Bakgrund: Relationen mellan sjuksköterska och patient har genomgått stora förändringar. Från att patienten tidigare sågs som ett objekt utan egna resurser, till att idag ses ur ett holistiskt perspektiv, som en individ med styrkor, tillgångar och som är expert på sin egen person. Begreppet patientdelaktighet uppmärksammades år 1978 av World Health Organization i  Alma-Ata deklarationen och har sedan dess fått större utrymme i vården. Patienters lagliga rätt till delaktighet i sin vård är idag omfattande och det är vårdpersonalens skyldighet att informera och involvera sina patienter. Patienter idag ställer allt högre krav på sjukvården och det är en utmaning för sjuksköterskor att kunna förhålla sig till dessa. Syfte: Syftet var att belysa faktorer som påverkar patienters delaktighet i sin vård. Metod: En litteraturstudie baserad på elva vetenskapliga artiklar analyserade med induktiv ansats. Resultat: Författarna fann elva underteman som påverkade patienters upplevelse av delaktighet i sin vård. Dessa utmynnade i de tre temana kunskap, relation och tid vilka alla hade gemensamt att individanpassning var önskvärt. Slutsats och klinisk betydelse: Resultatet visar att en förutsättning för känslan av delaktighet är att en vårdrelation uppstår mellan sjuksköterska och patient. När sjuksköterskan bekräftar patienten, anpassar sig efter denne och följer upp sina vårdhandlingar finns förutsättningar för att delaktighet uppnås. / Background: The relationship between nurse and patient has undergone major changes. The patient was previously seen as an object without it’s own resources, to now be seen in a holistic perspective, as an individual with strengths, assets and one who is an expert in his/herown person. The concept of patient participation was highlighted in 1978 by the World Health Organization in the Alma-Ata Declaration and has since then gained extention in care. Patients' legal right to participate in their care is extensive and it is the nursing staff's obligation to inform and involve their patients. Patients of today demand more from health care and it is a challenge for the nurse to be able to relate to them. Aim: The aim was tohighlight factors that influence patients' participation in their care. Method: A literature review based on elevenscientific articles analyzed with an inductive approach. Result: The authors found elevensub-themes that influenced patients' experience of participation in their care. These led to the three themes knowledge, relationship and time which all had in common that personalization was desirable. Conclusion and implication: The results show that a prerequisite for the feeling of participation is that a care relationship arises between nurse and patient. When the nurse confirms the patient, adapts to the patientand follow upon her actions are prerequisites for participation is achieved.

Patient participation is a central theme in health care policy in the United Kingdom (U.K.). Indeed, there is a trend in health care policy and practice towards encouraging patients to participate actively in their care, treatment and the services they use (Department of Health, 1989, 2003; 2004; 2005; 2006; 2008; 2009; 2010; 2011; 2012). Despite the current popularity surrounding such an approach to care, the concept remains elusive. Patient participation in nursing care specifically has not been examined adequately and remains one of the least understood ideas in clinical practice. The contribution that nurses make to this important activity has also not been explored. Furthermore, only a few studies have examined the nature of patient participation in nursing care from the frame of reference of the acute surgical patient (Henderson, 1997; Sahlston et al., 2008 and Larsson et al., 2011). Most studies have targeted clinically distinct patient groups and discrete aspects of patient participation within the context of chronic illness or medical and primary care practice. They are therefore limited by their precision and narrow focus (Cassileth et al., 1980; Haug & Levin, 1981; Vertinsky et al., 1984; Caress et al., 2005; Entwhistle et al., 2004; Collins et al., 2007; S. Parsons et al., 2010). Most have also drawn on positivist epistemologies and derived data from self-completed fixed choice questionnaires. An empirically grounded theory that explains the process of patient participation in surgical nursing care within the empirical world has yet to be published. The purpose of this grounded theory study was to explore the nature of patient participation in nursing care within the context of the acute surgical care setting. Ultimately the aim was to generate a substantive theory that could account for, and explain, the process by which patients’ participate in their surgical nursing care. A qualitative, inductive design, based on the classic grounded theory approach to data collection and data analysis (Glaser & Strauss, 1967; Glaser, 1978) was employed to examine the complex nature or natural history of patient participation within the context of contemporary surgical nursing practice. The informants of the research were patients and nurses on three acute surgical wards in an NHS Trust Hospital. Data were collected through 61 unstructured, audiotaped interviews (47 patients and 14 nurses) and 72 hours of participant observation. The interview and observational data were analysed using the constant comparative method of analysis (Glaser & Strauss, 1967; Glaser, 1978). The analytic process generated a substantive theory, labelled Engaging in Nursing Care. The theory explains how patient participation in nursing care within the acute surgical setting is established, developed, maintained or inhibited. It reveals an evolutionary context-sensitive process, which describes the complex and challenging nature of patient participation in nursing care as experienced by patients and nurses in the pre and post-operative period. Three dynamic phases: Establishing Readiness, Shaping Work and Incurring Rewards and Costs describe how patients engage in their nursing care prior to and after surgery. The phase Establishing Readiness describes the structural, organisational and environmental antecedents of patient participation within the context of the surgical care setting. Shaping Work describes the range and variation in participatory behaviour and the levels at which patients participate in their own nursing care throughout their surgical experience. The phase Incurring Rewards and Costs explains the varied effects of patient participation in surgical nursing care on the individual patient, the nurse and surgical ward performance and resources. A number of recommendations are made to enable nurses, educationalists, health care managers and policy makers to develop substantiated strategies and initiatives for the effective implementation of patient participation in modern surgical nursing practice.