This phenomenological study was designed to explore and describe the experience of older women who are caring for husbands with Parkinson's disease. The study was conducted with a sample of seven caregivers ranging in age from 50 -74 years who had lived with husbands with Parkinson's disease for 9-38 years. Data were collected by intensive interviewing usually at the home of the caregiver. The data were analyzed for common themes. The findings revealed that each wife experienced three phases during the course of caregiving. The three phases were: coping with illness, taking over, and separating life paths. These phases occurred in relation to the changes due to the illness, that each wife perceived in her husband, her marriage and herself. Each phase developed as the disease progressed and was meaningful to each wife because of her personal perceptions. Understanding the nature of caregiving in this way may help health care workers to provide more appropriate support for caregivers. Implications for practice are discussed. / Applied Science, Faculty of / Nursing, School of / Graduate

The name and the topic of my thesis is evaluation of the quality of given nursing care. The quality of nursing care as integral part of quality of medical care is gaining ground not only in medics but also in public. Words like quality, standard, audit are commonly used by every nurse but do they know meaning of separate words? Do they know how to ensure high-quality care and how to evaluate it? These and other questions must be answered in order to retrieve possible insufficiencies and thus, to ensure high-quality nursing care. That´s why I chose this topic for my thesis. Theoretical part first characterizes nursing, its aims and organization of nursing care. Extensive part is devoted to quality of nursing care, systems and models to ensure and evaluate the quality. Practical part is focused on research and its interpretation. There were two research units and were created by nurses from surgical wards of Hospital in České Budějovice and Hospital in Jihlava. In order to collect needed data I chose quantitative method, when the way of data collecting was questionnaire. The aim of the thesis was to chart nurses´ knowledge on evaluation of quality of given nursing care through two hypotheses. The hypothesis supposing that nurses working in Hospital České Budějovice know more about evaluation of quality of given nursing care than nurses working in Hospital Jihlava was confirmed. But it is evident from the results that both investigated units have certain reserves. The other hypothesis supposing that more than 80% nurses consider the audits helpful for improving the quality of nursing care was not confirmed. According to the results, for more than half of addressed nurses audit is only stressing matter when hospital management looks for faults in their work. I mean, this opinion results from insufficient knowledge or incorrect understanding of the audit sense. I would like to use the thesis and its results as a base for creating scientific lectures and subsequent presentation. The head nurse asked me to present my thesis and the results at the meeting of head nurses in autumn 2008. I was asked for the results by Jihlava Hospital management as well.

The Diploma thesis deals with standardisation of nursing care in the context of preparatory work for accreditation survey, i.e. a mutual harmony between standards developed in health care institutions and those developed by the SAK ČR accreditation commission. Standardisation is a process of setting essential rules which should guarantee providing a high quality nursing care. These rules (standards) enable to evaluate the quality of all nursing activities. Nurses should be aware of standardisation process and be actively engaged in it. The theoretical part describes the part of Czech nursing system concept focused on the quality of nursing care, defines the quality itself, maps the systems which help improve the quality of nursing care in health care institutions and refers to the formation of nursing standards. Practical part deals with five aims stated at the beginning: To map the quality of standardisation in nursing care as a preparatory part of accreditation survey. To find out if nursing care in hospitals is carried out through the method of nursing process. To find out if nursing care is supported by properly kept documentation. To find out if the needs of education were considered for all patients. To find out if nurses are aware of the importance of nursing care standardisation. We chose a quantitative research method. To collect the research data we used anonymous questionnaires. Each of the hospitals was given 50 questionnaires, i.e. 250 in total as the research group was made by respondents from the hospitals in Jindřichův Hradec, Pelhřimov, Tábor, Písek a Havlíčkův Brod. 230 completed questionnaires were returned and 204 of them represented then the research group. Within the research, we accomplished the aims stated, and proved these hypotheses: Hypothesis 1 (H1): The hospitals meet all requirements of accreditation survey of nursing care standardisation. H2: Nursing care in the hospitals is carried out through the method of nursing process. H3: Nursing care in the hospitals is supported by properly kept documentation. H4: The needs of education were considered for all patients and recorded in the nursing documentation. H5: The nurses are aware of the importance of nursing care standardisation. The quantitative research resulted into the statement that all hospitals meet the requirements of accreditation survey of nursing care standardisation. Nursing care in the hospitals is carried out through the method of nursing process which is properly recorded in nursing documentation. It was also found out that the needs of education were considered for all patients and properly recorded in the nursing documentation. The nurses are aware of the importance of nursing care standardisation. The facts resulted from the research prove that the quality of nursing care in the chosen hospitals is very high and meets the requirements of accreditation standards. The research findings will be offered to the hospital managements as an educational material for nurses and midwives.

Aim The aim of this qualitative study was to explore Indonesian nurses’ experiences of patient education and patients’ adherence to TB treatment. Background Tuberculosis (TB) is an infectious disease that 9.6 million people in the world suffer from. Indonesia is one of the world’s 22 high-burden countries with over 320.000 cases of TB in 2014. The UN’s (United Nation) goal is to have ended the TB epidemics by the year 2030. Nurses play a central role in accomplishing adherence to treatment and prevention of TB. Method To fulfil the aim a qualitative method using semi-structured interviews was used. The interviews were recorded and transcribed. The transcribed data was analysed by using a qualitative content analysis with a manifest approach. Findings The findings, based on the result of nine interviews, showed four themes: “Strategies for patient education”, “Factors affecting patient education and adherence to treatment”, ”Outcomes of patient education” and ”Feelings and opinions about patient education”. Conclusion This study showed that the nurses use different strategies when practicing patient education. It was also shown that the nurses are well aware about patient-related factors and how they affect patient education and adherence to TB treatment. Keywords Tuberculosis, nursing care, patient education, adherence

Bakgrund: I Sverige drabbas cirka 20 000 människor varje år av någon demenssjukdom. Sjukdomen medför med tiden intellektuella, psykologiska, beteendemässiga och kroppsliga försämringar som kan medföra minskad initiativförmåga och lidande. Genom att möjliggöra för personer med demenssjukdom att delta i aktiviteter som exempelvis musik, kan försämringar motverkas då musik stimulerar både kognitiva och fysiska funktioner. Syfte: Syftet med litteratursammanställningen var att belysa musikens betydelse för personer med demenssjukdom. Metod: Litteratursammanställningen inkluderade tio kvalitativa studier som valts från databaserna Cinahl, PubMed och PsycINFO. Studierna har granskats och analyserats med inspiration av kvalitativ innehållsanalys. Resultat: Resultatet av litteratursammanställningen visade att musik ökade livskvaliteten för personer med demenssjukdom och förbättrade interaktionen mellan dessa personer och vårdgivarna. Musik förbättrade även kommunikationen samt minskade beteendeförändringar. Konklusion: Resultatet visar på att musik fördelaktigt kan användas i demensvården för att främja välbefinnandet hos personer med demenssjukdom. Det finns emellertid ett behov av vidare forskning för att ytterligare kunna stödja fördelarna med musik i demensvården. / Background: Every year in Sweden nearly 20 000 people develop dementia. Dementia causes over time intellectual, psychological, behavioural and physical impairments which in turn can lead to decreased ability to take initiative and increased suffering. By providing people with dementia to participate in activities for instance music, impairments can be counteracted since music stimulate cognitive and physical functions. Aim: The aim is to illuminate the importance of music for people with dementia. Method: This litterature review include ten qualitative studies which were selected from the databases Cinahl, PubMed and PsycINFO. The chosen studies have been surveyed and analyzed with inspiration of a qualitative content analysis. Result: The result of the literature review showed that music increased quality of life for people with dementia and improved the interaction between patient and caregiver. Music also improved communication and reduced behavioral changes. Conclusion: Music can advantageously be used in dementa care in order to promote well-being for people with dementia. However, there is a need for further research to further support the benefits of music in dementia care.

M.P.H., Faculty of Health Sciences, University of the Witwatersrand, 2011 / Introduction: Globally and locally, the status of nurses and their profession is diminishing, ascribed partly due to the image of nursing portrayed in the media of a profession with heavy workloads, poor pay and no longer considered a career of choice. In South Africa, the increased disease burden due to HIV/AIDS and tuberculosis, together with a deteriorating health system and significant inequities in terms of nurse distribution, has led to grave public concerns about the profession. The media play a key role in national development, helping to shape public perceptions by influencing how society understands events. This cross-sectional study aimed to explore how nursing is framed in the mainstream press over a six-month period in 2010 using mixed methods of a quantitative content analysis and a qualitative discourse analysis. Methodology This cross-sectional study used a mixed method approach of both quantitative and qualitative methodologies. The content of all articles mentioning „nurse‟ or „nursing‟ from the press cutting agency Monitoring South Africa (1 January – 30 June 2010) was analysed, yielding a total of 242 articles. From these, 91 articles were purposively selected for the qualitative discourse analysis. A data coding sheet was developed to capture key dimensions from each article for the quantitative content analysis. Both descriptive and inferential analysis was carried out. For the qualitative discourse analysis press cuttings were converted and coded, and then thematic analysis was carried out Results The results of the quantitative analysis found that nursing is not well covered in the South African lay press, and when it is featured, articles appear in community publications with small circulations. Most articles on nursing were prominent (ie. full-length) and positive. International Nurses‟ Day (IND) was seen to influence the proportion of nursing articles with more than double the number of articles appearing in May compared to the total average of other months, and all coded „positive‟. However, when IND was excluded from analysis, negative articles were dominant, mainly around strikes and unprofessional behavior which featured in daily and larger circulation newspapers. In keeping with international literature, strikes as a theme received the most coverage, but unique to this study was the finding that nursing neglect or unprofessionalism received almost as much coverage as strikes, featuring in the majority of page 1 articles and in publications with large circulations. 5 Regarding voice, this study found that nurses were quoted in just over a quarter of articles which featured quotes, but that spokespeople were quoted twice as often, remarkably so even for IND. Most nurse quotes were around strikes and poor working conditions. Nurses were quoted more frequently in community newspapers and in Western Cape newspapers. Doctors were seldom quoted, and 90% of patient quotes were negative. While females were quoted first in the majority of articles, a third of their quotes were anonymous, mainly around negative topics such as labour, protest action and service delivery, indicating their fear of reprisal from their institutions. Males were quoted more often in second and third quotes of articles, with the extent of quotes approximately in proportion to their numbers in the profession. The results of the qualitative discourse analysis revealed a profession groaning under the weight of a crumbling health system. Articles on the working conditions, salaries and shortages of nurses were mostly sympathetic, but when nurses „went too far‟, they were portrayed as unprofessional, negligent and abusive. Nurses were also not taken seriously when they raised the alarm about deteriorating health systems, which is disturbing when they are at the forefront of healthcare delivery. Very few articles dealt with nursing as a profession or academic nursing in any detail. Although there were more positive than negative articles, and IND garnered significant positive coverage for the profession with nearly a third of all articles appearing in May when IND is celebrated, the lasting impression is that of negative coverage, particularly from the discourse on patient abuse, neglect or abandonment during strikes. Nurse voices are notably absent from these articles. Conclusion South African nursing would benefit from media advocacy and partnerships to promote the profession. As the majority workforce which undertakes essential, life-giving tasks, nurses are the backbone of the healthcare system and critical contributors to quality health care. Their place at the policy table and space in the press is well overdue.

A thesis completed by published work Submitted to the School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in fulfillment of the requirements for the degree of Doctor of Philosophy Johannesburg, South Africa 25 November 2016 / Background: In South Africa, nurses form the backbone of the health system, because of their numerical dominance, their skills and training, their close contact with patients and communities and their prominence in managerial and leadership roles at all levels of the health system. Objective: The aim of this PhD was to analyse the nature and dynamics of nursing management at primary health care (PHC) clinics in two South African provinces. The specific objectives were to: describe the social-demographic characteristics of selected PHC nursing managers; determine their job satisfaction levels; examine the work environment; determine the functionality of PHC support systems; and assess their managerial competencies. Methods: In 2012, a mixed methods cross-sectional study was conducted in Gauteng and Free State Provinces. Using stratified random sampling, 111 PHC nursing managers working in eight hour clinics were selected. After obtaining informed consent, these managers were invited to participate in three surveys: job satisfaction, facility assessment and a 360 degree competency evaluation. A sub-set of these managers (n=22) was requested to keep a diary for six weeks. STATA® was used to do quantitative data analysis, while the qualitative data was analysed using thematic content analysis. Results: A 95% response rate was obtained for all surveys. The majority of PHC clinic nursing managers were female (92%), black, married, with a mean age of 49 years (SD = 7.9), 90% were in permanent positions, and 36% had between 21-30 years of professional nursing experience. The overall job satisfaction scores for Gauteng and Free State PHC clinic nursing managers were 142.80 (SD± 24.3) and 143.41 (SD± 25.6) out of a possible score of 215. The predictors of their job satisfaction were: working in a clinic of choice (RRR = 3.10), being tired at work (RRR = 0.19) and experience of verbal abuse (RRR = 0.18). The facility assessment found that none of the selected clinics obtained scores of 100% for the vital elements of the National Core Standards. Overall, clinic nursing managers rated themselves high on the domains of communication (8.6), leadership and management (8.67), staff management (8.75), planning and priority setting (8.6), and problem-solving (8.83). The exception was the financial management domain where the nursing managers gave lower ratings (7.94). Health system deficiencies, human resources challenges, leadership and governance, and unsupportive management dominated the diary entries, and coalesced to produce many negative emotions experienced by these PHC clinic nursing managers. Conclusion: This PhD study has underscored the importance of PHC nursing managers, and has generated new knowledge on the overall levels and predictors of job satisfaction, the perceived competencies of these managers, together with information on the work environment and support systems. The successful implementation of PHC revitalisation and universal health coverage reforms cannot be achieved without addressing the concerns of PHC nursing managers and the health system issues affecting them. / MT2017

CoordenaÃÃo de AperfeiÃoamento de Pessoal de NÃvel Superior / A obstruÃÃo das vias aÃreas tem sido um grave problema de crianÃas asmÃticas. No entanto, poucos estudos se desenvolveram sobre medidas para sua melhoria. Este trabalho tem como tese que o cuidado de enfermagem com o uso da intervenÃÃo facilita a desobstruÃÃo das vias aÃreas de crianÃas asmÃticas. O objetivo geral à analisar a eficÃcia da intervenÃÃo para o diagnÃstico de enfermagem desobstruÃÃo ineficaz das vias aÃreas (DIVA) em crianÃa asmÃtica. Fez-se uma pesquisa do tipo ensaio clÃnico controlado e randomizado, de uma intervenÃÃo aplicada ao diagnÃstico de enfermagem DIVA e foram observados os seus efeitos sobre os desfechos. A pesquisa foi realizada em um hospital infantil da rede pÃblica de Fortaleza â CE nos meses de julho a setembro de 2009. A amostra se constituiu por 42 crianÃas asmÃticas de ambos os sexos em internamento (21 em cada grupo), conforme critÃrios de elegibilidade. As crianÃas selecionadas foram randomicamente divididas em dois grupos por meio de sorteio simples: grupo intervenÃÃo e controle. O grupo controle compÃs-se por crianÃas que receberam apenas o tratamento padrÃo da unidade de internamento hospitalar; e o grupo intervenÃÃo, pelas crianÃas que, alÃm de receberem o tratamento padrÃo, receberam a intervenÃÃo proposta neste estudo. Os dados organizaram-se em tabelas, analisados com base em frequÃncia absoluta e percentual e em medidas de tendÃncia central, de dispersÃo e testes de associaÃÃo (Qui-quadrado e Fisher) e de diferenÃa de mÃdia (Teste t) e coeficientes de correlaÃÃo de Pearson e Spearman. Considerou-se relaÃÃo estatisticamente significante aquelas com valor de p < 0,05. O projeto de pesquisa foi aprovado pelo Comità de Ãtica em Pesquisa da Universidade Federal do CearÃ. Os principais achados deste estudo mostram prevalÃncia do sexo masculino na amostra em geral. As crianÃas estudadas apresentaram, em mÃdia, 20,90 meses de idade (+ 10,382), peso mÃdio de 11,3 Kg (+ 2,739) e mediana de 2 dias de internaÃÃo. As caracterÃsticas definidoras prevalentes, nos dois grupos, foram ruÃdos adventÃcios respiratÃrios, tosse ineficaz e murmÃrios vesiculares diminuÃdos. O diagnÃstico de enfermagem DIVA dos participantes deste estudo relaciona-se a fatores de secreÃÃes nos brÃnquios, muco excessivo, espasmo da via aÃrea e hiperplasia das paredes brÃnquicas. De acordo com os dados do estudo, observa-se que, antes da intervenÃÃo, nÃo houve diferenÃa estatisticamente significante no estado de saÃde das crianÃas. ApÃs a intervenÃÃo, os indicadores asfixia e ruÃdos respiratÃrios anormais, apresentaram mÃdia de postos maiores no grupo intervenÃÃo, demonstrando, assim, melhoria do quadro obstrutivo das crianÃas que receberam a intervenÃÃo. No grupo intervenÃÃo, a diferenÃa entre o estado de saÃde, antes e apÃs a intervenÃÃo, foi maior que no grupo controle, em demonstraÃÃo da eficÃcia da intervenÃÃo. O rigor metodolÃgico e o embasamento cientÃfico para desenvolvimento e aplicaÃÃo da intervenÃÃo favorecem a comprovaÃÃo da tese de que o cuidado de enfermagem com o uso da intervenÃÃo facilita a desobstruÃÃo das vias aÃreas de crianÃa asmÃtica.

CoordenaÃÃo de AperfeiÃoamento de Pessoal de NÃvel Superior / A assistÃncia ao recÃm-nascido com integridade da pele prejudicada deve ser prioridade para equipe de enfermagem. Objetivou-se analisar o uso das intervenÃÃes propostas pela Nursing Intervention Classification (NIC) indicadas para o diagnÃstico de enfermagem Integridade da pele prejudicada na Unidade de Terapia Intensiva Neonatal. Estudo exploratÃrio, descritivo, utilizando-se mapeamento cruzado em trÃs unidades neonatais pÃblicas, em Fortaleza-CE-Brasil. Participaram 42 enfermeiros atuantes em Neonatologia. A coleta de dados foi realizada de maio a setembro/2011, conforme a disponibilidade dos participantes. Aprovado pelo Comità de Ãtica das instituiÃÃes pesquisadas. No primeiro momento da coleta, os enfermeiros indicaram as atividades realizadas junto aos recÃm-nascidos com o diagnÃstico de enfermagem Integridade da pele prejudicada. Em seguida, foi realizada comparaÃÃo dessas atividades com as intervenÃÃes propostas pela NIC, caracterizando o mapeamento. A anÃlise ocorreu entre outubro/2011 e janeiro/2012. Para revisÃo e refinamento do mapeamento, os resultados obtidos foram encaminhados a nove enfermeiros experts em diagnÃstico de enfermagem, por meio do correio convencional e eletrÃnico. O mapeamento revelou que das 75 atividades sugeridas na NIC, 57 corresponderam Ãs indicadas pelos enfermeiros. As mais citadas pelos enfermeiros como desempenhadas cotidianamente foram relacionadas ao cuidado com lesÃes: aplicar um curativo adequado ao tipo de lesÃo; reposicionar o paciente pelo menos a cada duas horas, conforme apropriado; posicionar o paciente, de modo a evitar a tensÃo sobre a lesÃo, conforme apropriado; e remover curativo e fita adesiva. Tratamento tÃpico: aplicar emolientes à Ãrea afetada; aplicar curativo oclusivo transparente sempre que necessÃrio; e evitar o uso de sabonete alcalino na pele. SupervisÃo da pele: examinar a pele e as mucosas quanto à vermelhidÃo, ao calor exagerado, ao edema e à drenagem; e documentar mudanÃas na pele e mucosas. As atividades sugeridas pela NIC mais realizadas segundo opiniÃo dos enfermeiros (mÃdia ponderal entre 0,8 e 1) relacionadas ao cuidado com lesÃes: aplicar um curativo adequado ao tipo de lesÃo; manter tÃcnica assÃptica durante realizaÃÃo; trocar curativos, conforme a quantidade de exsudato e drenagem; limpar com soro fisiolÃgico ou substancias nÃo tÃxicas; posicionar o paciente, de modo a evitar tensÃo sobre a lesÃo e reposicionar o paciente pelo menos a cada duas horas. Referentes ao tratamento tÃpico: manter limpas, secas e sem vincos as roupas de cama; aplicar curativo oclusivo transparente; proporcionar higiene Ãntima; aplicar antibiÃtico tÃpico à Ãrea afetada; e aplicar emolientes à Ãrea afetada. Quanto à supervisÃo da pele: observar as extremidades quanto à cor, ao calor, ao inchaÃo, aos pulsos, à textura, ao edema e Ãs ulceraÃÃes; monitorar cor e temperatura da pele; e examinar a condiÃÃo da incisÃo cirÃrgica. ApÃs submissÃo do mapeamento à avaliaÃÃo por enfermeiros peritos, foi sugerido que das 22 atividades de cuidado com a pele, 13 permaneceriam com a nomenclatura NIC. Com relaÃÃo ao tratamento tÃpico, 23 atividades tiveram discretas alteraÃÃes e 10 permaneceram inalteradas. Relativo à supervisÃo da pele, trÃs foram modificadas e nove atividades mantiveram a nomenclatura NIC. Concluiu ser possÃvel a utilizaÃÃo da NIC como terminologia padronizada para descrever os cuidados de enfermagem prescritos, uma vez que essa classificaÃÃo mostrou-se, em sua maioria, adequada à realidade neonatal. / The assistance to newborns with impaired skin integrity should be a priority for the nursing staff. Thus, we aimed to analyze the use of the interventions proposed by the Nursing Intervention Classification (NIC) indicated for the nursing diagnosis Impaired skin integrity in the Neonatal Intensive Care Unit. This is an exploratory descriptive study using cross-mapping in three public neonatal units, in Fortaleza-CE, Brazil. The population was composed of 42 nurses working in neonatology. Data collection was conducted from May to September 2011, according to the availability of participants. The study was approved by the Ethics Committee of the institutions surveyed. In the first moment of collection, nurses indicated the activities they performed along with the newborns with the nursing diagnosis Impaired skin integrity. Next, we compared these activities with the interventions proposed by NIC, characterizing the mapping. The analysis occurred between October 2011 and January 2012. To review and refinement of the mapping, the results obtained were sent to nine nurses experts in nursing diagnosis through conventional mail and e-mail. The mapping revealed that from the 75 activities suggested by NIC, 57 corresponded to those indicated by nurses. The most mentioned by nurses as routinely performed were related to the care of injuries: apply an adequate bandage for the type of injury; reposition the patient at least once every two hours, as recommended; positioning the patient in order to avoid tension on the injury, as recommended; and remove bandage and tape. Topical Treatment: apply moisturizers to the affected area; apply a transparent occlusive dressing when necessary; and avoid the use of alkaline soap on the skin. Skin surveillance: examine the skin and mucous membranes for redness, excessive heat, edema and drainage, and document changes in the skin and mucous membranes. The activities suggested by NIC most performed according to the nursesâ opinion (weighted average of 0.8-1) related to the care of injuries were: apply an appropriate bandage for the type of injury; maintain aseptic technique during performance; changing dressings according to the amount of exudate and draining; cleaning with saline or non-toxic substances; positioning the patient in order to prevent tension on the wound; and reposition the patient at least once every two hours. As regards to topical treatment: keep bed linen clean, dry and wrinkle-free; apply transparent occlusive dressing; provide intimate hygiene; apply topical antibiotics to the affected area; and apply moisturizer to the affected area. As for the skin surveillance: observe the extremities for color, warmth, swelling, pulses, texture, edema and ulceration; monitor skin color and temperature; and examine the condition of the surgical incision. After submitting the mapping to the evaluation of expert nurses, it was suggested that, of the 22 activities of skin care, 13 remain with the NIC taxonomy. Regarding the topical treatment, 23 activities had minor changes and 10 remained unchanged. On the skin surveillance, 3 activities were modified and 9 kept the NIC taxonomy. We concluded that is possible to use the NIC as a standardized terminology to describe the nursing care prescribed, once this classification has proven, in most cases, appropriate to neonatal reality.

In recent times there has been an emphasis on patients participating in their own nursing care. Studies have demonstrated that when patients participate in their own care, they experience positive outcomes, such as greater satisfaction with care, a sense of control, decreased vulnerability, and being effectively prepared for discharge. Practising nurses are of the view that patients should be involved in the planning, implementation, and evaluation of care in keeping with nursing's philosophy of provide holistic or patient-centred care. Despite this there is literature to show that nurses' espoused pro-participatory attitudes were not always enacted in the practice setting. There was a paucity of research to explain why this situation existed. Therefore, the purpose of this grounded theory study was to explore, describe, and analyse nurses' and patients' perspectives on the phenomenon of patient participation within the context of hospital nursing practice in Western Australia.Data were collected through formal and informal interviews with nurses, patients, non nurses, a doctor and relatives, focus group interview with nurses, participant observation, listening to nurses' handovers, examination of nurses' notes, and published literature. Thirty three Registered Nurses and 32 patients from medical, surgical, and extended care wards were formally interviewed. Additionally, 28 nurses and 17 patients were informally interviewed during participant observation. The total hours of participant observation was 142. The constant comparative method was used to analyse the data.The findings revealed that the basic social problem that faced nurses and patients was incongruence in their understandings of the meaning of patient participation and in their philosophies about nursing care. This had led to nurses and patients adopting three styles of participation, that is, ++ / participation inclusion which involved patients participating in all aspects of their care, including making decisions about their treatments, participation marginalisation which encompassed patients participating only in their daily living activities and pain management, and participation preclusion which involved patients not participating in any aspects of their care. This resulted in nurses and patients coming together with their own different styles of patient participation, which caused conflict in viewpoints about how care should be provided and received at the bedside. Exacerbating the problem of incongruence were the hospital contextual conditions of economic constraints, management structures, presence of technology, and culture of medical dominance. These contextual conditions also modified the process that nurses and patients used to deal with the problem.The basic social process that nurses and patients used to deal with the problem of incongruence was labelled accommodating the incongruence and involved three phases. It was found that varying intervening conditions that affected the nurses, patients, or both, and the day-to-day ward environment modified this process. The first phase, which was labelled coming to terms with the incongruence, involved nurses and patients encountering and acknowledging that there was an incongruence. The second phase, which was termed rationalising the incongruence, involved nurses and patients observing and assessing each other's behaviours. The third phase, which was labelled seeking resolution: minimising the incongruence, involved nurses and patients adjusting their behaviours so as to achieve some balance. This third phase was nurse-driven with patients playing a subsidiary role. This was considered to be due to nurses being at their optimum physical level of functioning and in their own socio-cultural work ++ / environment as opposed to patients who were ill and therefore vulnerable. Nurses adjusted their behaviours, depending on the patients' preferred style of participation, by either increasing patients' control and level of participation, as well as increasing their own level of control, to upgrade patients' input; or decreasing patients' control and level of participation and decreasing their own level of control to downgrade patients' input; or alternatively converging patients' control and level of participation to meet with their own style of participation, without them increasing of decreasing their own control. Through converging, the nurses were able to upgrade or downgrade patients' input. From this nurse-patient interactive process, which was dynamic and reciprocal, a theory of patient participation emerged. This was labelled Accommodating Incongruity. Implications for nursing practice, management, theory, education, research, and consumerism are discussed and directions for future research are provided.