic healthcare system requires educational skills when implementing a patient-centred care approach where patients are seen as partners.35 Possibilities - Communication The nurse plays a crucial role in promoting the patient’s opportunity to participate in their care.36 At the same time, this is a challenging task. The nurse must identify each patient’s specific needs and a find balance between assessing the patient’s condition and the need for nursing. Studies show that when the nurse asks open-ended questions and inquires about the current situation, the patient’s ability to participate actively in their care is encouraged and strengthened.37 By deliberately handing over responsibilities in various nursing activities, the patient feels encouraged to understand, participate in, and increase their journal of the european wound management association 2019 vol 20 no 1 53 commitment to healing.28,29 When professionals listened to the patient and focused on them as a person rather than on their disease, they felt secure.29 Listening to the patient is also an attribute that demonstrates empathy by the nurse. Patients experienced something more than just being taken care of; they experienced hope, which, in turn, created a catalyst for empowerment and participation.38 Listening and encouraging participation without the patient feeling pressure to take a decision is a winning concept.39 When the patient’s role is strengthened with increased participation, improved patient safety is observed, leading to independence and confidence.36 Possibilities - Routine The interaction between a patient and their nurse increases the patient’s sense of participation and leads to safer care. Patients who felt they were treated respectfully were more willing to speak up and felt that they could correct any inaccuracies, leading to increased patient safety.27,30 Having time for reflection and supervision also plays an important role in the nurses’ ability to implement person-centred.34 Patient-centred rounds have a positive impact on the nurses’ work situation and have contributed to better teamwork and reduced hierarchy between different healthcare professionals.31 When working in a person-centred environment, documentation is performed together with the patient and their relatives, which prevents misunderstandings and clarifies communication.32 Possibilities - Organisation The development of nursing skills in communication strategies and person-centred care as a measure of patient safety would promote patient participation.26 However, attention should be paid to nurses’ concerns about maintaining confidentiality in connection with the patient.30 The workplace culture, (i.e., the employees’ perception of methods, procedures, and behaviours) affects patient participation. The need for a strong relationship between the work environment and person-centred care has been presented.40 A positive workplace culture is a prerequisite for person-centred care and, thus, patient participation. Nurses should have opportunities to continue their education, so that they can further