A qualitative study of patient competence for patient engagement in their safety——from the perspective of nurses and patients

A qualitative study of patient competence for patient engagement in their safety——from the perspective of nurses and patients | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article A qualitative study of patient competence for patient engagement in their safety——from the perspective of nurses and patients Ying Lu, Jin Jin Zhang, Xue Liu, Yao Ling Zhou, Han Qin Zhang, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4955143/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 24 Oct, 2024 Read the published version in BMC Nursing → Version 1 posted 4 You are reading this latest preprint version Abstract Objectives: To elucidate the essential competencies required for patient engagement in their own safety. Method: We adopted a phenomenological approach in qualitative research to conduct semi-structured interviews with nurses (n=14) and adult patients (n=13) from different departments. By deeply exploring their experiences and feelings about patient participation in patient safety, we sought to understand their views on the qualities that patients need to possess in order to participate in their own safety. Results：From the interviews，we identified seven major themes, including competence of information sharing, competence of taking patient engagement as responsibility and right, competence of making equal communication, competence of maintaining trust relationship with health personnels, competence of accepting non-punitive safety culture, need of resource support, need of channels to provide accurate health information, five of them showed essential competences for patients and two of them showed patients’ need for promoting their engagement. Conclusion：The findings of this study show necessary competence and needs in patient engagement process of patient, offer a foundational reference for constructing a measurement tool for patient engagement in patient safety competence in the future, so that medical staff and patients can provide reference for the future targeted construction of patient competence improvement programs. At the same time, improving patient competence and engagement to better achieve safety goals requires the joint efforts of patients, medical staff, medical institutions, the government, and society. Patient engagement Patient safety Patient competence qualitative study 1. Introduction Patient safety has become an escalating global public health concern, with its prevalence and gravity on the rise 1 . In recent years, there has been an increasing acknowledgment of the significance of patient engagement in enhancing patient safety and augmenting health outcomes. Patient engagement (PE) refers to the process by which an individual patient communicates, influences, and actively participates in the clinical process 2 , which harnesses the patient's experience, authority and opportunities to synergize with the expertise of healthcare professionals 3 , positing the patient as a vital human resource within the medical process, crucial for ensuring patient safety. The World Health Organization (WHO) advocates for actively including families and patients in the medical process to mitigate preventable harm in healthcare, as outlined in the Global Patient Safety Action Plan for 2021–2030 4 . The concept of engaging patients as active participants in their healthcare management is both clinically advantageous and inherently complex, contrasting markedly with the experiences of healthy individuals or those managing a single health issue. As patients, there are limitations on their energy and physical abilities, the responsibility of PE may impose an additional physical or mental burden 5 , and mastering complex medical knowledge presents an even greater challenge. Although PE behaviors offer theoretical benefits for patient safety, the quality of evidence supporting their effectiveness in improving patient safety is currently relatively low 6 . The effects of PE in some studies for the medical process were uncertain 7 , 8 . The absence of a unified standard for PE models results in diverse behaviors and patterns of PE. Ineffective or erroneous engaging behaviors may pose certain clinical risks, and clinical staff expressed some concerns regarding the uncertain risks associated with PE 5 , 9 , 10 . In this process, the balance between the responsibilities and rights of medical staff and patients has become an important factor troubling both clinical practitioners and patients. For patients, excessive responsibility for their safety can become a source of pressure and challenge 11 , they may question their competencies to participate effectively. On the other hand, in the context of patient participation, medical personnel still bear the vast majority of the responsibility for maintaining patient safety, which includes addressing safety risks that may arise from patients' improper participation behaviors due to limited knowledge, attitudes, or differences in values 12 . This implies a certain degree of contradictory relationship between patients' participation behaviors and responsibilities. Therefore, many studies promoting patient participation have emphasized the term "effective" 7 , 13 . Some medical staffs believe that only patients with higher competence, such as healthy literacy, safety awareness, would and could engage effectively and serve as good partner 14 , 15 . With adequate resources and support, it is feasible to moderately enhance the competency levels of the patient population, thereby improving their involvement in their own safety 15 – 19 . To facilitate more effective and reasonable patient participation in their safety, healthcare providers must conduct a comprehensive assessment of patients’ competence to engage and the resources at their disposal 20 . Based on this assessment, targeted empowerment strategies can be implemented. Simultaneously, compensatory strategies should be adopted to address areas of deficiency. This approach ensures that patients are better equipped to make informed decisions regarding their health, thereby promoting a safer and more inclusive healthcare environment. Although the competence of patients has been a concern, particularly in decision-making and self-care processes 15 , 21 – 23 , there is no clear description of the patient competencies needed throughout the process of engagement, furthermore, due to the absence of comprehensive literacy assessment methods, the effectiveness of intervention measures remains questionable. Patient safety is a multidimensional issue that involves the interaction between healthcare providers and patients. To improve patient safety, both must work together to ensure that healthcare providers can provide appropriate support and education, while ensuring that patients are empowered to actively engage in their own treatment process. Therefore, when exploring the necessary competencies required for patients to engage in their own safety, it is necessary to consider the perspectives of both healthcare providers and patients. This article conducted semi-structured interviews with nurses, nursing managers, and patients at a Grade A hospital in Wuhan, China, inquiring about their understanding, experience and feelings about PE during work or medical treatment, and explores the necessary competence that patients need to possess to engage in their safety, in order to clarify the goal of further promoting PE in patient safety in the future. 2. Method 2.1Study design Our research team employed a phenomenological approach 24 to investigate the competence of PE in their safety from the perspectives of nurses and patients with semi-structural interviewing method. Different from structural interview, semi-structural interview is more flexible but not going off-topic. By semi-structural interview, we can learn about the nurse’s and patients’ experience with patient safety issues as well as their perspectives about patient competence for PE by their words. 2.2Study setting and participants The study was conducted at a Tier-A tertiary hospital in Wuhan, China. The inclusion and exclusion criteria for participants were showed in Table 2.2 Table 2.2 Inclusion Criteria Participants Inclusion criteria Nurse (1) a clinical nursing tenure exceeding 5 years (2) middle or higher professional title (3) Working in adult wards (4) voluntarily participated in this study Patient (1) aged 18 years or older (2) understand the objectives of the study and voluntarily engaged in this study (3) conscious and without mental disorder (4) physical condition is stable (5) not in acute stage or advanced stage of tumor (6) have communication ability, can speak Chinese and understand Mandarin. 2.3Outline of the interview Prior to initiating the interviews, we crafted an interview protocol and modified the content of the interview outline with counsel of two experts experienced in qualitative research studies in our research group. The outline's content is bifurcated: the first part gathers general information regarding the nurses and patient. The interview outline showed in Table 2.3 Table 2.3 Interview Outline Participants Interview outline Nurse 1.General information Gender Highest Education Professional Title Length of work Department 2.Key questions for interview (1) Could you elaborate on your comprehension of patient engagement in patient safety and your perspectives on this subject? (2)Please share your clinical practice and experiences regarding the facilitation of patient engagement in patient safety. (3)What benefits do you perceive arising from patient engagement in patient safety? (4)Does patient engagement in patient safety present any challenges for you or your colleagues? Please share your experiences. (5)What attributes, competencies, or criteria do you believe patients should possess or fulfill to be actively involved in their own safety? (6) What kind of support do you think is necessary to further promote patient engagement for patient safety? (7) Do you have any additional insights to contribute? Patient 1.General information Age Gender Medical Insurance Type Education Background Inpatient Department 2.Key questions for interview (1) How do you interpret the concept of patient engagement in patient safety? (2)Have you or anyone you know experienced adverse safety events during medical treatment? Can you detail the experience? (3) What types of health or safety information do you usually pay attention to while hospitalized? (4) What actions have you taken to protect your own safety during medical treatment? Why did you take these actions? Please share your experience. (5)How do you perceive your responsibilities concerning personal safety? (6)Have you encountered obstacles in engaging in or maintaining your own security? If so, what were they, and how did you overcome them? (7)Do you think you possess the requisite qualities or abilities to engage in the maintenance of your own security? Can you provide some examples? (8)What additional support do you think is necessary for you to effectively maintain your safety as a patient? (9) Do you have any further suggestions or opinions on how hospitals can better support patients' engagement in patient safety? (10)Is there any other information or perspective you would like to add? Throughout the interviewing process, the line of questioning may be adapted in response to the participants' contributions or their behavior that interviewer observed, questions already answered in the patient's response would not be repeated. The conversations during the interview were recorded by the recorder and notebook, the length of each interview is between 26min to 68min, and were transferred into literature in 24 hours after the interview. 1.4 Data analysis Colaizzi’s analysis method 25 was employed to examine the aggregated data. The research team transcribed the audio recordings and notes into electronic text formats within 24 hours, constituting the raw data. The researcher meticulously reviewed the raw data multiple times to attain a profound comprehension of its contents, proceeding with initial coding. Based on the initial coding, the researcher categorized the coded content by looking for commonalities, and extracted and summarized themes from it. The analyzed themes were then reviewed by the researcher, who revisited all the coded data to review whether the codes could be generalized to the themes that had been proposed, and if there were codes for which themes could not be found, the themes were re-grouped. And then, we reviewed the raw data to check whether all the data segments could truly reflect the content of the themes. Subsequently, we reviewed the theme content to check whether there were themes with broad content and unclear pointers, and if so, they were categorized into more clearly defined sub-themes and the above steps were repeated. After the initial identification of themes, we then conducted a review of the relationships between different themes, checking whether there were themes that were similar and could be merged, and whether there were themes whose logical relationship was one of containment. The themes were finally confirmed through continuous review and adjustment of the content and themes over and over again. 1.5 Triangulation In order to substantiate the credibility of our findings, researcher triangulation was adopted. Data gleaned from the semi-structured interviews were recorded, followed by thematic analyses post-initial coding to identify the themes. In the process of thematic analysis, two researchers independently read and initially analyzed the original data, and then discussed the results of the analysis with other members of the research team, summarizing similar or identical themes, discussing themes with differences, and re-analyzing the corresponding raw data. Through multiple consensus meetings and iterative reviews of thematic content, a unified agreement was established, affirming the final themes. 1.6 Ethical Approval Ethical approval for this study was obtained from the Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, Ethics No: UHCT-IEC-SOP-016-03-01 3. Results 3.1 General Information of Interview Participants A total of 27 participants accepted the interview and contributed their perspectives, comprising 14 clinical nurses and 13 patients, with 4 of nurses are nursing managers. The general information of participants were showed in Table 3.1.1 and 3.1.2. Table 3.1.1 General Information of Patients(n = 13) Gender Age Medical Insurance Type Highest Education Inpatient Department P1 Male 63 Insurance for urban residents High school Cardiovascular department P2 Female 58 Insurance for urban workers High school Cardiovascular department P3 Female 70 Insurance for urban residents Middle school Thoracic surgery department P4 Male 43 Insurance for urban workers High school Thoracic surgery department P5 Female 49 Insurance for urban residents College Neurology department P6 Male 57 Insurance for urban residents Middle school Neurology department P7 Female 67 The new rural cooperative medical insurance Middle school Gastrointestinal surgery department P8 Female 36 Insurance for urban workers Bachelor degree Gynecology department P9 Male 60 Insurance for urban workers Bachelor degree Cardiovascular department P10 Female 35 self-financing Bachelor degree Thoracic surgery department P11 Male 43 Insurance for urban workers High school Gastrointestinal surgery department P12 Female 60 Insurance for urban workers High school Gynecology department P13 Male 62 Insurance for urban workers Middle school Department of Hepatobiliary surgery Table 3.1.2 General information of clinical nurses and nursing managers (n = 15) Gender Highest Education Working Years Title of Professional Position Department N1 female Bachelor degree 7 Supervisor nurse Department of cardiology N2 female Bachelor degree 9 Supervisor nurse Department of cardiology N3 female Bachelor degree 10 Supervisor nurse Department of cardiolog N4 female Bachelor degree 12 Supervisor nurse Department of neurology N5 female Bachelor degree 13 Supervisor nurse Department of Gynecological tumor N6 female Bachelor degree 11 Supervisor nurse Department of Gastroenterology N7 female Bachelor degree 15 Supervisor nurse Department of Pancreatic surgery N8 female Master degree 8 Supervisor nurse Department of Gynecology N9 female Bachelor degree 13 Supervisor nurse Department of Maxillofacial surgery N10 female Bachelor degree 10 Supervisor nurse Department of Gastrointestinal surgery M1 female Master degree 25 Chief nurse Day surgery ward M2 female Master degree 18 Chief nurse Department of Stomatology M3 female Bachelor degree 19 Chief nurse Department of Neurology M4 female Bachelor degree 17 Chief nurse Department of Hepatobiliary surgery 3.2 Major themes 3.2.1 Competence of Information Sharing There existed both consensus and divergence in the understanding of PE for patient safety when we queried patients and nurses. Both nurses and patients think the key element in PE and PE competence is information sharing, however, their concerns are not same. Nurses prioritize the provision of information by patients during clinical practice, they focus more on patients' conditions and treatment needs for a better caring plan as professionals, whereas patients emphasize their opportunities to receive more information from healthcare providers and concern more about their own rights. Clearly, the competence of providing, receiving and understanding information of patient is of paramount importance for both patient and nurses. N1: Only the patient knows their true desires and needs, as well as the types of safety measures they prefer. Engagement is the process make patients have opportunity to provide us more information about themselves or their requirement. P8: I believe engagement entails asking more questions, which is within my capacity and should be met by healthcare providers. I need to know all about myself. 3.2.2 Competence of Taking PE as Responsibility and Right Responsibility and right for security is one of the key concerns of PE for both sides. All nurses believe that patients should fulfill responsibilities and obligations to maintain their own safety in some case. Nursing professionals hold the view that patients must be fully informed about their conditions, treatment and caring plans as well as associated risks, and should be required to provide informed consent. In instances where the patient need protective concealment, family members should also undertake the corresponding responsibility, acting as the patient's proxy. Certain nursing personnel posit that a patient's lack of awareness regarding risks does not foster greater trust in medical staff but rather escalates the potential for discord between doctor and patient. When patients' expectations are too high and the risk is not fully known and expected, the responsibility will be fully imposed on medical staff, and when there is an inevitable safety risk under normal circumstances, The huge gap between reality and expectation will cause patients and their families to fall into bad emotions, which will lead to unnecessary conflicts between doctors and patients. N10: For example, for cancer chemotherapy patients, we now have a variety of chemotherapy programs, with each presenting its own set of pros and cons, of course, it is imperative for medical staff to conduct evaluations based on individual patient circumstances, thereby facilitating informed decision-making, yet the unpredictability of cancer means that we cannot assure the effectiveness of any given program, it is a step by step, each program in the individual effect is different. Consequently, our role is limited to presenting potential outcomes alongside risk information, among which the possible risks and benefits also include treatment costs, so patients need to consider and make choices among them. At present, there are many clinical trial programs available for cancer patients, with risks and benefits still being evaluated during the trial phase, and some patients are not in good economic condition. Some patients, facing economic hardships, may opt to engage in these studies if they fulfill the trial's eligibility criteria. Therefore, it is imperative that patients thoroughly read and sign the informed consent form acknowledging the risks, including those that are unknown and uncertain. It is essential for patients to possess a strong sense of responsibility. At the same time, most nurses recognize that even when adhering to established procedures in clinical practice, mistakes are inevitable, which will lead to safety risks. Medical personnel have the responsibility to ensure the safety of patients, but they also hope that patients can consciously engage in a role of verification and oversight. Several nurses shared with us the safety incidents they have experienced or heard about in the course of their work that highlighting instances where PE averted serious adverse outcomes. They believe that the proper PE behavior of patients has great value and significance in promoting patient safety. N3: Of course, we have to operate in accordance with the procedures in clinical practice, but it is really very difficult to ensure that we can ensure a complete absence of errors, isn't it? No one is perfect. What we hope is that upon a patient's arrival at the hospital, they retain a strong sense of personal responsibility, not to completely rely on the medical staff, but to cooperate with the medical staff to ensure their own safety, such as to assist the medical staff to verify information, monitoring the operation of medical staff, and ensuring adherence to hand hygiene protocols of the medical staff. N5 Once, a student nurse went to hang an IV drip for a patient in the morning. Because the morning shift was very busy, she helped out with the task. Likely overwhelmed by the multitude of medications in her possession, an error occurred—the IV designated for patient 33 was mistakenly set up for patient 32. When I went to remove the needle for another patient in the room, before I even reached the bedside, the patient in bed 32 promptly noticed the information on the medication packaging and said, "Hey, this isn't my name on it." He immediately told me, and upon checking, I found that indeed one bag of medication had been mistakenly hung at bed 32. I quickly apologized to the patient and told him that his action was very good, as it prevented an accident. Some nurses have reported that patients lacking a sense of responsibility, their engaging behaviors, such as providing false information, not only fail to promote safety, but may also escalate safety risks. A nurse shared her perspective, stating: N8: Despite being instructed to fast and refrain from drinking before surgery, some patients still consume food in the mistaken belief that it poses no safety risks. In reality, this is extremely hazardous, especially when patients, despite being informed of the risks, persist in their actions and deceive caregivers by falsely claiming, for instance, that they have not eaten, therefore providing us with incorrect information that can severely mislead clinical judgment. Often, the truth comes to light only through our repeated questioning and observation of subtle clues. Such actions are very dangerous, and there have been many medical incidents have arisen as a consequence. Even though we emphasize the dangers of such behavior to patients multiple times, they fail to take a responsible attitude towards their own safety and neglect their well-being. All nurses advocate for patient involvement, believing that patients have the right to ensure their safety throughout medical treatment, a right that all healthcare professionals should respect. Even if patients do not possess adequate knowledge or competencies, and despite the potential for increased workload on medical staff, hospitals and healthcare providers should still encourage patients to fully engage in the maintenance of their own safety and provide them with sufficient support. N3: PE is meaningful and deserves vigorous promotion. In fact, regardless of the level of literacy, we support it. It's not just about the patients; clinical medical staff and hospital management must enhance their awareness, possess relevant knowledge, and take actions to optimize the entire medical environment. N2: Even when we encounter challenges in communication with certain patients or find them troublesome amidst our busy work schedules, they still serve a crucial role in providing us with information on potential concerns. If a patient reports any discomfort, I would be more vigilant and cautious, and our observations would be more closely monitored. There might be times when it turns out to be false alarms, and it might increase the workload, but we are more relieved that the patient is unharmed and safe. The majority of patients believe they should be responsible for their own safety, and as a result, some patients will engage in proactive behaviors. However, a minority of patients, despite agreeing that they are the primarily responsible for their own safety, remain disengaged from the medical process, under the assumption that hospitals are safe places and medical staffs will ensure their well-being. A small subset of patients dissents from the PE model, thinking that ensuring safety of patients should be the sole responsibility of medical professionals. P5: I take my health and safety very seriously. The family and social education I've received, although I didn't study medicine, still made me aware of the importance of health and safety. P2: Most hospitals, especially those of higher levels, are generally safe environments. Of course, you are certainly responsible for your own safety, but within the hospital, it's relatively safe. Doctors and nurses are readily available to address any issues, so there's no need to worry too much. P11: Since I'm hospitalized, I just need to follow the doctor's advice; the doctor will take responsibility for my safety, so I don't need to worry about it myself 3.2.3 Competence of Maintaining Trust Relationship with Health Personnels All nurses and nursing managers assert that trust is an essential prerequisite for PE to yield positive outcomes. They believe that PE in their own safety is a collaborative process between the doctor and the patient, rather than a task to be completed by the patient alone. When asked about the troubles or adverse outcomes caused by incorrect PE and the underlying reasons, almost all nurses mentioned "distrust" in the process of summarizing. N2 Ultimately, patients lack a medical background, and our criteria for judgment differ from theirs. Even if we have explained, we cannot fully make him understand the significance of treatments like dialysis. Therefore, popular traditional impressions and some incorrect views may still be a major factor in the patient's decision-making. Hence, we will try our best to enhance the patient’s understanding but, more importantly, to earn their trust. Trust plays a dual role in patient participation behaviors. In certain instances reported among nurses and patients, trust has a positive effect, promoting correct patient participation and fostering a good cooperative relationship between doctors and patients. In other cases, an over-reliance on medical staff due to trust is the primary cause of reduced patient participation levels. N6: When patients trust medical staff, they can cooperate better. For example, after we have provided health education on ankle pump exercises, some patients are able to follow our instructions diligently, performing each movement accurately and fully, for the required duration, not only in the hospital but also consciously at home. They often give us feedback, and the results are very good. However, some patients may harbor some hostility towards medical staff for various reasons, such as cost or negative emotions brought on by illness. Others may only trust their professors and distrust other doctors and nurses. They may not listen to the precautions and health education we provide, resulting in poor cooperation. P7: I think the doctors and nurses here are very good. I don't understand medical professional knowledge, nor do I want to ask too many questions. However, I believe that following their advice is always the right thing to do, and cooperating with them is enough. I feel the outcome is very good. Regardless of the role trust plays in patient participation in safety, it has led to better outcomes, with patients exhibiting higher compliance. Many nursing staff have indicated that gaining the trust of patients is a key step in ensuring patient safety in medical work. Some medical personnel believe that the mass media should play a role in this process. M3: At present, some news outlets frequently report negative conflicts between doctors and patients, which has led to a decrease in trust among many patients towards medical staff. Especially in the current era of rampant self-media, if patients or their families are dissatisfied with the treatment outcomes or have other grievances, they may publicize online what they perceive as improperly conduct by doctors, nurses, or hospitals, which can sometimes be just misunderstandings. Under such public opinion circumstances, the doctor-patient relationship becomes even more strained, and the trust of patients in medical staff is greatly affected. However, in reality, the negative incidents publicized online are only a small minority. The vast majority of healthcare providers administer treatment for patients in compliance with established regulations and standards, always prioritizing the patients' interests and life safety. I believe that the online public opinion environment needs to be improved, and the mass media should also promote more positive cases, help the public establish the correct safety concepts, and work together to create a harmonious doctor-patient environment. 3.2.4 Competence of Making Equal Communication To address the challenges in patient participation and foster correct and effective engagement, all nursing staff have identified communication as crucial. They believe that thorough communication with patients is the most effective approach. Through such communication, medical personnel can understand the patient's concerns and needs, while patients can gain the information they require and be aware of their safety risks. Additionally, nursing staff have highlighted the importance of equal communication, where medical staff and patients must respect each other and collaborate to achieve health and safety objectives. M2: If the relationship between medical staffs and patients is asymmetrical, or if communication is impeded, it may be difficult to reach a consensus with the patient on health management, and it may also be hard to achieve the purpose of our service. Although medical staff are more professional, the individual needs of patients vary. Therefore, there must be equal mutual communication between both parties, so that we can understand their needs, and they can understand the purpose and benefits of our recommendations. Only in this way can we achieve the goal of their health, which is also the goal of our service; otherwise, it is difficult. Moreover, I believe that only by respecting the patient's decision-making rights, fully involving them, and allowing them to fully understand our practices can they better cooperate with our various treatments and nursing, and thus better serve the patient's health. 3.2.5 Competence of Accepting Non-punitive Safety Culture A safety culture that eschews punitive measures is vital for both medical staff and patients. While all the nurses interviewed expressed their approval of patient involvement, some expressed concerns when discussing the supervisory role of patients. They worry that medical staff might be reluctant to involve patients in the process for fear that patients will discover their mistakes. N7: Despite our rigorous compliance with legal and regulatory standards, errors can occasionally occur, particularly for novice medical personnel who may not have enough experience. The dissatisfaction and criticism from patients, even in the absence of adverse outcomes, can undermine the confidence of medical staff. To prevent accusations or complaints, some practitioners may opt to reduce the information they share with patients or limit their involvement in the process. Additionally, patients have expressed analogous apprehensions, fearing that their perceived lack of competence might result in erroneous reports or misguided suggestions, which could provoke discontent from healthcare professionals. P12: They are all very busy, and I don't understand professional medical knowledge. They must have their reasons for doing things in a certain way. I might not be right, and I'm afraid that asking too many questions might make them think I'm a troublesome person. 3.2.6 Need of Resource Support Human resources Both patients and healthcare professionals have highlighted the issue of inadequate human resources, which impedes the advancement of patient involvement in clinical processes. Nursing staff, in particular, have shared their concerns about the additional workload associated with fostering patient participation, a burden that could potentially exacerbate tensions between healthcare providers and patients. N8: Naturally, we endorse patient participation; however, it demands additional exertions from clinical staff. For instance, there is a need for more meticulous and targeted health education, coupled with positive promotion through mass media. Undoubtedly, there is a continuous need to resolve a variety of patient issues in the course of work. Current clinical tasks are already overwhelming, and medical staff can only take on these additional responsibilities at the expense of their own rest time, leading to excessively burdens and also challenges the maintenance of quality care. It is unrealistic to expect this degree of commitment from everyone; there is an urgent need for hospitals and departments to provide additional human resource support to allieviate the workload for each staff member. N7 In our routine nursing practice, if we are not busy, we can address patient inquiries patiently. However, during extremely busy times, especially when I am interrupted during the administration of nursing treatments or medication preparation, it becomes quite troubling. These interruptions can easily lead to mistakes in my work and could potentially cause accidents. Yet, ignoring patients' concerns can breed dissatisfaction, with some even lodging complaints. Moreover, when I am too busy to explain things thoroughly to patients due to lack of time and faced with a multitude of pending tasks, I can only briefly outline the essentials to patients, which may also lead to misunderstandings and can easily spark disputes. Some patients have also complained that the busy work of medical staff prevents them from obtaining a comprehensive understanding of their own conditions. When patients seek for additional information from medical staff, they find it difficult to get support, and thus cannot engage effectively. P 10: When I try to consult with the professor, I can never find him; his colleagues tell me he's either engaged in surgery, attending to clinic patients, or in a meeting. The morning rounds are always rushed, and I can't ask more questions. 3.2.7 Need of Channels to Provide Accurate Health Information Many nurses have pointed out that in today's era of advanced artificial intelligence and the internet, the online spaces have become one of the primary sources for patients seeking information. The abundant information resources available online can serve as a valuable supplement to the busy clinical workload. However, given that most patients have not received formal medical education and lack the ability to discern accurate information, they are prone to being deceived by false information or misleading advertisements, which can lead to adverse outcomes. N8: Actually, in promoting patient involvement, improving patients' health literacy is essential, but it cannot be solely reliant on hospitals. After all, the time patients have for medical visits is limited, and our work is very busy. As an individual caregiver, I sometimes have to manage more than a dozen patients, and the time I can allocate for educating each patient is very limited. Patients are required to seek relevant information by themselves, but the online information is often cluttered. Ideally, medical professionals or organizations should establish their own media or public platforms to provide scientific health education to the general public. A portion of elderly patients have expressed their frustration with the difficulty of discerning authentic from false information online. This has led them to refrain from seeking information through the internet and instead, they place their trust exclusively in the expertise and guidance provided by healthcare professionals. P7: I'm hesitant to search online because I'm afraid of being deceived; there's a lot of false information on the internet. 4. Discussion From the viewpoints of both nurses and patients, the sharing of information is important, and both parties prefer to have more information in order to better achieve safety goals. However, it should be noted that patients' desire to share information may be affected by their level of knowledge and trust. Although patients possessing higher levels of education and extensive medical knowledge may be capable of supplying more information and attaining a profound understanding of it, nursing staff do not believe this ensures that patient participation will invariably result in safer treatment outcomes. Nevertheless, it is imperative to acknowledge that a reservoir of medical knowledge may significantly influence the extent of patient participation and their perceived self-efficacy 21 , 26 . Due to insufficient knowledge reserves, some patients may hesitate to raise their doubts to medical staff, which requires medical staff to take the initiative to invite, guide, and inquire to promote active patient participation. At the same time, if patients lack the necessary knowledge reserves, they may ignore some abnormal situations or potential risk factors, and find it difficult to identify or be aware of the risks and adverse events that have occurred. Previous studies have indicated that access to information can enhance patients' self-efficacy and risk perception of participation, thereby increasing their willingness to engage in their care 12 . In this study, when discussing the support needs and directions for future improvement, almost all nursing staff emphasized the need to enhance health education for patients based on their specific needs, in order to fostering a deeper understanding of their own conditions and augmenting their knowledge of safety and health. Therefore, compared with the improvement of health knowledge, it is more important to build a correct concept of safety and awareness of participation among the public. In addition, compared with the improvement of health knowledge, it is more important to build a correct concept of safety and awareness of engagement among the public. In the opinion of most interviewed nurses, patient participation holds the potential to enhance patient safety. However, ensuring proper and effective engagement of patients is contingent upon patients possessing a sense of responsibility for their own safety. When patients possess a sense of safety and have a responsible attitude toward their own safety, they become more active in the process of clinical treatment process, cooperating with healthcare providers to maintain their own safety behaviors, and this is also a point that requires ongoing education and development. However, limited human resources restrict the implementation of further health education within clinical practice. The inadequacy of human resources is an important factor impeding the further participation of patients. In the case of lack of information, medical staff, being the primary information providers for patients, may not have sufficient time and energy to share more adequate information with patients, which causes patients' dissatisfaction and also becomes a potential risk of doctor-patient conflicts. The abundance of online information resources offers the possibility to overcome limitations. With the development of network media, online health information has become one of the main sources of patient health information. However, in this study, many patients and nursing staff have expressed concerns regarding the overwhelming amount of health information online. Many nursing professionals stated that it is the responsibility of the state, government, and medical institutions to disseminate accurate medical knowledge and filter out erroneous information, rather than imposing the difficult task of discerning reliable information on patients, which is too demanding for them. Medical and health institutions should establish professional information channels on online platforms and take responsibility for spreading accurate and reliable medical knowledge. Many studies also leverage information sharing on network platforms to enhance patients' comprehensive understanding of their own conditions, promote patient participation, and improve patient safety maintenance ability 27 , 28 . On the other hand, the government and the public media must also assume the responsibility of instilling the correct safety concept of patients, cultivating public awareness of safety participation, encouraging appropriate PE during medical treatment, protecting their own rights and interests, and sharing the maintenance responsibilities of safety with medical staff. This study also found that the medical-patient relationship profoundly affects the effectiveness of PE. A good doctor-patient relationship is the foundation for promoting proper patients engagement behaviors, with trust in healthcare providers being an essential precondition for patients to undertake appropriate participatory actions. Although some patients in this study exhibited over-reliance on medical personnel due to excessive trust and thus diminished their active participation, trust in medical personnel remains the basis for ensuring effective communication between doctors and patients and improving the level of patient cooperation. In the absence of trust in medical personnel, patients may withhold true information, exhibit hostility, and engage in non-compliant behavior, which will cause difficulties and unsafe consequences for medical personnel. Patients' reliance on medical personnel depends on their sense of responsibility for their own safety, a sentiment that aligns with, rather than conflicts with, their trust in medical personnel. Patients who possess a strong sense of safety and responsibility are better equipped to cooperate with medical personnel in the process of medical treatment. Through effective verification and oversight, to make up for the omissions of medical personnel in busy clinical work, and identify potential medical errors to ensure their own safety. It is noteworthy that previous study 5 has also indicated that a decline in relationship between patient and may be one of the negative effects brought about by PE. This deterioration can be attributed to differences in decision-making between doctors and patients, as well as the anxiety that arises from an overload of information. Establishing equal communication between doctors and patients is an effective way to foster meaningful PE and achieve positive health outcomes. This finding aligns with prior studies which suggest that when patients perceive their role and status as subordinate to that of healthcare providers, their engagement in error reduction is significantly diminished. 29 .In this study, patients demonstrate hesitancy in expressing their confusion to medical staff due to a deficient grasp of the concept of relationship equivalence. Meanwhile, this study also revealed that disparities in power between patients and medical staff can lead to communication barriers. Patients may be reluctant to ask questions or challenge the authority of medical staff, or refuse to follow the advice of medical staff, resulting in non-compliant behaviors. This, in turn, escalates security risks. When patients exhibit a negative attitude and contempt for medical staff, it can induce fear among medical personnel of becoming subjects of patient complaints or conflict, thereby diminishing patient participation. Therefore, establishing an equal communication relationship is imperative for promoting effective patient participation and ensuring safety. In the process of patient participation in reducing errors, the construction of a safety culture without punishment can increase the willingness of medical staff to support and promote patient participation. Previous qualitative studies of health care workers have found that 30 , 31 one of the main reasons medical staff do not support patient participation is the fear of becoming the target of patient complaints or causing conflict. In the cases mentioned by the nurse, the medical staff strongly support the behavior of the patient which identify safety risk and put forward the stop in time. Conversely, the medical staff would feel panic for the behavior such as accusations and complaints. At the same time, it is worth noting that patients are also afraid to present potentially misguided advice or questions to medical staff because of similar concerns. Therefore, we need to cultivate a more inclusive culture of PE, wherein both medical professionals and patients mut engage in mutual understanding, tolerance and collaboration to collectively advance patient safety. In the future, it is essential to publicize patient participation in patient safety through public media in China and even in a larger scope, establish a proper safety concept for the public, and assist patients in developing their own awareness of safety responsibility in the process of medical treatment. Meanwhile, medical institutions should invest more human resources for clinical practice, thereby offering enhanced support for patient participation. More medical institutions, particularly government health institutions, should establish official health information platforms, providing patients with diverse ways and channels for assessing accurate and reliable health and safety information, and assist the national government and online platforms to combat health rumors and promote citizens' health. In the future, healthcare providers should implement more individualized and targeted health education for patients. Meanwhile, tools designed to systematically evaluate patients’ participation literacy and conditions are needed, so as to more comprehensively understand the obstacles that patients may encounter in the process of participation through measurement and facilitate the resolution of these issues. Relevant guidelines and systems regarding patient participation in patient safety warrant further research to provide sufficient reference for clinical practice. At the same time, there is a critical need to strengthen the development of a proper safety culture, not for the purpose of punishment or blame, but rather for the goal of enhancing safety. 5.Strengths and limitations This study adopts a phenomenological approach, from the perspectives of two roles in the clinical, the nurses and patients, who experience more PE 31 , to ascertain the specific competencies patients must possess to effectively engage in their safety processes. By digging deep into the experience and true feelings of both parties in the participation process, more abundant information is obtained, and the similarities and differences in the opinions of both parties on the attributes of competence required by patients in the safety process of participation are explained. However, certain limitations exist; to achieve a richer sharing of experiences, this study invited only experienced senior nurses for interviews, and did not interview newly hired or less experienced nurses. The findings are predicated solely on the recollections of the nursing staff regarding their own sentiments from earlier in their careers or on their retelling of the feelings of other less experienced staff, which may have a certain degree of recall bias. 6. Conclusion From the dual perspectives of nurses and patients, this study describes the necessary competence for correct participation of patients, encompassing information sharing, patient's safety awareness and sense of responsibility, trust between medical staff and patients, and equitable communication, construction of medical-patient participation safety culture without punishment, as well as the provision of adequate human resources and robust network information platform support. Achieving these competence improvements requires not only the efforts of patients, but also the concerted efforts of medical staff, healthcare institutions, national governmental bodies and social media platforms. At the same time, there is a future need to develop clearer measurement tools for gauging patient participation in patient safety competencies, offering medical staff and patients themselves with clear references for enhancement strategies. Declarations 7. Clinical Trial Number Not applicable Availability of data and materials: The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions. Competing interests: I declare that the authors have no competing interests as defined by BMC, or other interests that might be perceived to influence the results and/or discussion reported in this paper. Funding: This study funded by Wuhan Union Hospital (P016.01003.22003.100). Authors' contributions: Y.L, JJ.Z and X.L engaged in the process of collecting and analyzing data as well as main manuscript text writing. HQ.Z and YL.Z engaged in revising the manuscript. QY.Y and N.Z gave the proper instruction to the research design and conception. All authors have reviewed the manuscript and approved the submitted version. Acknowledgements: Not applicable References Organization WH. Medication safety in polypharmacy: technical report. World Health Organization, 2019. Higgins T, Larson E, Schnall R. Unraveling the meaning of patient engagement: A concept analysis. Patient Educ Couns. 2017;100:30–6. Castro EM, Van Regenmortel T, Vanhaecht K, Sermeus W, Van Hecke A. Patient empowerment, patient participation and patient-centeredness in hospital care: A concept analysis based on a literature review. Patient Educ Couns. 2016;99:1923–39. Global Patient Safety Action. Plan 2021–2030. https://www.who.int/teams/integrated-health-services/patient-safety/policy/global-patient-safety-action-plan (accessed Dec 12, 2023). Van der Voorden M, Ahaus K, Franx A. Explaining the negative effects of patient participation in patient safety: an exploratory qualitative study in an academic tertiary healthcare centre in the Netherlands. BMJ Open. 2023;13:e063175. Newman B, Joseph K, Chauhan A, et al. Do patient engagement interventions work for all patients? A systematic review and realist synthesis of interventions to enhance patient safety. Health Expect. 2021;24:1905–23. Lawton R, O’Hara JK, Sheard L, et al. Can patient involvement improve patient safety? A cluster randomised control trial of the Patient Reporting and Action for a Safe Environment (PRASE) intervention. BMJ Qual Saf. 2017;26:622–31. Pinto A, Vincent C, Darzi A, Davis R. A qualitative exploration of patients’ attitudes towards the ‘Participate Inform Notice Know’ (PINK) patient safety video. Int J Qual Health Care. 2013;25:29–34. Bell SK, Gerard M, Fossa A, et al. A patient feedback reporting tool for OpenNotes: implications for patient-clinician safety and quality partnerships. BMJ Qual Saf. 2017;26:312–22. Opsahl AG, Ebright P, Cangany M, Lowder M, Scott D, Shaner T. Outcomes of Adding Patient and Family Engagement Education to Fall Prevention Bundled Interventions. J Nurs Care Qual. 2017;32:252–8. Entwistle VA, Mello MM, Brennan TA. Advising Patients About Patient Safety: Current Initiatives Risk Shifting Responsibility. Joint Comm J Qual Patient Saf. 2005;31:483–94. Schwappach DLB, Wernli M. Barriers and facilitators to chemotherapy patients’ engagement in medical error prevention. Ann Oncol. 2011;22:424–30. Van der Voorden M, Franx A, Ahaus K. Actions for mitigating the negative effects of patient participation in patient safety: a qualitative study. BMC Health Serv Res. 2024;24:700. Chegini Z, Arab-Zozani M, Shariful Islam SM, Tobiano G, Abbasgholizadeh Rahimi S. Barriers and facilitators to patient engagement in patient safety from patients and healthcare professionals’ perspectives: A systematic review and meta-synthesis. Nurs Forum. 2021;56:938–49. Goodridge D, McDonald M, New L, et al. Building patient capacity to participate in care during hospitalisation: a scoping review. BMJ Open. 2019;9. 10.1136/bmjopen-2018-026551 . Stout L, Joseph S. Blood transfusion: patient identification and empowerment. Br J Nurs. 2016;25:138–43. Schwappach DLB, Wernli M. Am I (un)safe here? Chemotherapy patients’ perspectives towards engaging in their safety. Qual Saf Health Care. 2010;19:e9. Di Tosto G, Hefner JL, Walker DM, Gregory ME, McAlearney AS, Sieck CJ. Development of a conceptual model of the capacity for patients to engage in their health care: a group concept mapping study. BMC Health Serv Res. 2023;23:846. Hibbard JH, Stockard J, Mahoney ER, Tusler M. Development of the Patient Activation Measure (PAM): conceptualizing and measuring activation in patients and consumers. Health Serv Res. 2004;39:1005–26. Newman B, Joseph K, Chauhan A, et al. Do patient engagement interventions work for all patients? A systematic review and realist synthesis of interventions to enhance patient safety. Health Expect. 2021;24:1905–23. Kang J-H. Influences of decision preferences and health literacy on temporomandibular disorder treatment outcome. BMC Oral Health. 2022;22:385. Grisso T, Appelbaum PS, Hill-Fotouhi C. The MacCAT-T: a clinical tool to assess patients’ capacities to make treatment decisions. Psychiatr Serv. 1997;48:1415–9. Morreim EH. Three concepts of patient competence. Theor Med. 1983;4:231–51. Groenewald T. A Phenomenological Research Design Illustrated. Int J Qualitative Methods. 2004;3:42–55. Colaizzi PF. Psychological research as the phenomenologist views it. 1978. Won MH, Shin S-H. Mediating effects of patient safety perception and willingness to participate in patient safety on the relationship between health literacy and patient participation behavior among inpatients. Front Public Health. 2024;12:1349891. Coughlin SS, Stewart JL, Young L, Heboyan V, De Leo G. Health literacy and patient web portals. Int J Med Inf. 2018;113:43–8. Lyles CR, Nelson EC, Frampton S, Dykes PC, Cemballi AG, Sarkar U. Using Electronic Health Record Portals to Improve Patient Engagement: Research Priorities and Best Practices. Ann Intern Med. 2020;172:S123–9. Doherty C, Stavropoulou C. Patients’ willingness and ability to participate actively in the reduction of clinical errors: a systematic literature review. Soc Sci Med. 2012;75:257–63. Shemesh D, Olsha O, Goldin I, Danin S. Patient Safety: The Doctor’s Perspective. J Vasc Access. 2015;16:S118–20. Davis RE, Sevdalis N, Vincent CA. Patient involvement in patient safety: the health-care professional’s perspective. J Patient Saf. 2012;8:182–8. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 24 Oct, 2024 Read the published version in BMC Nursing → Version 1 posted Editorial decision: Revision requested 28 Aug, 2024 Editor assigned by journal 28 Aug, 2024 Submission checks completed at journal 27 Aug, 2024 First submitted to journal 22 Aug, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4955143","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":346141613,"identity":"b0887627-541a-418f-bbed-c8c308286527","order_by":0,"name":"Ying Lu","email":"","orcid":"","institution":"Union Hospital of Tongji Medical College of Huazhong University of Science and Technology","correspondingAuthor":false,"prefix":"","firstName":"Ying","middleName":"","lastName":"Lu","suffix":""},{"id":346141614,"identity":"8a0d2f42-2d54-4727-8535-d3209dedb066","order_by":1,"name":"Jin Jin Zhang","email":"","orcid":"","institution":"Zhongnan Hospital of Wuhan University","correspondingAuthor":false,"prefix":"","firstName":"Jin","middleName":"Jin","lastName":"Zhang","suffix":""},{"id":346141615,"identity":"f202b446-320d-4d46-97f3-950fb0643481","order_by":2,"name":"Xue Liu","email":"","orcid":"","institution":"Huazhong University of Science and Technology Union Shenzhen Hospital","correspondingAuthor":false,"prefix":"","firstName":"Xue","middleName":"","lastName":"Liu","suffix":""},{"id":346141617,"identity":"add220c4-884f-4122-88fc-44215f04746e","order_by":3,"name":"Yao Ling Zhou","email":"","orcid":"","institution":"Huanggang Polytechnic College","correspondingAuthor":false,"prefix":"","firstName":"Yao","middleName":"Ling","lastName":"Zhou","suffix":""},{"id":346141618,"identity":"cfefe70b-6d00-4d30-8c7d-b1fb88395867","order_by":4,"name":"Han Qin Zhang","email":"","orcid":"","institution":"Mahidol University","correspondingAuthor":false,"prefix":"","firstName":"Han","middleName":"Qin","lastName":"Zhang","suffix":""},{"id":346141619,"identity":"c70027c3-d764-425f-979c-b15bdab3d9d3","order_by":5,"name":"Qiao Yuan Yan","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA1klEQVRIiWNgGAWjYLCCBAjF+CChooY0LcwGD84cI80yNsmHLcyElRkcP3vwxoMam8QNx88eq0hsYGPgb+9OwK/lTF6yRcKxtMQNZ/LSbiTukGGQOHN2A34tB3LMJBLYDiduADJuJJ5hYzCQyCWg5fwboJZ/QC1ARkFiGzMRWm4AbUlsA2oBMhiI0iJ5442xRWJfmvFMIEMi4cwxHoJ+4TufY3jzxzcb2T4g4+OPiho5/vZe/FoUDjAwSABpxwaoAA9e5SAg3wDRYk9Q5SgYBaNgFIxcAAAaJVEdpxDaPQAAAABJRU5ErkJggg==","orcid":"","institution":"Union Hospital of Tongji Medical College of Huazhong University of Science and Technology","correspondingAuthor":true,"prefix":"","firstName":"Qiao","middleName":"Yuan","lastName":"Yan","suffix":""},{"id":346141620,"identity":"465b50c7-a0c0-4e05-9ebb-c3a89656c703","order_by":6,"name":"Na Zeng","email":"","orcid":"","institution":"China Three Gorges University","correspondingAuthor":false,"prefix":"","firstName":"Na","middleName":"","lastName":"Zeng","suffix":""}],"badges":[],"createdAt":"2024-08-22 04:55:32","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4955143/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4955143/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12912-024-02440-8","type":"published","date":"2024-10-24T15:57:42+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":67681895,"identity":"0fb93743-c0cb-422f-9826-08156035a13d","added_by":"auto","created_at":"2024-10-28 16:10:59","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":568568,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4955143/v1/73863012-4f86-4da6-b774-f468e310092d.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"A qualitative study of patient competence for patient engagement in their safety——from the perspective of nurses and patients","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003ePatient safety has become an escalating global public health concern, with its prevalence and gravity on the rise \u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e. In recent years, there has been an increasing acknowledgment of the significance of patient engagement in enhancing patient safety and augmenting health outcomes. Patient engagement (PE) refers to the process by which an individual patient communicates, influences, and actively participates in the clinical process\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e, which harnesses the patient's experience, authority and opportunities to synergize with the expertise of healthcare professionals\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e, positing the patient as a vital human resource within the medical process, crucial for ensuring patient safety. The World Health Organization (WHO) advocates for actively including families and patients in the medical process to mitigate preventable harm in healthcare, as outlined in the Global Patient Safety Action Plan for 2021\u0026ndash;2030\u003csup\u003e4\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThe concept of engaging patients as active participants in their healthcare management is both clinically advantageous and inherently complex, contrasting markedly with the experiences of healthy individuals or those managing a single health issue. As patients, there are limitations on their energy and physical abilities, the responsibility of PE may impose an additional physical or mental burden\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e, and mastering complex medical knowledge presents an even greater challenge. Although PE behaviors offer theoretical benefits for patient safety, the quality of evidence supporting their effectiveness in improving patient safety is currently relatively low \u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e. The effects of PE in some studies for the medical process were uncertain \u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e,\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e. The absence of a unified standard for PE models results in diverse behaviors and patterns of PE. Ineffective or erroneous engaging behaviors may pose certain clinical risks, and clinical staff expressed some concerns regarding the uncertain risks associated with PE\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e,\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e,\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e. In this process, the balance between the responsibilities and rights of medical staff and patients has become an important factor troubling both clinical practitioners and patients. For patients, excessive responsibility for their safety can become a source of pressure and challenge\u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e, they may question their competencies to participate effectively. On the other hand, in the context of patient participation, medical personnel still bear the vast majority of the responsibility for maintaining patient safety, which includes addressing safety risks that may arise from patients' improper participation behaviors due to limited knowledge, attitudes, or differences in values\u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e. This implies a certain degree of contradictory relationship between patients' participation behaviors and responsibilities. Therefore, many studies promoting patient participation have emphasized the term \"effective\"\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e,\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e. Some medical staffs believe that only patients with higher competence, such as healthy literacy, safety awareness, would and could engage effectively and serve as good partner\u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e,\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e. With adequate resources and support, it is feasible to moderately enhance the competency levels of the patient population, thereby improving their involvement in their own safety\u003csup\u003e\u003cspan additionalcitationids=\"CR16 CR17 CR18\" citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u003c/sup\u003e. To facilitate more effective and reasonable patient participation in their safety, healthcare providers must conduct a comprehensive assessment of patients\u0026rsquo; competence to engage and the resources at their disposal\u003csup\u003e\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u003c/sup\u003e. Based on this assessment, targeted empowerment strategies can be implemented. Simultaneously, compensatory strategies should be adopted to address areas of deficiency. This approach ensures that patients are better equipped to make informed decisions regarding their health, thereby promoting a safer and more inclusive healthcare environment. Although the competence of patients has been a concern, particularly in decision-making and self-care processes\u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e,\u003cspan additionalcitationids=\"CR22\" citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u003c/sup\u003e, there is no clear description of the patient competencies needed throughout the process of engagement, furthermore, due to the absence of comprehensive literacy assessment methods, the effectiveness of intervention measures remains questionable. Patient safety is a multidimensional issue that involves the interaction between healthcare providers and patients. To improve patient safety, both must work together to ensure that healthcare providers can provide appropriate support and education, while ensuring that patients are empowered to actively engage in their own treatment process. Therefore, when exploring the necessary competencies required for patients to engage in their own safety, it is necessary to consider the perspectives of both healthcare providers and patients. This article conducted semi-structured interviews with nurses, nursing managers, and patients at a Grade A hospital in Wuhan, China, inquiring about their understanding, experience and feelings about PE during work or medical treatment, and explores the necessary competence that patients need to possess to engage in their safety, in order to clarify the goal of further promoting PE in patient safety in the future.\u003c/p\u003e"},{"header":"2. Method","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e2.1Study design\u003c/h2\u003e \u003cp\u003eOur research team employed a phenomenological approach\u003csup\u003e\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u003c/sup\u003e to investigate the competence of PE in their safety from the perspectives of nurses and patients with semi-structural interviewing method. Different from structural interview, semi-structural interview is more flexible but not going off-topic. By semi-structural interview, we can learn about the nurse\u0026rsquo;s and patients\u0026rsquo; experience with patient safety issues as well as their perspectives about patient competence for PE by their words.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e2.2Study setting and participants\u003c/h2\u003e \u003cp\u003eThe study was conducted at a Tier-A tertiary hospital in Wuhan, China. The inclusion and exclusion criteria for participants were showed in Table\u0026nbsp;2.2\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2.2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eInclusion Criteria\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParticipants\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eInclusion criteria\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNurse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e(1) a clinical nursing tenure exceeding 5 years\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e(2) middle or higher professional title\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e(3) Working in adult wards\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e(4) voluntarily participated in this study\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePatient\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e(1) aged 18 years or older\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e(2) understand the objectives of the study and voluntarily engaged in this study\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e(3) conscious and without mental disorder\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e(4) physical condition is stable\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e(5) not in acute stage or advanced stage of tumor\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e(6) have communication ability, can speak Chinese and understand Mandarin.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003e2.3Outline of the interview\u003c/h2\u003e \u003cp\u003ePrior to initiating the interviews, we crafted an interview protocol and modified the content of the interview outline with counsel of two experts experienced in qualitative research studies in our research group. The outline's content is bifurcated: the first part gathers general information regarding the nurses and patient. The interview outline showed in Table\u0026nbsp;2.3\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2.3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eInterview Outline\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParticipants\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eInterview outline\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNurse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.General information\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eHighest Education\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eProfessional Title\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eLength of work\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDepartment\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.Key questions for interview\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(1) Could you elaborate on your comprehension of patient engagement in patient safety and your perspectives on this subject?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(2)Please share your clinical practice and experiences regarding the facilitation of patient engagement in patient safety.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(3)What benefits do you perceive arising from patient engagement in patient safety?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(4)Does patient engagement in patient safety present any challenges for you or your colleagues? Please share your experiences.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(5)What attributes, competencies, or criteria do you believe patients should possess or fulfill to be actively involved in their own safety?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(6) What kind of support do you think is necessary to further promote patient engagement for patient safety?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(7) Do you have any additional insights to contribute?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePatient\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.General information\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMedical Insurance Type\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eEducation Background\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eInpatient Department\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.Key questions for interview\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(1) How do you interpret the concept of patient engagement in patient safety?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(2)Have you or anyone you know experienced adverse safety events during medical treatment? Can you detail the experience?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(3) What types of health or safety information do you usually pay attention to while hospitalized?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(4) What actions have you taken to protect your own safety during medical treatment? Why did you take these actions? Please share your experience.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(5)How do you perceive your responsibilities concerning personal safety?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(6)Have you encountered obstacles in engaging in or maintaining your own security? If so, what were they, and how did you overcome them?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(7)Do you think you possess the requisite qualities or abilities to engage in the maintenance of your own security? Can you provide some examples?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(8)What additional support do you think is necessary for you to effectively maintain your safety as a patient?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(9) Do you have any further suggestions or opinions on how hospitals can better support patients' engagement in patient safety?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(10)Is there any other information or perspective you would like to add?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e Throughout the interviewing process, the line of questioning may be adapted in response to the participants' contributions or their behavior that interviewer observed, questions already answered in the patient's response would not be repeated.\u003c/p\u003e \u003cp\u003eThe conversations during the interview were recorded by the recorder and notebook, the length of each interview is between 26min to 68min, and were transferred into literature in 24 hours after the interview.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003e1.4 Data analysis\u003c/h2\u003e \u003cp\u003eColaizzi\u0026rsquo;s analysis method\u003csup\u003e\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u003c/sup\u003e was employed to examine the aggregated data. The research team transcribed the audio recordings and notes into electronic text formats within 24 hours, constituting the raw data. The researcher meticulously reviewed the raw data multiple times to attain a profound comprehension of its contents, proceeding with initial coding. Based on the initial coding, the researcher categorized the coded content by looking for commonalities, and extracted and summarized themes from it. The analyzed themes were then reviewed by the researcher, who revisited all the coded data to review whether the codes could be generalized to the themes that had been proposed, and if there were codes for which themes could not be found, the themes were re-grouped. And then, we reviewed the raw data to check whether all the data segments could truly reflect the content of the themes. Subsequently, we reviewed the theme content to check whether there were themes with broad content and unclear pointers, and if so, they were categorized into more clearly defined sub-themes and the above steps were repeated. After the initial identification of themes, we then conducted a review of the relationships between different themes, checking whether there were themes that were similar and could be merged, and whether there were themes whose logical relationship was one of containment. The themes were finally confirmed through continuous review and adjustment of the content and themes over and over again.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003e1.5 Triangulation\u003c/h2\u003e \u003cp\u003eIn order to substantiate the credibility of our findings, researcher triangulation was adopted. Data gleaned from the semi-structured interviews were recorded, followed by thematic analyses post-initial coding to identify the themes. In the process of thematic analysis, two researchers independently read and initially analyzed the original data, and then discussed the results of the analysis with other members of the research team, summarizing similar or identical themes, discussing themes with differences, and re-analyzing the corresponding raw data. Through multiple consensus meetings and iterative reviews of thematic content, a unified agreement was established, affirming the final themes.\u003c/p\u003e \u003cp\u003e \u003cstrong\u003e1.6 Ethical Approval\u003c/strong\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eEthical approval\u003c/strong\u003e \u003cp\u003e for this study was obtained from the Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, Ethics No: UHCT-IEC-SOP-016-03-01\u003c/p\u003e \u003c/p\u003e "},{"header":"3. Results","content":"\u003cp\u003e3.1 General Information of Interview Participants\u003c/p\u003e\n\u003cp\u003eA total of 27 participants accepted the interview and contributed their perspectives, comprising 14 clinical nurses and 13 patients, with 4 of nurses are nursing managers. The general information of participants were showed in Table\u0026nbsp;3.1.1 and 3.1.2.\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n \u003cdiv class=\"colspec\" align=\"left\"\u003e\u003cbr\u003e\u003c/div\u003e\n \u003ctable id=\"Tab3\" border=\"1\"\u003e\n \u003ccaption\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 3.1.1\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eGeneral Information of Patients(n\u0026thinsp;=\u0026thinsp;13)\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eGender\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eMedical Insurance Type\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eHighest Education\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eInpatient Department\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eP1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eInsurance for urban residents\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHigh school\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCardiovascular department\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eP2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eInsurance for urban workers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHigh school\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCardiovascular\u003c/p\u003e\n \u003cp\u003edepartment\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eP3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eInsurance for urban residents\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMiddle school\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eThoracic surgery\u003c/p\u003e\n \u003cp\u003edepartment\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eP4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eInsurance for urban workers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHigh school\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eThoracic surgery department\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eP5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eInsurance for urban residents\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCollege\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNeurology department\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eP6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eInsurance for urban residents\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMiddle school\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNeurology department\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eP7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eThe new rural cooperative medical insurance\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMiddle school\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGastrointestinal surgery department\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eP8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eInsurance for urban workers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBachelor degree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGynecology department\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eP9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eInsurance for urban workers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBachelor degree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCardiovascular department\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eP10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eself-financing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBachelor degree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eThoracic surgery department\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eP11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eInsurance for urban workers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHigh school\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGastrointestinal surgery department\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eP12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eInsurance for urban workers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHigh school\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGynecology department\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eP13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eInsurance for urban workers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMiddle school\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDepartment of Hepatobiliary surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cdiv class=\"gridtable\"\u003e\n \u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n \u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n \u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n \u003cdiv class=\"colspec\" align=\"char\"\u003e\u0026nbsp;\u003c/div\u003e\n \u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n \u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n \u003ctable id=\"Tab4\" border=\"1\"\u003e\n \u003ccaption\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 3.1.2\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eGeneral information of clinical nurses and nursing managers (n\u0026thinsp;=\u0026thinsp;15)\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eGender\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eHighest Education\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eWorking Years\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eTitle of Professional Position\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eDepartment\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eN1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003efemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBachelor degree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSupervisor nurse\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDepartment of cardiology\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eN2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003efemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBachelor degree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSupervisor nurse\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDepartment of cardiology\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eN3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003efemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBachelor degree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSupervisor nurse\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDepartment of cardiolog\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eN4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003efemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBachelor degree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSupervisor nurse\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDepartment of neurology\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eN5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003efemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBachelor degree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSupervisor nurse\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDepartment of Gynecological tumor\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eN6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003efemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBachelor degree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSupervisor nurse\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDepartment of Gastroenterology\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eN7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003efemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBachelor degree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSupervisor nurse\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDepartment of Pancreatic surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eN8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003efemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMaster degree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSupervisor nurse\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDepartment of Gynecology\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eN9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003efemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBachelor degree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSupervisor nurse\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDepartment of Maxillofacial surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eN10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003efemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBachelor degree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSupervisor nurse\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDepartment of Gastrointestinal surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eM1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003efemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMaster degree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eChief nurse\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDay surgery ward\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eM2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003efemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMaster degree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eChief nurse\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDepartment of Stomatology\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eM3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003efemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBachelor degree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eChief nurse\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDepartment of Neurology\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eM4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003efemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBachelor degree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eChief nurse\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDepartment of Hepatobiliary surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e3.2 Major themes\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e3.2.1 Competence of Information Sharing\u003c/p\u003e\n\u003cp\u003eThere existed both consensus and divergence in the understanding of PE for patient safety when we queried patients and nurses. Both nurses and patients think the key element in PE and PE competence is information sharing, however, their concerns are not same. Nurses prioritize the provision of information by patients during clinical practice, they focus more on patients\u0026apos; conditions and treatment needs for a better caring plan as professionals, whereas patients emphasize their opportunities to receive more information from healthcare providers and concern more about their own rights. Clearly, the competence of providing, receiving and understanding information of patient is of paramount importance for both patient and nurses.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eN1: Only the patient knows their true desires and needs, as well as the types of safety measures they prefer. Engagement is the process make patients have opportunity to provide us more information about themselves or their requirement.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eP8: I believe engagement entails asking more questions, which is within my capacity and should be met by healthcare providers. I need to know all about myself.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e3.2.2 Competence of Taking PE as Responsibility and Right\u003c/p\u003e\n\u003cp\u003eResponsibility and right for security is one of the key concerns of PE for both sides. All nurses believe that patients should fulfill responsibilities and obligations to maintain their own safety in some case. Nursing professionals hold the view that patients must be fully informed about their conditions, treatment and caring plans as well as associated risks, and should be required to provide informed consent. In instances where the patient need protective concealment, family members should also undertake the corresponding responsibility, acting as the patient\u0026apos;s proxy. Certain nursing personnel posit that a patient\u0026apos;s lack of awareness regarding risks does not foster greater trust in medical staff but rather escalates the potential for discord between doctor and patient. When patients\u0026apos; expectations are too high and the risk is not fully known and expected, the responsibility will be fully imposed on medical staff, and when there is an inevitable safety risk under normal circumstances, The huge gap between reality and expectation will cause patients and their families to fall into bad emotions, which will lead to unnecessary conflicts between doctors and patients.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eN10: For example, for cancer chemotherapy patients, we now have a variety of chemotherapy programs, with each presenting its own set of pros and cons, of course, it is imperative for medical staff to conduct evaluations based on individual patient circumstances, thereby facilitating informed decision-making, yet the unpredictability of cancer means that we cannot assure the effectiveness of any given program, it is a step by step, each program in the individual effect is different. Consequently, our role is limited to presenting potential outcomes alongside risk information, among which the possible risks and benefits also include treatment costs, so patients need to consider and make choices among them. At present, there are many clinical trial programs available for cancer patients, with risks and benefits still being evaluated during the trial phase, and some patients are not in good economic condition. Some patients, facing economic hardships, may opt to engage in these studies if they fulfill the trial\u0026apos;s eligibility criteria. Therefore, it is imperative that patients thoroughly read and sign the informed consent form acknowledging the risks, including those that are unknown and uncertain. It is essential for patients to possess a strong sense of responsibility.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eAt the same time, most nurses recognize that even when adhering to established procedures in clinical practice, mistakes are inevitable, which will lead to safety risks. Medical personnel have the responsibility to ensure the safety of patients, but they also hope that patients can consciously engage in a role of verification and oversight. Several nurses shared with us the safety incidents they have experienced or heard about in the course of their work that highlighting instances where PE averted serious adverse outcomes. They believe that the proper PE behavior of patients has great value and significance in promoting patient safety.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eN3: Of course, we have to operate in accordance with the procedures in clinical practice, but it is really very difficult to ensure that we can ensure a complete absence of errors, isn\u0026apos;t it? No one is perfect. What we hope is that upon a patient\u0026apos;s arrival at the hospital, they retain a strong sense of personal responsibility, not to completely rely on the medical staff, but to cooperate with the medical staff to ensure their own safety, such as to assist the medical staff to verify information, monitoring the operation of medical staff, and ensuring adherence to hand hygiene protocols of the medical staff.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eN5 Once, a student nurse went to hang an IV drip for a patient in the morning. Because the morning shift was very busy, she helped out with the task. Likely overwhelmed by the multitude of medications in her possession, an error occurred\u0026mdash;the IV designated for patient 33 was mistakenly set up for patient 32. When I went to remove the needle for another patient in the room, before I even reached the bedside, the patient in bed 32 promptly noticed the information on the medication packaging and said, \u0026quot;Hey, this isn\u0026apos;t my name on it.\u0026quot; He immediately told me, and upon checking, I found that indeed one bag of medication had been mistakenly hung at bed 32. I quickly apologized to the patient and told him that his action was very good, as it prevented an accident.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eSome nurses have reported that patients lacking a sense of responsibility, their engaging behaviors, such as providing false information, not only fail to promote safety, but may also escalate safety risks. A nurse shared her perspective, stating:\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eN8: Despite being instructed to fast and refrain from drinking before surgery, some patients still consume food in the mistaken belief that it poses no safety risks. In reality, this is extremely hazardous, especially when patients, despite being informed of the risks, persist in their actions and deceive caregivers by falsely claiming, for instance, that they have not eaten, therefore providing us with incorrect information that can severely mislead clinical judgment. Often, the truth comes to light only through our repeated questioning and observation of subtle clues. Such actions are very dangerous, and there have been many medical incidents have arisen as a consequence. Even though we emphasize the dangers of such behavior to patients multiple times, they fail to take a responsible attitude towards their own safety and neglect their well-being.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eAll nurses advocate for patient involvement, believing that patients have the right to ensure their safety throughout medical treatment, a right that all healthcare professionals should respect. Even if patients do not possess adequate knowledge or competencies, and despite the potential for increased workload on medical staff, hospitals and healthcare providers should still encourage patients to fully engage in the maintenance of their own safety and provide them with sufficient support.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eN3: PE is meaningful and deserves vigorous promotion. In fact, regardless of the level of literacy, we support it. It\u0026apos;s not just about the patients; clinical medical staff and hospital management must enhance their awareness, possess relevant knowledge, and take actions to optimize the entire medical environment.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eN2: Even when we encounter challenges in communication with certain patients or find them troublesome amidst our busy work schedules, they still serve a crucial role in providing us with information on potential concerns. If a patient reports any discomfort, I would be more vigilant and cautious, and our observations would be more closely monitored. There might be times when it turns out to be false alarms, and it might increase the workload, but we are more relieved that the patient is unharmed and safe.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe majority of patients believe they should be responsible for their own safety, and as a result, some patients will engage in proactive behaviors. However, a minority of patients, despite agreeing that they are the primarily responsible for their own safety, remain disengaged from the medical process, under the assumption that hospitals are safe places and medical staffs will ensure their well-being. A small subset of patients dissents from the PE model, thinking that ensuring safety of patients should be the sole responsibility of medical professionals.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eP5: I take my health and safety very seriously. The family and social education I\u0026apos;ve received, although I didn\u0026apos;t study medicine, still made me aware of the importance of health and safety.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eP2: Most hospitals, especially those of higher levels, are generally safe environments. Of course, you are certainly responsible for your own safety, but within the hospital, it\u0026apos;s relatively safe. Doctors and nurses are readily available to address any issues, so there\u0026apos;s no need to worry too much.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eP11: Since I\u0026apos;m hospitalized, I just need to follow the doctor\u0026apos;s advice; the doctor will take responsibility for my safety, so I don\u0026apos;t need to worry about it myself\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e3.2.3 Competence of Maintaining Trust Relationship with Health Personnels\u003c/p\u003e\n\u003cp\u003eAll nurses and nursing managers assert that trust is an essential prerequisite for PE to yield positive outcomes. They believe that PE in their own safety is a collaborative process between the doctor and the patient, rather than a task to be completed by the patient alone. When asked about the troubles or adverse outcomes caused by incorrect PE and the underlying reasons, almost all nurses mentioned \u0026quot;distrust\u0026quot; in the process of summarizing.\u003c/p\u003e\n\u003cp\u003eN2 \u003cem\u003eUltimately, patients lack a medical background, and our criteria for judgment differ from theirs. Even if we have explained, we cannot fully make him understand the significance of treatments like dialysis. Therefore, popular traditional impressions and some incorrect views may still be a major factor in the patient\u0026apos;s decision-making. Hence, we will try our best to enhance the patient\u0026rsquo;s understanding but, more importantly, to earn their trust.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eTrust plays a dual role in patient participation behaviors. In certain instances reported among nurses and patients, trust has a positive effect, promoting correct patient participation and fostering a good cooperative relationship between doctors and patients. In other cases, an over-reliance on medical staff due to trust is the primary cause of reduced patient participation levels.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eN6: When patients trust medical staff, they can cooperate better. For example, after we have provided health education on ankle pump exercises, some patients are able to follow our instructions diligently, performing each movement accurately and fully, for the required duration, not only in the hospital but also consciously at home. They often give us feedback, and the results are very good. However, some patients may harbor some hostility towards medical staff for various reasons, such as cost or negative emotions brought on by illness. Others may only trust their professors and distrust other doctors and nurses. They may not listen to the precautions and health education we provide, resulting in poor cooperation.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eP7: I think the doctors and nurses here are very good. I don\u0026apos;t understand medical professional knowledge, nor do I want to ask too many questions. However, I believe that following their advice is always the right thing to do, and cooperating with them is enough. I feel the outcome is very good.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eRegardless of the role trust plays in patient participation in safety, it has led to better outcomes, with patients exhibiting higher compliance. Many nursing staff have indicated that gaining the trust of patients is a key step in ensuring patient safety in medical work. Some medical personnel believe that the mass media should play a role in this process.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eM3: At present, some news outlets frequently report negative conflicts between doctors and patients, which has led to a decrease in trust among many patients towards medical staff. Especially in the current era of rampant self-media, if patients or their families are dissatisfied with the treatment outcomes or have other grievances, they may publicize online what they perceive as improperly conduct by doctors, nurses, or hospitals, which can sometimes be just misunderstandings. Under such public opinion circumstances, the doctor-patient relationship becomes even more strained, and the trust of patients in medical staff is greatly affected. However, in reality, the negative incidents publicized online are only a small minority. The vast majority of healthcare providers administer treatment for patients in compliance with established regulations and standards, always prioritizing the patients\u0026apos; interests and life safety. I believe that the online public opinion environment needs to be improved, and the mass media should also promote more positive cases, help the public establish the correct safety concepts, and work together to create a harmonious doctor-patient environment.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e3.2.4 Competence of Making Equal Communication\u003c/p\u003e\n\u003cp\u003eTo address the challenges in patient participation and foster correct and effective engagement, all nursing staff have identified communication as crucial. They believe that thorough communication with patients is the most effective approach. Through such communication, medical personnel can understand the patient\u0026apos;s concerns and needs, while patients can gain the information they require and be aware of their safety risks. Additionally, nursing staff have highlighted the importance of equal communication, where medical staff and patients must respect each other and collaborate to achieve health and safety objectives.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eM2: If the relationship between medical staffs and patients is asymmetrical, or if communication is impeded, it may be difficult to reach a consensus with the patient on health management, and it may also be hard to achieve the purpose of our service. Although medical staff are more professional, the individual needs of patients vary. Therefore, there must be equal mutual communication between both parties, so that we can understand their needs, and they can understand the purpose and benefits of our recommendations. Only in this way can we achieve the goal of their health, which is also the goal of our service; otherwise, it is difficult. Moreover, I believe that only by respecting the patient\u0026apos;s decision-making rights, fully involving them, and allowing them to fully understand our practices can they better cooperate with our various treatments and nursing, and thus better serve the patient\u0026apos;s health.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e3.2.5 Competence of Accepting Non-punitive Safety Culture\u003c/p\u003e\n\u003cp\u003eA safety culture that eschews punitive measures is vital for both medical staff and patients. While all the nurses interviewed expressed their approval of patient involvement, some expressed concerns when discussing the supervisory role of patients. They worry that medical staff might be reluctant to involve patients in the process for fear that patients will discover their mistakes.\u003c/p\u003e\n\u003cp\u003eN7: \u003cem\u003eDespite our rigorous compliance with legal and regulatory standards, errors can occasionally occur, particularly for novice medical personnel who may not have enough experience. The dissatisfaction and criticism from patients, even in the absence of adverse outcomes, can undermine the confidence of medical staff. To prevent accusations or complaints, some practitioners may opt to reduce the information they share with patients or limit their involvement in the process.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eAdditionally, patients have expressed analogous apprehensions, fearing that their perceived lack of competence might result in erroneous reports or misguided suggestions, which could provoke discontent from healthcare professionals.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eP12: They are all very busy, and I don\u0026apos;t understand professional medical knowledge. They must have their reasons for doing things in a certain way. I might not be right, and I\u0026apos;m afraid that asking too many questions might make them think I\u0026apos;m a troublesome person.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e3.2.6 Need of Resource Support\u003c/p\u003e\n\u003cp\u003eHuman resources\u003c/p\u003e\n\u003cp\u003eBoth patients and healthcare professionals have highlighted the issue of inadequate human resources, which impedes the advancement of patient involvement in clinical processes. Nursing staff, in particular, have shared their concerns about the additional workload associated with fostering patient participation, a burden that could potentially exacerbate tensions between healthcare providers and patients.\u003c/p\u003e\n\u003cp\u003eN8: \u003cem\u003eNaturally, we endorse patient participation; however, it demands additional exertions from clinical staff. For instance, there is a need for more meticulous and targeted health education, coupled with positive promotion through mass media. Undoubtedly, there is a continuous need to resolve a variety of patient issues in the course of work. Current clinical tasks are already overwhelming, and medical staff can only take on these additional responsibilities at the expense of their own rest time, leading to excessively burdens and also challenges the maintenance of quality care. It is unrealistic to expect this degree of commitment from everyone; there is an urgent need for hospitals and departments to provide additional human resource support to allieviate the workload for each staff member.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eN7 \u003cem\u003eIn our routine nursing practice, if we are not busy, we can address patient inquiries patiently. However, during extremely busy times, especially when I am interrupted during the administration of nursing treatments or medication preparation, it becomes quite troubling. These interruptions can easily lead to mistakes in my work and could potentially cause accidents. Yet, ignoring patients\u0026apos; concerns can breed dissatisfaction, with some even lodging complaints. Moreover, when I am too busy to explain things thoroughly to patients due to lack of time and faced with a multitude of pending tasks, I can only briefly outline the essentials to patients, which may also lead to misunderstandings and can easily spark disputes.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eSome patients have also complained that the busy work of medical staff prevents them from obtaining a comprehensive understanding of their own conditions. When patients seek for additional information from medical staff, they find it difficult to get support, and thus cannot engage effectively.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eP 10: When I try to consult with the professor, I can never find him; his colleagues tell me he\u0026apos;s either engaged in surgery, attending to clinic patients, or in a meeting. The morning rounds are always rushed, and I can\u0026apos;t ask more questions.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e3.2.7 Need of Channels to Provide Accurate Health Information\u003c/p\u003e\n\u003cp\u003eMany nurses have pointed out that in today\u0026apos;s era of advanced artificial intelligence and the internet, the online spaces have become one of the primary sources for patients seeking information. The abundant information resources available online can serve as a valuable supplement to the busy clinical workload. However, given that most patients have not received formal medical education and lack the ability to discern accurate information, they are prone to being deceived by false information or misleading advertisements, which can lead to adverse outcomes.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eN8: Actually, in promoting patient involvement, improving patients\u0026apos; health literacy is essential, but it cannot be solely reliant on hospitals. After all, the time patients have for medical visits is limited, and our work is very busy. As an individual caregiver, I sometimes have to manage more than a dozen patients, and the time I can allocate for educating each patient is very limited. Patients are required to seek relevant information by themselves, but the online information is often cluttered. Ideally, medical professionals or organizations should establish their own media or public platforms to provide scientific health education to the general public.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eA portion of elderly patients have expressed their frustration with the difficulty of discerning authentic from false information online. This has led them to refrain from seeking information through the internet and instead, they place their trust exclusively in the expertise and guidance provided by healthcare professionals.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eP7: I\u0026apos;m hesitant to search online because I\u0026apos;m afraid of being deceived; there\u0026apos;s a lot of false information on the internet.\u003c/em\u003e\u003c/p\u003e"},{"header":"4. Discussion","content":"\u003cp\u003eFrom the viewpoints of both nurses and patients, the sharing of information is important, and both parties prefer to have more information in order to better achieve safety goals. However, it should be noted that patients' desire to share information may be affected by their level of knowledge and trust. Although patients possessing higher levels of education and extensive medical knowledge may be capable of supplying more information and attaining a profound understanding of it, nursing staff do not believe this ensures that patient participation will invariably result in safer treatment outcomes. Nevertheless, it is imperative to acknowledge that a reservoir of medical knowledge may significantly influence the extent of patient participation and their perceived self-efficacy\u003csup\u003e\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e,\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u003c/sup\u003e. Due to insufficient knowledge reserves, some patients may hesitate to raise their doubts to medical staff, which requires medical staff to take the initiative to invite, guide, and inquire to promote active patient participation. At the same time, if patients lack the necessary knowledge reserves, they may ignore some abnormal situations or potential risk factors, and find it difficult to identify or be aware of the risks and adverse events that have occurred. Previous studies have indicated that access to information can enhance patients' self-efficacy and risk perception of participation, thereby increasing their willingness to engage in their care\u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e. In this study, when discussing the support needs and directions for future improvement, almost all nursing staff emphasized the need to enhance health education for patients based on their specific needs, in order to fostering a deeper understanding of their own conditions and augmenting their knowledge of safety and health. Therefore, compared with the improvement of health knowledge, it is more important to build a correct concept of safety and awareness of participation among the public.\u003c/p\u003e \u003cp\u003eIn addition, compared with the improvement of health knowledge, it is more important to build a correct concept of safety and awareness of engagement among the public. In the opinion of most interviewed nurses, patient participation holds the potential to enhance patient safety. However, ensuring proper and effective engagement of patients is contingent upon patients possessing a sense of responsibility for their own safety. When patients possess a sense of safety and have a responsible attitude toward their own safety, they become more active in the process of clinical treatment process, cooperating with healthcare providers to maintain their own safety behaviors, and this is also a point that requires ongoing education and development.\u003c/p\u003e \u003cp\u003eHowever, limited human resources restrict the implementation of further health education within clinical practice. The inadequacy of human resources is an important factor impeding the further participation of patients. In the case of lack of information, medical staff, being the primary information providers for patients, may not have sufficient time and energy to share more adequate information with patients, which causes patients' dissatisfaction and also becomes a potential risk of doctor-patient conflicts.\u003c/p\u003e \u003cp\u003eThe abundance of online information resources offers the possibility to overcome limitations. With the development of network media, online health information has become one of the main sources of patient health information. However, in this study, many patients and nursing staff have expressed concerns regarding the overwhelming amount of health information online. Many nursing professionals stated that it is the responsibility of the state, government, and medical institutions to disseminate accurate medical knowledge and filter out erroneous information, rather than imposing the difficult task of discerning reliable information on patients, which is too demanding for them. Medical and health institutions should establish professional information channels on online platforms and take responsibility for spreading accurate and reliable medical knowledge. Many studies also leverage information sharing on network platforms to enhance patients' comprehensive understanding of their own conditions, promote patient participation, and improve patient safety maintenance ability\u003csup\u003e\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e,\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u003c/sup\u003e. On the other hand, the government and the public media must also assume the responsibility of instilling the correct safety concept of patients, cultivating public awareness of safety participation, encouraging appropriate PE during medical treatment, protecting their own rights and interests, and sharing the maintenance responsibilities of safety with medical staff.\u003c/p\u003e \u003cp\u003eThis study also found that the medical-patient relationship profoundly affects the effectiveness of PE. A good doctor-patient relationship is the foundation for promoting proper patients engagement behaviors, with trust in healthcare providers being an essential precondition for patients to undertake appropriate participatory actions. Although some patients in this study exhibited over-reliance on medical personnel due to excessive trust and thus diminished their active participation, trust in medical personnel remains the basis for ensuring effective communication between doctors and patients and improving the level of patient cooperation. In the absence of trust in medical personnel, patients may withhold true information, exhibit hostility, and engage in non-compliant behavior, which will cause difficulties and unsafe consequences for medical personnel. Patients' reliance on medical personnel depends on their sense of responsibility for their own safety, a sentiment that aligns with, rather than conflicts with, their trust in medical personnel. Patients who possess a strong sense of safety and responsibility are better equipped to cooperate with medical personnel in the process of medical treatment. Through effective verification and oversight, to make up for the omissions of medical personnel in busy clinical work, and identify potential medical errors to ensure their own safety. It is noteworthy that previous study\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e has also indicated that a decline in relationship between patient and may be one of the negative effects brought about by PE. This deterioration can be attributed to differences in decision-making between doctors and patients, as well as the anxiety that arises from an overload of information. Establishing equal communication between doctors and patients is an effective way to foster meaningful PE and achieve positive health outcomes. This finding aligns with prior studies which suggest that when patients perceive their role and status as subordinate to that of healthcare providers, their engagement in error reduction is significantly diminished.\u003csup\u003e\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e\u003c/sup\u003e.In this study, patients demonstrate hesitancy in expressing their confusion to medical staff due to a deficient grasp of the concept of relationship equivalence. Meanwhile, this study also revealed that disparities in power between patients and medical staff can lead to communication barriers. Patients may be reluctant to ask questions or challenge the authority of medical staff, or refuse to follow the advice of medical staff, resulting in non-compliant behaviors. This, in turn, escalates security risks. When patients exhibit a negative attitude and contempt for medical staff, it can induce fear among medical personnel of becoming subjects of patient complaints or conflict, thereby diminishing patient participation. Therefore, establishing an equal communication relationship is imperative for promoting effective patient participation and ensuring safety.\u003c/p\u003e \u003cp\u003eIn the process of patient participation in reducing errors, the construction of a safety culture without punishment can increase the willingness of medical staff to support and promote patient participation. Previous qualitative studies of health care workers have found that \u003csup\u003e\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e,\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e\u003c/sup\u003e one of the main reasons medical staff do not support patient participation is the fear of becoming the target of patient complaints or causing conflict. In the cases mentioned by the nurse, the medical staff strongly support the behavior of the patient which identify safety risk and put forward the stop in time. Conversely, the medical staff would feel panic for the behavior such as accusations and complaints. At the same time, it is worth noting that patients are also afraid to present potentially misguided advice or questions to medical staff because of similar concerns. Therefore, we need to cultivate a more inclusive culture of PE, wherein both medical professionals and patients mut engage in mutual understanding, tolerance and collaboration to collectively advance patient safety.\u003c/p\u003e \u003cp\u003eIn the future, it is essential to publicize patient participation in patient safety through public media in China and even in a larger scope, establish a proper safety concept for the public, and assist patients in developing their own awareness of safety responsibility in the process of medical treatment. Meanwhile, medical institutions should invest more human resources for clinical practice, thereby offering enhanced support for patient participation. More medical institutions, particularly government health institutions, should establish official health information platforms, providing patients with diverse ways and channels for assessing accurate and reliable health and safety information, and assist the national government and online platforms to combat health rumors and promote citizens' health. In the future, healthcare providers should implement more individualized and targeted health education for patients. Meanwhile, tools designed to systematically evaluate patients\u0026rsquo; participation literacy and conditions are needed, so as to more comprehensively understand the obstacles that patients may encounter in the process of participation through measurement and facilitate the resolution of these issues. Relevant guidelines and systems regarding patient participation in patient safety warrant further research to provide sufficient reference for clinical practice. At the same time, there is a critical need to strengthen the development of a proper safety culture, not for the purpose of punishment or blame, but rather for the goal of enhancing safety.\u003c/p\u003e \u003cp\u003e5.Strengths and limitations\u003c/p\u003e \u003cp\u003eThis study adopts a phenomenological approach, from the perspectives of two roles in the clinical, the nurses and patients, who experience more PE \u003csup\u003e\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e\u003c/sup\u003e, to ascertain the specific competencies patients must possess to effectively engage in their safety processes. By digging deep into the experience and true feelings of both parties in the participation process, more abundant information is obtained, and the similarities and differences in the opinions of both parties on the attributes of competence required by patients in the safety process of participation are explained.\u003c/p\u003e \u003cp\u003eHowever, certain limitations exist; to achieve a richer sharing of experiences, this study invited only experienced senior nurses for interviews, and did not interview newly hired or less experienced nurses. The findings are predicated solely on the recollections of the nursing staff regarding their own sentiments from earlier in their careers or on their retelling of the feelings of other less experienced staff, which may have a certain degree of recall bias.\u003c/p\u003e \u003cp\u003e6. Conclusion\u003c/p\u003e \u003cp\u003eFrom the dual perspectives of nurses and patients, this study describes the necessary competence for correct participation of patients, encompassing information sharing, patient's safety awareness and sense of responsibility, trust between medical staff and patients, and equitable communication, construction of medical-patient participation safety culture without punishment, as well as the provision of adequate human resources and robust network information platform support. Achieving these competence improvements requires not only the efforts of patients, but also the concerted efforts of medical staff, healthcare institutions, national governmental bodies and social media platforms. At the same time, there is a future need to develop clearer measurement tools for gauging patient participation in patient safety competencies, offering medical staff and patients themselves with clear references for enhancement strategies.\u003c/p\u003e "},{"header":"Declarations","content":"\u003cp\u003e7. Clinical Trial Number\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003eAvailability of data and materials: The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.\u003c/p\u003e\n\u003cp\u003eCompeting interests: \u0026nbsp;I declare that the authors have no competing interests as defined by BMC, or other interests that might be perceived to influence the results and/or discussion reported in this paper.\u003c/p\u003e\n\u003cp\u003eFunding: This study funded by Wuhan Union Hospital (P016.01003.22003.100).\u003c/p\u003e\n\u003cp\u003eAuthors\u0026apos; contributions: Y.L, JJ.Z and X.L engaged in the process of collecting and analyzing data as well as main manuscript text writing. HQ.Z and YL.Z engaged in revising the manuscript. QY.Y and N.Z gave the proper instruction to the research design and conception. All authors have reviewed the manuscript and approved the submitted version.\u003c/p\u003e\n\u003cp\u003eAcknowledgements: Not applicable\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eOrganization WH. 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Patients\u0026rsquo; willingness and ability to participate actively in the reduction of clinical errors: a systematic literature review. Soc Sci Med. 2012;75:257\u0026ndash;63.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eShemesh D, Olsha O, Goldin I, Danin S. Patient Safety: The Doctor\u0026rsquo;s Perspective. J Vasc Access. 2015;16:S118\u0026ndash;20.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDavis RE, Sevdalis N, Vincent CA. Patient involvement in patient safety: the health-care professional\u0026rsquo;s perspective. J Patient Saf. 2012;8:182\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-nursing","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"nurs","sideBox":"Learn more about [BMC Nursing](http://bmcnurs.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/nurs/default.aspx","title":"BMC Nursing","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Patient engagement, Patient safety, Patient competence, qualitative study","lastPublishedDoi":"10.21203/rs.3.rs-4955143/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4955143/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eObjectives: To elucidate the essential competencies required for patient engagement in their own safety.\u003c/p\u003e\n\u003cp\u003eMethod: We adopted a phenomenological approach in qualitative research to conduct semi-structured interviews with nurses (n=14) and adult patients (n=13) from different departments. By deeply exploring their experiences and feelings about patient participation in patient safety, we sought to understand their views on the qualities that patients need to possess in order to participate in their own safety.\u003c/p\u003e\n\u003cp\u003eResults：From the interviews，we identified seven major themes, including competence of information sharing, competence of taking patient engagement as responsibility and right, competence of making equal communication, competence of maintaining trust relationship with health personnels, competence of accepting non-punitive safety culture, need of resource support, need of channels to provide accurate health information, five of them showed essential competences for patients and two of them showed patients’ need for promoting their engagement.\u003c/p\u003e\n\u003cp\u003eConclusion：The findings of this study show necessary competence and needs in patient engagement process of patient, offer a foundational reference for constructing a measurement tool for patient engagement in patient safety competence in the future, so that medical staff and patients can provide reference for the future targeted construction of patient competence improvement programs. At the same time, improving patient competence and engagement to better achieve safety goals requires the joint efforts of patients, medical staff, medical institutions, the government, and society.\u003c/p\u003e","manuscriptTitle":"A qualitative study of patient competence for patient engagement in their safety——from the perspective of nurses and patients","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-09-26 14:24:17","doi":"10.21203/rs.3.rs-4955143/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-08-28T07:29:32+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-08-28T07:22:47+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-08-27T14:48:13+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Nursing","date":"2024-08-22T04:54:08+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-nursing","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"nurs","sideBox":"Learn more about [BMC Nursing](http://bmcnurs.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/nurs/default.aspx","title":"BMC Nursing","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"3bc3a5e0-f580-4dab-88df-52f50738ba52","owner":[],"postedDate":"September 26th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2024-10-28T16:02:45+00:00","versionOfRecord":{"articleIdentity":"rs-4955143","link":"https://doi.org/10.1186/s12912-024-02440-8","journal":{"identity":"bmc-nursing","isVorOnly":false,"title":"BMC Nursing"},"publishedOn":"2024-10-24 15:57:42","publishedOnDateReadable":"October 24th, 2024"},"versionCreatedAt":"2024-09-26 14:24:17","video":"","vorDoi":"10.1186/s12912-024-02440-8","vorDoiUrl":"https://doi.org/10.1186/s12912-024-02440-8","workflowStages":[]},"version":"v1","identity":"rs-4955143","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4955143","identity":"rs-4955143","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}