Patient participation, a prerequisite for care: A grounded theory study of healthcare professionals' perceptions of what participation means in a paediatric care context

Developing Communication Support Material for Sharing Information with Patients Undergoing an 18F-FDG PET/CT Examination

Our aim was to develop communication support material for information sharing related to an 18F-FDG PET/CT examination. Methods: The study had a qualitative design adapting a multiphase structure. A prototype of communication support material consisting of illustrations and text related to an 18F-FDG PET/CT examination was developed. Interviews were conducted with patients scheduled for an 18F-FDG PET/CT examination for the first time, and questionnaires were collected from health care professionals with experience in 18F-FDG PET/CT. The communication support material was revised until consensus was reached about it. Results: The results are based on interviews with patients (n = 10) and questionnaires collected from health care professionals (n = 9). The overall theme revealed that patient information about an 18F-FDG PET/CT examination is a balancing act between text and illustrations. The analysis showed 2 categories: "illustrations as a complement" and "easy-to-understand layout." Conclusion: The participants strengthened the development of the communication support material by bringing in valuable viewpoints from various perspectives. The results support a person-centered approach in which information about an 18F-FDG PET/CT examination can be adapted to each patient's needs as a balancing act between text and illustrations.

Person-centered care for common mental disorders in Ontario's primary care patient-centered medical homes: a qualitative study of provider perspectives

BACKGROUND

For more than a decade, the Patient-Centered Medical Home model has been a guiding vision for the modernization of primary care systems. In Canada, Ontario's Family Health Teams (FHTs) were designed in the mid-2000s with the medical home model in mind. These primary care clinics aim to provide accessible, comprehensive, and person-centered primary care services to communities across Ontario. Their services typically include mental health care for people experiencing common mental disorders, such as depression and anxiety disorders. It remains unclear, however, whether the mental health care delivered within FHTs is consistent with person-centered care approaches. In the current study, we aimed to explore the perspectives of FHT providers on the care delivered to people with common mental disorders to determine whether, and to what extent, they believed this care was person-centered.

METHODS

We conducted a qualitative grounded theory study involving interviews with 65 health professionals and administrators from 18 FHTs across Ontario. Transcripts were coded using a three-step process of initial, focused, and axial coding that mixed inductive and deductive approaches informed by sensitizing concepts on person-centeredness.

RESULTS

Practices and challenges associated with the delivery of mental health care in a person-centered way were captured by several themes regrouped into five domains: (1) patient as unique person, (2) patient-provider relationship, (3) sharing power and responsibility, (4) connecting to family and community, and (5) creating person-centered care environments. FHT providers perceived that they delivered person-centered care by delivering mental health care that was responsive, flexible, and consistent with biopsychosocial approaches. They emphasized the importance of creating long-lasting relationships with patients grounded in empathy and trust. Their challenges included being able to ensure continuity of care, adequately prioritizing patients' mental health issues, and meaningfully engaging patients and families as partners in care.

CONCLUSIONS

Our findings suggest that FHT providers have adopted a range of person-centered practices for people with common mental disorders. However, greater attention to practices such as shared decision making, supporting self-management, and involving families in care would strengthen person-centeredness and bring teams closer to the Patient-Centered Medical Home vision.

Children's voices on their values and moral dilemmas when being cared and treated for cancer- a qualitative interview study

BACKGROUND

Childhood cancers affect about 350 children every year in Sweden and are life-threatening diseases. During the treatment period, situations arise that can become morally challenging for the child. When knowing children's values and morally challenging situations in childhood cancer care, targeted ethics support could be developed and used in care.

AIM

To explore children's values and moral dilemmas ​​when undergoing cancer treatment.

METHODS

This is a qualitative study based on empirical data. The data collection was conducted through three focus group interviews and six individual interviews with children between 10 and 18 years (n = 16). A content analysis methodology was used to generate themes. Children who were/have been treated for cancer at three childhood cancer centres in Sweden were invited to participate. The study was approved by the Swedish Ethical Review Authority. The children's participation was based on voluntariness and consent/assent.

FINDINGS

During the analysis, five themes of values emerged: Personal relationships, Bodily ease and identity, Feeling in control and being involved, Positive distractions and Right care that is needed. Their moral dilemmas were thematized into: Should I consider others or not? Should I rest or not? and Should I refuse treatment or not?

CONCLUSION

Children undergoing cancer treatment want to have personal relationships with healthcare professionals. Their moral dilemmas were about questioning their own physical and psychological well-being against their expectations, the values of others and the treatment required. Further research is needed to understand how to deal with moral dilemmas in children undergoing cancer treatment.

Children's cognition and attitudes during long-term cancer treatment: an ethnographic study

BACKGROUND

Cancer treatment for children is typically long-term and difficult, and the experience is unique for each child. When designing child-centred care, individuals' values and preferences are considered equally important as the clinical evidence; therefore, understanding children's thoughts and attitudes while they receive long-term treatment could offer valuable insights for better clinical practice.

METHODS

We conducted long-term consecutive participatory observations and interviews with seven children, who were hospitalised and receiving cancer treatment for the first time. The daily observational data on those children's discourses, behaviours and interactions with health professionals were systematically collected and thematically examined. The analysis was expanded to explore significant narratives for each child to capture their narrative sequence over time.

RESULTS

The initial analysis identified 685 narrative indexes for all observation data, which were categorised into 21 sub-codes. Those sub-codes were assembled into five main themes by thematic analysis: making promises with health professionals, learning about the treatment procedures through participation, taking care of oneself, increasing the range of activities one can perform and living an ordinary life.

CONCLUSION

We observed a forward-looking attitude toward understanding cancer, accepting treatment and looking forward to the future among children undergoing in-hospital cancer treatment. In addition, the children developed cognitively, affectively and relationally throughout cancer treatment processes. These findings have implications for better clinical practice in child-centred care, including children's participation in shared decision-making in paediatric oncology.

Impact of family-centered care in families with children with intellectual disability: A systematic review

Background

Family-Centered Care (FCC) is an approach to healthcare planning, delivery and evaluation, based on beneficial partnerships between health professionals, patients and families. FCC may be particularly relevant for families with children with intellectual disability (ID), given their needs of continuum care.

Objective

To identify which components of the FCC are practiced and which health outcomes are considered effective in families with children with ID.

Method

A systematic review guided by the PRISMA STATEMENT 2020 approach and the STROBE reporting guidelines was performed on specific databases through the EBSCOhost Web platform: MEDLINE with Full Text, CINAHL PLUS with Full Text, Academic Search Complete and Psychology and Behavioral Sciences Collection. Peer-reviewed articles published in English or Portuguese languages from 2018 to September 2023 were retrieved. Methodological quality was established using the Quality Assessment Tool for Observational, Cohort and Cross-Sectional Studies - NHLBI, NIH.

Results

Ten studies met the eligibility criteria and were synthetized. The results revealed nine components, reflecting the way FCC was developed: shared decision-making; family education; respect for culture; family engagement; recognition of the family's needs, characteristics and interests; specialized care support; social and emotional support; family functionality; and family seen as a unit. The health outcomes demonstrate effective gains in improving children's health through family satisfaction with health services. Also achieved psychological and social benefits, with improved family well-being and quality of life, favoring family empowerment.

Conclusions

The evidence suggests that FCC components involves an effective partnership between the family and health professionals as the main key in developing care plans, as well as the experience that the family unit brings to the delivery of care. FCC approach include all family members as decision-makers, providing emotional, physical and instrumental levels of support. Health outcomes emerged in three strands; for children with ID, families and health services.

'Do you feel well or unwell?' A study on children's experience of estimating their nausea using the digital tool PicPecc

Research with childhood cancer has progressed greatly in recent years, resulting in much improved treatment that is more intensive. However, with this new treatment children often experience negative symptoms, and research shows that nausea is a symptom that most affects them. Pictorial support in person-centred care for children (PicPecc) is a digital picture-based tool for children who undergo treatment due to their cancer diagnosis and helps them more effectively communicate and self-report their symptoms and emotions. The aim of the study was to investigate children's experience of (i) using mHealth in nausea management and (ii) their acceptability of using an application (App). Semi-structured interviews were conducted with eight children aged five to fifteen years. Data were analysed with qualitative content analysis. The findings were presented in three categories: 1) Communicating feelings, 2) Playfulness generated in motivation and 3) App adaptable to children's capabilities. Using an App contributed to new opportunities for the children to participate in their care. They experienced their treatment in different ways and used different strategies to manage and distract themselves from their symptoms. Using the PicPecc App can increase healthcare staff's understanding of how children experience nausea when they undergo chemotherapy.

Nurses' and Families' perceptions and practices and factors influencing the implementation of family-centred care for hospitalised children and their families

AIMS AND OBJECTIVES

To explore the perceptions of family-centred care among nurses and the family members of hospitalised children and investigate the facilitators of and barriers to the implementation of family-centred care in Malawi.

BACKGROUND

In Malawi, approximately 34% of children have long-term illnesses that require hospitalisation. Family-centred care ensures that the delivery of healthcare is grounded in partnerships between healthcare providers, patients and their families, which can improve the psychological well-being of families. However, there is lack a good understanding of how families and nurses perceive this concept, its facilitators and the barriers.

DESIGN

This was an exploratory qualitative study. Data were analysed deductively and inductively using the five-step qualitative content analysis method.

METHODS

Twenty-nine nurses and 31 families were recruited. Data were collected through in-depth, semi-structured and face-to-face individual interviews. The study was reported using the COREQ checklist.

RESULTS

Both nurses and families of hospitalised children recognised the importance of nurse-family partnerships in family-centred care. Four themes emerged as follows: Perceptions of family-centred care, elements of family-centred care, facilitators of family-centred care and barriers to family-centred care. Specific information to families and the religious beliefs of families were identified as important facilitator and barrier to family-centred care, respectively.

CONCLUSION

The implementation of family-centred care is promising in Malawi, as it is positively perceived by nurses and families, and its implementation is consistent with the Institute for Patient and Family-Centred Care Framework.

RELEVANCE TO CLINICAL PRACTICE

Our findings present the best practices, gaps and challenges in the context of a low-income country regrading implementation of family-centred care. Education programmes on family-centred care are crucial for sustaining the current gains.

Children and adolescents living with HIV: participatory health care proposal

OBJECTIVE

To present a proposal for participatory health care based on the Human Rights of children and adolescents living with HIV.

METHOD

Qualitative study with participatory approach that used the Sensitive Creative Method. The participants were 16 health professionals from three Specialized Care Services in southern Brazil. Data were submitted to Discourse Analysis in the French current.

RESULTS

The first thematic category highlighted the perspectives on the right to participation as a new meaning in the science of care. The second category revealed the construction of a participatory care proposal by health professionals, that can be implemented in the daily practice of teamsin six moments.

FINAL CONSIDERATIONS

The implementation has the potential to promote the legitimacy of the right to participation and, consequently, the qualification of health care.

Ethical concerns when recruiting children with cancer for research: Swedish healthcare professionals' perceptions and experiences

BACKGROUND

Research is crucial to improve treatment, survival and quality of life for children with cancer. However, recruitment of children for research raises ethical challenges. The aim of this study was to explore and describe ethical values and challenges related to the recruitment of children with cancer for research, from the perspectives and experiences of healthcare professionals in the Swedish context. Another aim was to explore their perceptions of research ethics competence in recruiting children for research.

METHODS

An explorative qualitative study using semi-structured interviews with key informants. Seven physicians and ten nurses were interviewed. Interviews were analysed using inductive qualitative content analysis.

RESULTS

The respondents' ethical challenges and values in recruitment mainly concerned establishing relationships and trust, meeting informational needs, acknowledging vulnerability, and balancing roles and interests. Ensuring ethical competence was raised as important, and interpersonal and communicative skills were highlighted.

CONCLUSION

This study provides empirical insight into recruitment of children with cancer, from the perspectives of healthcare professionals. It also contributes to the understanding of recruitment as a relational process, where aspects of vulnerability, trust and relationship building are important, alongside meeting informational needs. The results provide knowledge on the complexities raised by paediatric research and underpin the importance of building research ethics competence to ensure that the rights and interests of children with cancer are protected in research.

A Norm-Creative Method for Co-constructing Personas With Children With Disabilities: Multiphase Design Study

BACKGROUND

An increase in the demand for child participation in health care requires tools that enable and empower children to be involved in the co-production of their own care. The development of such tools should involve children, but participatory design and research with children have challenges, in particular, when involving children with disabilities where a low level of participation is the norm. Norm-creative and participatory approaches may bring more effective design solutions for this group. "Personas" is a methodology for increasing user perspectives in design and offers representation when users are absent. However, research on participatory persona generation in this context is limited.

OBJECTIVE

The objective of this study was to investigate how norm-creative and participatory design approaches can be integrated in a persona generation method to suit children with disabilities in the design of games for health that target this group.

METHODS

The method development involved interview transcripts and image-based workshops. Sixteen children with various disabilities participated in persona generation through co-creation of characters and scenarios. The results from the workshops were validated together with 8 children without disabilities, 1 young adult with a disability, and 1 rehabilitation professional. A qualitative thematic design analysis was iterated throughout the process.

RESULTS

The results consisted of an image-based and iterative co-construction method. It was accompanied by examples of personas that were generated and validated within a games for health case. The method showed effectiveness in enabling flexible co-construction and communication. The data resonated with social model perspectives, and the development is discussed in terms of participation levels, salutogenic descriptions of barriers, and norm-creative tradeoffs.

CONCLUSIONS

The resulting method may influence future design projects toward more inclusiveness and enable increased representation for children with disabilities in research and design. Using this method to its full potential requires a norm-critical awareness as well as extensive facilitation. Suggestions for further research include the application of the method to design processes in similar contexts or user groups.

Children's decision making in cancer therapy: A long-term observational study

BACKGROUND

The survival rate of children with cancer has increased substantially in recent years. Shared decision making (i.e., the ability of children with cancer to express their will and share it with medical personnel) has become a particularly important issue. The nature and developmental processes of children's decision making in hospital should be understood. There is, however, a lack of research in this area.

METHODS

From January 2016 to March 2018, we conducted a longitudinal qualitative observational study, within the context of medical anthropology, in a hospital pediatric ward in Japan. We investigated the nature and development of decision making among seven children aged 5-12 years with hematologic cancers. We recorded their everyday behaviors, interactions, narratives, and events in the ward. The recording was conducted systematically and it was analyzed thematically using both variable-oriented and process-oriented modes to assess causal relationships between phenomena.

RESULTS

The thematic analysis identified three thematic scenes in which children developed their will regarding cancer treatment: (1) adjusting to hospital life; (2) forming friendships with other children; and (3) communicating with medical personnel. Sharing information, building trusting relationships, and sharing treatment goals with medical personnel were identified as forms of children's participation in medical decision making. Through cultivated friendships, children's peer groups were sources of resilience and strength in overcoming difficulties in hospital life.

CONCLUSIONS

The development of children's decision making in a pediatric oncology ward was based on various rich human relationships. Such relationships should be promoted to improve shared decision making substantially.

A Qualitative Study: What Do Nurses in Charge in Emergency Departments Do?

Background

The nurse-in-charge (NIC) role has been implemented in many emergency departments (EDs) to assist with smooth operations and coordination across the ED, together with the emergency physician in charge (EPIC). This work aims to describe the problem-solving approaches used by NICs and the coordination of their role with other team members.

Methods

Observations and semi-structured interviews were performed with NICs in a single centre, where NICs were purposively sampled for a variety of experience levels. During the observations, field notes were taken for every action conducted by the NIC in ED; the semi-structured interviews involved a combination of question prompts and a blank diagram of the ED that the NICs were asked to annotate. Constant comparative analysis based on grounded theory methodology was used for this qualitative study. 

Results

Eight different problem-solving approaches were identified. These are placing, targeting, guiding, juggling, chasing, team-leading, escalating and de-escalating. The last three were exclusive to NICs, whereas the others were shared to some degree with the EPIC. Seven team situational awareness processes used by NICs for coordination with other team members were identified, leading to a discussion on team synchronisation and shared awareness mechanisms. In particular, shared internal models amongst the NICs and also other team members provide a framework for analysing how team members function together in a healthcare setting. 

Conclusions

Emergency department NICs have a number of problem-solving approaches that have been defined and shown to have a degree of overlap with the emergency physician in charge. Shared awareness between the NIC and other ED team members facilitate decision-making and smooth coordination. These findings provide a better understanding of the role of the NIC and are useful for describing solutions for patient flow.

Creating a communication space in the healthcare context: Children’s perspective of using the eHealth service, Sisom

According to the United Nation's Convention of the Rights of the Child, children have the right to participate in their own healthcare and make their opinions heard. The aim of this study was thus to explore the impact of using an eHealth service, Sisom, to gain the children's perspectives during their healthcare appointments. Data were gathered through individual interviews with a purposeful sample of 16 children, aged 6-13 years old, treated for different diseases and using the eHealth service, Sisom, during their healthcare appointments. The interviews were analysed using a constructivist grounded theory. The results showed that using Sisom made children's voice heard by creating a communication space in the healthcare setting. This meant that the children got involved in the communication, were acknowledged as an important person who could give the answers to questions and were given time. Implementing the use of Sisom is a way to make children's needs and preferences explicitly visible for decision-making in practice and thereby supporting the further development of child-centred care in practice.

The Scope of Family-Centred Care Practices, and the Facilitators and Barriers to Implementation of Family-Centred Care for Hospitalised Children and their Families in Developing Countries: An Integrative Review

PROBLEM

Limited knowledge exists regarding the scope practices and implementation from developing countries. This integrative review aims to report research on the scope of FCC practices, facilitators and barriers to the FCC implementation for hospitalised children and their families in developing countries.

ELIGIBILITY CRITERIA

Qualitative, quantitative, mixed-method studies, reports, systematic reviews and integrative reviews reporting implementation, barriers and facilitators of FCC, published in English between 2008 and 2018, from developing countries were evaluated. Joanna Briggs Institute Appraisal Tools were used for methodological assessment.

SAMPLE

Eleven studies from developing countries met the inclusion criteria. Four studies were randomised controlled trials, five were cross-sectional, one was a quasi-experimental while one was a qualitative study.

RESULTS

The scope of FCC research focuses on information sharing, family participation, and respect and dignity and FCC implementation focuses on practices and perceptions, measurement and impact of FCC. Both personal and health system facilitators and barriers exist but their influence on FCC implementation is limited. Research on needs of families and hospitalised children is also limited.

CONCLUSION

FCC practice and research are still in infancy stage in developing countries. There is limited understanding on scope of FCC practices, the needs of parents and children, and the influence of facilitators and barriers.

IMPLICATIONS

The limited findings reported in this review support the need for international collaboration to FCC to critique FCC research and integrate it with other philosophies such as child and family centred care and child centred care as is the case in some developed countries.

Barriers and Enablers Affecting Successful Implementation of the Electronic Health Service Sisom: Multicenter Study of Child Participation in Pediatric Care

Background

Children’s participation in health care is one of the most important components in the management of their disease. Electronic health (eHealth) services that are adapted to the needs of children have the potential for restructuring how children and professionals work together. Therefore, a digital interactive assessment and communication tool, Sisom, was developed to give children aged between 6 and 12 years a voice in their own health care. However, the implementation of eHealth services such as Sisom in daily practice in pediatric health care is rarely investigated.

Objective

The aim of this study was to explore the process of implementing Sisom for children in pediatric care in Sweden. More specifically, the study aimed to (1) evaluate whether the implementation strategy was conducted as planned, (2) understand the barriers and facilitators of the implementation strategy in pediatric care settings, (3) gain insight into how professionals work with the specific intervention, and (4) gain insight into the usefulness and effects of the intervention from the professionals’ perspectives.

Methods

A process evaluation design was used to study the implementation of Sisom at 4 pediatric care centers in Sweden. An extensive amount of qualitative and quantitative data was collected before, during, and after the intervention through self-report checklists, memos, and interviews with professionals. In total, 46 children, aged between 6 and 13 years, participated. The children used Sisom on two occasions during 6 months. When they used Sisom, a printed report formed the basis for a forthcoming dialogue between professionals, children, and their parents.

Results

To our knowledge, this is the first implementation study of an eHealth communication tool aimed at strengthening children’s participation in pediatric health care. Key factors for successful implementation were alignment of the solution with the values and goals of the organization, health care professionals’ beliefs in the usefulness and usability of the solution, and health care professionals’ willingness to change their professional roles guided by the solution.

Conclusions

The results from the study show that it is possible to restructure health care delivery toward a child-centered approach, if there is a willingness and preparedness in the organization to implement an eHealth solution with the aim of restructuring the way of working with children’s participation.

Patient Participation in Nursing Care: Views From Ghanaian Nurses, Nursing Students, and Patients

Previous studies on patient participation reported inconclusive benefits of patient participation in health care. Consequently, the World Health Organization is actively highlighting the need for the participation of patients and their families in their care. The aim of this study was to explore the views of nurses, nursing students, and patients on patient participation in Ghanaian hospitals. Sixty-five participants made up of 15 patients, 25 registered general nurses, and 25 undergraduate nursing students were involved in the study. Data collection was done through interviews and focus group discussions. Content analysis was utilized in analyzing the data to generate four main categories. These categories were as follows: (a) meaning of patient participation in Ghana, (b) patient participation encouraged more during discharge education, (c) patient participation in nursing care higher in private and smaller hospitals, and (d) perceived facilitators and inhibitors of patient participation in nursing care. Participants in this study indicated that patient participation in nursing care meant involvement of patient in treatment decisions and nursing care procedures. Participants agreed that patient participation in nursing care was mostly encouraged during discharge education. Participation was perceived to be higher in private and smaller hospitals. Wealth and higher education were perceived as facilitators of patient participation while workload and high patient acuity were perceived as inhibitors.

Children's active participation in decision-making processes during hospitalisation: An observational study

AIMS AND OBJECTIVES

The aim was to explore and describe the child's active participation in daily healthcare practice at children's hospital units in Sweden.

OBJECTIVES

(a) Identify everyday situations in medical and nursing care that illustrate children's active participation in decision-making, (b) identify various ways of active participation, actual and optimal in situations involving decision-making and (c) explore factors in nursing and medical care that influence children's active participation in decision-making.

BACKGROUND

Despite active participation being a fundamental right for children, they are not always involved in decision-making processes during their health care. There still remains uncertainty on how to support children to actively participate in decisions concerning their health care.

DESIGN

A qualitative study with overt, nonparticipant observations fulfilling the COREQ checklist criteria.

METHODS

Observations of interactions between children aged 2 and 17 years with both acute and chronic conditions, their parents, and healthcare professionals were conducted at three paediatric hospitals in Sweden. The Scale of Degrees of Self Determination was used to grade identified situations. The scale describes five levels of active participation, with level one being the least and level five being the most active level of participation. Normative judgements were also made.

RESULTS

Children's active participation was assessed as being generally at levels four and five. Children demonstrated both verbal and nonverbal ways of communication during decision-making. Findings indicated that children's, parents' and healthcare professional's actions influenced children's active participation in decision-making processes involving healthcare.

CONCLUSIONS

Healthcare professionals specialised in paediatrics need to embrace both a child perspective and a child's perspective, plan care incorporating key elements of a child-centred care approach, to ensure children's active participation at a level of their choosing.

RELEVANCE TO CLINICAL PRACTICE

There is a need for awareness creation to help healthcare professionals facilitate children's active participation in their care and decision-making.

Parents' and Staff Perceptions of Parental Needs During a Child's Hospital Admission: An Australian Study

PURPOSE

This study aimed to identify parents' and staff perceptions of parents' needs during a hospital admission and relationships between needs, socio-demographic and clinical variables.

DESIGN AND METHODS

A cross-sectional descriptive design. Forty-six parents whose child received care and 17 staff who worked within a paediatric ward at a secondary hospital in Western Australia completed the Needs of Parents' Questionnaire in 2016.

RESULTS

Parent and staff perceptions of the importance of needs were congruent but differences arose between parents and staff on whether these needs were met and needed. Parents were more likely to rate needs as less important, more met and more needed than staff members. Demographic characteristics significantly influenced parents' and staff perceptions of parents' needs in hospital.

CONCLUSIONS

Staff need to acknowledge that the parent and child's hospital trajectory and demographical characteristics can influence the parent and child's needs in hospital. For family centred healthcare delivery to be effective, care delivery needs to be aligned to what parents and children state their needs are at that time.

PRACTICE IMPLICATIONS

This study has highlighted that future international collaborative research networks are needed to critique the concepts and clinical implications of FCC from a broader lens and recipients, deliverers and providers of healthcare need to be cognisance of contemporary FCC literature.

Patient participation, a prerequisite for care: A grounded theory study of healthcare professionals' perceptions of what participation means in a paediatric care context

Aims

To explore healthcare professionals' perceptions of what patient participation means in a paediatric care context .

Design

A qualitative explorative design with grounded theory.

Methods

Fifteen healthcare professionals who worked in paediatric care settings were either interviewed or asked open-ended questions in a survey, during December 2015-May 2016. Grounded theory was used as a method.

Results

The study results provide a theoretical conceptualization of what patient participation meant for healthcare professionals in paediatric care and how participation was enabled. The core category "participation a prerequisite for care" emerged as the main finding explaining the concept as ethical, practical and integrated in the care givers way of working. However, the concept was implicit in the organization. Four additional categories illustrated the healthcare professionals' different strategies used to enhance patient participation; "meeting each child where the child is," "building a relationship with the child," "showing respect for each individual child" and "making the most of the moment."