Research In Nursing & Health[JOURNAL]
Sun
40 papers
Photovoice in mental illness research: A review and recommendations.
Han CS, Oliffe JL
Health (London) · 2016 Mar · PMID 25673051 · Full text
In the past few decades, photovoice research has gained prominence, providing context rich insights through participants' photographs and narratives. Emergent within the field of photovoice research have been health stud...
In the past few decades, photovoice research has gained prominence, providing context rich insights through participants' photographs and narratives. Emergent within the field of photovoice research have been health studies embracing diverse illness issues. The goal of this scoping review article was to describe the use of photovoice in mental illness, paying particular attention to the following: (1) the study design and methods, (2) empirical findings, and (3) dissemination strategies. Nine qualitative studies (seven drawing from primary and two secondary analyses) featuring diverse approaches to analysis of data comprising individual and/or focus group interviews using participant-produced photographs were included in the review. Described were participant's experiences of living with mental illness and/or substance overuse, including feelings of loneliness and being marginalized, along with their support care needs (e.g. physical, emotional, and spiritual) to garner self-confidence, respite, and/or recovery. Empirically, the reviewed articles confirmed the value of participant-produced photographs for obtaining in-depth understandings about individual's mental illness experiences while a focus on stigma and recovery was prominent. In terms of dissemination, while most of the published articles shared some participants' photographs and narratives, less evident were strategies to actively engage the public or policymakers with the images. Recommendations for future photovoice research include conducting formal analyses of participant photographs and strategically lobbying policymakers and raising public awareness through virtual and "in person" photo exhibitions while de-stigmatizing and affirming the experiences of those who are challenged by mental illness.
Gatekeeping access to the midwifery unit: Managing complaints by bending the rules.
Allan HT, Odelius A, Hunter BJ … +3 more , Bryan K, Knibb W, Shawe J
Health (London) · 2015 Nov · PMID 25631490 · Publisher ↗
While poor communication between service users and front-line staff causes many service user complaints in the British National Health Service, staff rarely reflect on the causes of these complaints. We discuss findings...
While poor communication between service users and front-line staff causes many service user complaints in the British National Health Service, staff rarely reflect on the causes of these complaints. We discuss findings from an action research project with midwives which suggest that the midwives struggled to fully understand complaints from women, their partners and families particularly about restricted visiting and the locked door to the midwifery unit. They responded to individual requests to visit out of hours while maintaining the general policy of restricted visiting. In this way, the door was a gatekeeping device which allowed access to the unit within certain rules. The locked door remained a barrier to women and their families and as a result was a common source of informal complaints. We argue that the locked door and restricted visiting to the midwifery unit were forms of gatekeeping and boundary making by midwives which reveals a tension between their espoused woman-centred care and contemporary midwifery practice which is increasingly constrained by institutional values.
Silent subjects, loud diseases: Enactment of personhood in intensive care.
Koksvik GH
Health (London) · 2016 Mar · PMID 25627696 · Publisher ↗
The topic of this article is personhood in the case of verbally inexpressive, typically unconscious patients or patients with a low level of lucidity. My aim is to show how personhood is done and undone in a close-knit n...
The topic of this article is personhood in the case of verbally inexpressive, typically unconscious patients or patients with a low level of lucidity. My aim is to show how personhood is done and undone in a close-knit network of personnel, patients, disease, technology, and treatment, borrowing the concept of enactment as developed by Annemarie Mol. The empirical data are based on grounded ethnographic fieldwork conducted in three separate intensive care units in three European countries: Spain, Norway, and France in the spring of 2014. Four weeks were spent at each site. The method used was participant observations and semi-structured interviews with 24 intensive care unit staff members (9 doctors, 12 nurses, and 3 nurses' aides).
Down syndrome screening information in midwifery practices in the Netherlands: Strategies to integrate biomedical information.
Rosman S
Health (London) · 2016 Mar · PMID 25504473 · Publisher ↗
The aim of this qualitative study was to analyse counselling with regard to prenatal screening in midwifery consultations in the Netherlands where a national prenatal screening programme has only existed since 2007, afte...
The aim of this qualitative study was to analyse counselling with regard to prenatal screening in midwifery consultations in the Netherlands where a national prenatal screening programme has only existed since 2007, after years of social and political debates. The methodology is based on in situ observations of 25 counselling consultations in four midwifery practices in two main cities in the Netherlands. The results of this study show that, since midwives are obliged to offer information on Down syndrome screening to all pregnant women (2007), they have to deal with the communication of medical screening information using biostatistical concepts to explain risks, calculations, probabilities and chromosomal anomalies. In order to avoid the risk of medicalization of their consultation, midwives develop strategies that allow them to integrate this new biomedical discourse while maintaining their low medicalized approach of midwife-led care. One of their main strategies is to switch from 'alarming' biomedical messages to 'reassuring words' in order to manage the anxiety induced by the information and to keep the control over their low medicalized consultation. They also tend to distance themselves from the obligation to talk about screening. The way midwives handle these counselling consultations allows them to respect their obligation to propose information, and to remain faithful to their struggle to protect the natural process of pregnancy as well as their professional autonomy.
The language of sedation in end-of-life care: The ethical reasoning of care providers in three countries.
Seale C, Raus K, Bruinsma S … +7 more , van der Heide A, Sterckx S, Mortier F, Payne S, Mathers N, Rietjens J, UNBIASED consortium
Health (London) · 2015 Jul · PMID 25389235 · Publisher ↗
The application of ethically controversial medical procedures may differ from one place to another. Drawing on a keyword and text-mining analysis of 156 interviews with doctors and nurses involved in end-of-life care ('c...
The application of ethically controversial medical procedures may differ from one place to another. Drawing on a keyword and text-mining analysis of 156 interviews with doctors and nurses involved in end-of-life care ('care providers'), differences between countries in care providers' ethical rationales for the use of sedation are reported. In the United Kingdom, an emphasis on titrating doses proportionately against symptoms is more likely, maintaining consciousness where possible. The potential harms of sedation are perceived to be the potential hastening of social as well as biological death. In Belgium and the Netherlands, although there is concern to distinguish the practice from euthanasia, rapid inducement of deep unconsciousness is more acceptable to care providers. This is often perceived to be a proportionate response to unbearable suffering in a context where there is also greater pressure to hasten dying from relatives and others. This means that sedation is more likely to be organised like euthanasia, as the end 'moment' is reached, and family farewells are organised before the patient is made unconscious for ever. Medical and nursing practices are partly responses to factors outside the place of care, such as legislation and public sentiment. Dutch guidelines for sedation largely tally with the practices prevalent in the Netherlands and Belgium, in contrast with those produced by the more international European Association for Palliative Care whose authors describe an ethical framework closer to that reportedly used by UK care providers.
The best laid plans? Women's choices, expectations and experiences in childbirth.
Malacrida C, Boulton T
Health (London) · 2014 Jan · PMID 23426792 · Publisher ↗
The past decades have seen a drastic increase in the medicalization of childbirth, evidenced by increasing Caesarean section rates in many Western countries. In a rare moment of congruence, alternative health-care provid...
The past decades have seen a drastic increase in the medicalization of childbirth, evidenced by increasing Caesarean section rates in many Western countries. In a rare moment of congruence, alternative health-care providers, feminist advocates for women's health and, most recently, mainstream medical service providers have all expressed serious concerns about the rise in Caesarean section rates and women's roles in medicalization. These concerns stem from divergent philosophical positions as well as differing assumptions about the causes for increasing medicalization. Drawing on this debate, and using a feminist and governmentality framing of the problem, we interviewed 22 women who have recently had children about their birthing choices, their expectations and their birth experiences. The women's narratives revealed a disjuncture between their expectations of choosing, planning and achieving as natural a birth as possible, and their lived experiences of births that did not typically go to plan. They also reveal the disciplining qualities of both natural and medical discourses about birth and choice. Furthermore, their narratives counter assumptions that women, as ideal patient consumers, are driving medicalization.
Understanding context for quality improvement: artefacts, affordances and socio-material infrastructure.
Allen D
Health (London) · 2013 Sep · PMID 23117591 · Publisher ↗
Against a backdrop of growing concern for patient safety and service quality, modern health-care systems are witnessing a proliferation of improvement initiatives. The impact is often variable, however, and a key theme t...
Against a backdrop of growing concern for patient safety and service quality, modern health-care systems are witnessing a proliferation of improvement initiatives. The impact is often variable, however, and a key theme to emerge from evaluations of these efforts is a recognition of the effects of local context on the success or otherwise of an intervention. However, the 'context' tends to be understood in terms of higher order issues such as structure, culture and leadership. This article explores a dimension of context not typically taken into account in the health-care improvement literature: the infrastructural context. Many quality improvement interventions hinge on the introduction of artefacts to support behavioural change in the workplace. Despite calls from scholars of technology in practice for a greater acknowledgement of the role of such mundane artefacts in supporting the organisation of health-care work, they are rarely considered in these terms in evaluations of improvement efforts. In this article, I argue that understanding the potential generative effects of artefacts for quality improvement purposes requires an understanding of their 'affordances' and how these relate to the socio-material infrastructure into which they are to be introduced, and/or the technologies they are designed to replace. Integrated care pathway implementation is examined to illustrate this position. Drawing on qualitative case studies of integrated care pathway development processes undertaken in the UK National Health Service and ethnographic research on the international care pathway community, I consider the infrastructural reasons behind the challenges of making pathways work in organising health care, and why, contrary to the aspirations of their proponents, they often appear to increase rather than decrease paperwork.
'Catching up': The significance of occupational communities for the delivery of high quality home care by community nurses.
Adams M, Robert G, Maben J
Health (London) · 2013 Jul · PMID 23079580 · Publisher ↗
This article examines the importance of some informal work practices among community nurses during a period of significant organizational change. Ethnographic fieldwork in two purposively selected adult community nursing...
This article examines the importance of some informal work practices among community nurses during a period of significant organizational change. Ethnographic fieldwork in two purposively selected adult community nursing services in England comprised 79 hours of observation of routine practice, 21 interviews with staff and 23 interviews with patients. We identified the informal work practice of 'catching up', informal work conversations between immediate colleagues, as an important but often invisible aspect of satisfying work relationships and of the relational care of patients. Drawing on anthropological literatures on 'communities of practice' the article examines two central issues concerning the practices of 'catching up': (1) how informal learning processes shape community nursing work; (2) how this informal learning is shaped both in relation to the ideals of community nursing work and the wider political and organizational contexts of community nursing practice. Our findings highlight the distinctive value of informal workplace 'catch ups' for nurses to manage the inherent challenges of good home care for patients and to develop a shared ethic of care and professional identity. Our findings also indicate the decline of 'catching up' between nurses along with diminishing time and opportunity for staff to care holistically for patients in present service climates.
Faux masculinities among college men who experience depression.
Oliffe JL, Galdas PM, Han CS … +1 more , Kelly MT
Health (London) · 2013 Jan · PMID 22674749 · Publisher ↗
Depression is a significant problem among college men that can be complicated by masculine ideals of stoicism, reluctance to seek help, and risky self-management strategies. Underpinning these issues are complexities in...
Depression is a significant problem among college men that can be complicated by masculine ideals of stoicism, reluctance to seek help, and risky self-management strategies. Underpinning these issues are complexities in recognizing what behaviors might be indicative of college men's depressive symptoms. Findings drawn from a qualitative study of 25 Canadian-based college men who self-identified or were diagnosed with depression revealed three predominant masculine identities: the angry man; the solitary man; and the risk-reliant man. Within each of these themes men embodied aspects of idealized masculinity that were difficult to distinguish as symptoms of depression or as representative of the activities with which many college men partake. The angry man identity described men who expressed anger, at least in part, to dissipate depression invoked pain and emotional distress. The solitary man category included men who self-isolated, fearing that others would recognize and judge them as harboring depression. Risk-reliant men employed strategies including alcohol and other drug overuse rather than relinquish control by engaging with professional health care providers and services. Guided by the overall findings we argue this phenomenon as 'faux masculinities' - characterized by men's engagement in practices consistent with idealized masculine identities but that emerge from and/or in response to the experience of depression. Faux masculinities are discussed within the context of the challenges posed for college men and their health care providers in pointing toward targeted depression interventions.
Medication communication during ward rounds on medical wards: Power relations and spatial practices.
Liu W, Manias E, Gerdtz M
Health (London) · 2013 Mar · PMID 22674748 · Publisher ↗
Communication plays a crucial role in the management of medications. Ward rounds are sites where health professionals from different disciplines and patients come together to exchange medication information and make trea...
Communication plays a crucial role in the management of medications. Ward rounds are sites where health professionals from different disciplines and patients come together to exchange medication information and make treatment decisions. This article examines power relations and spatial practices surrounding medication communication between patients and health professionals including doctors, nurses and pharmacists during ward rounds. Data were collected in two medical wards of a metropolitan teaching hospital in Melbourne, Australia. Data collection methods involved participant observations, field interviews, video-recordings, together with individual and group reflexive interviews. A critical discourse analysis was undertaken to identify the location sites where power relations were reproduced or challenged in ward rounds. Findings demonstrated that traditional medical hierarchies constructed the ways in which doctors communicated about medications during ward rounds. Nurses and pharmacists ventured into the ward round space by using the discourse of preparation and occupying a peripheral physical position. Doctors privileged the discourse of medication rationalization in their ward round discussions, competing with the discourse of inquiry taken up by patients and families. Ward rounds need to be restructured to provide opportunities for nurses and pharmacists to speak at dedicated times and in strategic locations. By critically reflecting upon the complex process of medication communication during ward rounds, greater opportunities exist for enhanced team communication among health professionals.
The resilient subject: exploring subjectivity, identity and the body in narratives of resilience.
Aranda K, Zeeman L, Scholes J … +1 more , Morales AS
Health (London) · 2012 Sep · PMID 22547553 · Publisher ↗
International research and policy interest in resilience has increased enormously during the last decade. Resilience is now considered to be a valuable asset or resource with which to promote health and well-being and fo...
International research and policy interest in resilience has increased enormously during the last decade. Resilience is now considered to be a valuable asset or resource with which to promote health and well-being and forms part of a broader trend towards strength based as opposed to deficit models of health. And while there is a developing critique of resilience's conceptual limits and normative assumptions, to date there is less discussion of the subject underpinning these notions, nor related issues of subjectivity, identity or the body. Our aim in this article is to begin to address this gap. We do so by re-examining the subject within two established narratives of resilience, as 'found' and 'made'. We then explore the potential of a third narrative, which we term resilience 'unfinished'. This latter story is informed by feminist poststructural understandings of the subject, which in turn, resonate with recently articulated understandings of an emerging psychosocial subject and the contribution of psychoanalysis to these debates. We then consider the potential value of this poststructural, performative and embodied psychosocial subject and discuss the implications for resilience theory, practice and research.
The use of routinely collected patient data for research: a critical review.
Foster V, Young A, Medicines for Neonates Investigator Group … +10 more , Modi N, Brocklehurst P, Abbott J, Costeloe K, Field D, Majeed A, Kemp J, Ashby D, Young A, Petrou S
Health (London) · 2012 Jul · PMID 22071234 · Publisher ↗
Over recent years in the UK there has been growing interest in the potential for routinely collected NHS (National Health Service) patient data to be used for secondary purposes, facilitated by the potential of increasin...
Over recent years in the UK there has been growing interest in the potential for routinely collected NHS (National Health Service) patient data to be used for secondary purposes, facilitated by the potential of increasingly sophisticated electronic databases. This article is based on a critically reflective literature review which analyses the key debates pertaining to this issue. The work arose in the context of a programme of research concerning routine patient data use in neonatal care. The article includes analysis of commentary (opinion and ethical inquiry) as well as empirically derived claims. It aims to deconstruct the knowledge assumptions on which relevant research studies have been based or are proposed and it also incorporates ontological position and moral argument. Results are presented according to three predominant debates: the prevailing claim that all health research benefits civic society; the varieties of informed consent and choices open to patients regarding secondary uses of their data; and the 'rights and responsibilities' of patients when it comes to their data being used for research purposes. It examines the relevance of these themes specifically to the neonatal context and the implications for our own research, concluding that employing an alternative ethical model to the traditional professional one might be useful in order to provide a further perspective on the issue.
Expert nurses and the division of labour in hospitals.
Carmel S, Baker-McClearn D
Health (London) · 2012 May · PMID 21693481 · Publisher ↗
This article analyses nursing expertise with a particular focus at the level of clinical and organizational practice. Through an examination of a specialist team of hospital nurses, and drawing on the concept of a commun...
This article analyses nursing expertise with a particular focus at the level of clinical and organizational practice. Through an examination of a specialist team of hospital nurses, and drawing on the concept of a community of practice, the article provides a critique of discussions of nursing expertise which can be overly normative, individualistic or divorced from practice. The theoretical background to our analysis is the division of labour in health care; the case study on which this analysis is based is a particular health policy: the introduction of critical care outreach services. The empirical portions of the article are based on a qualitative study of eight such services in England. In the first part of the analysis we elaborate on three ways in which 'expertise' can be deployed in practice: teaching and training; consultancy and advice; and practical clinical action. Each of these is shown to be related to the development of a community of practice. In the second part of the analysis we examine in more detail the impact of outreach nurses on the division of labour in health care and on traditional occupational hierarchies. A general implication of our findings is that expertise has fundamentally social characteristics which need to be acknowledged in academic and policy discourse.
A qualitative analysis of changes in relationship dynamics and roles between people with cancer and their primary informal carer.
Ussher JM, Tim Wong WK, Perz J
Health (London) · 2011 Nov · PMID 21177721 · Publisher ↗
It is widely accepted that cancer is an intersubjective experience that impacts upon the psychological well-being of people with cancer and informal carers, as well as on couple relationships. This qualitative study exam...
It is widely accepted that cancer is an intersubjective experience that impacts upon the psychological well-being of people with cancer and informal carers, as well as on couple relationships. This qualitative study examined the nature and consequences of cancer on the relationship between informal carers and the person with cancer, from the perspective of Australian cancer carers. Sixty-two carers (42 women and 20 men), across a range of cancer types, stages and relationship dyads took part in semi-structured interviews. Participants reported that cancer had precipitated a change in roles and in the dynamics of the relationship, including having to take on quasi-medical tasks and decisions, neglecting self and other relationships, changes to the emotions or personality of the person with cancer, changed patterns of communication, and changes to sexuality and intimacy. The impact of the changed relationship included sadness, anger and frustration, as well as feelings of love and being closer together, resulting in relationship enhancement. Women were more likely to report changes in the person with cancer and to mourn the previous relationship, while more men reported relationship enhancement.
Prostate cancer support groups, health literacy and consumerism: are community-based volunteers re-defining older men's health?
Oliffe JL, Bottorff JL, McKenzie MM … +3 more , Hislop TG, Gerbrandt JS, Oglov V
Health (London) · 2011 Nov · PMID 21177714 · Publisher ↗
In this article we describe the connections between prostate cancer support groups (PCSGs) and men's health literacy and consumer orientation to health care services. The study findings are drawn from participant observa...
In this article we describe the connections between prostate cancer support groups (PCSGs) and men's health literacy and consumer orientation to health care services. The study findings are drawn from participant observations conducted at 16 PCSGs in British Columbia, Canada and 54 individual interviews that focused on men's experiences of attending group meetings. Men's communication and interactions at PCSGs provide important insights for how men talk about and conceptualize health and illness. For example, biomedical language often predominated at group meetings, and men used numbers and measures to engage with risk discourses in linking prostate cancer markers to various treatment options and morbidity and mortality rates. Many groups afforded opportunities for men to interact with health care providers as a means to better understand the language and logic of prostate cancer management. The health literacy skills fostered at PCSGs along with specific group-informed strategies could be mobilized in the men's subsequent clinical consultations. Consumer discourses and strategies to contest power relations with health care professionals underpinned many men's search for prostate cancer information and their commitment to assisting other men. Key were patients' rights, and perhaps responsibility, to compare diverse health products and services in making decisions across the entire trajectory of their prostate cancer. Overall, the study findings reveal PCSGs as having the capacity to contest as well as align with medical expertise and services facilitating men's transition from patient to informed health care consumers. The processes through which this occurs may direct the design of older men's health promotion programs.
Holding onto womanhood: a qualitative study of heterosexual women with sexual desire loss.
Hinchliff S, Gott M, Wylie K
Health (London) · 2009 Jul · PMID 19491236 · Publisher ↗
This article explores heterosexual women's accounts of sexual, desire loss, particularly the ways in which it can affect their sense of themselves, as women. In-depth interviews were conducted with 17 participants recrui...
This article explores heterosexual women's accounts of sexual, desire loss, particularly the ways in which it can affect their sense of themselves, as women. In-depth interviews were conducted with 17 participants recruited, through a psychosexual clinic in England, and the data analysed using a, material-discursive approach. The findings showed that having sexual desire, loss often challenged participants' perceptions of themselves as women. Specific challenges related to dealing with isolation and otherness, addressing their own feelings of not being 'proper wives' because they did not sexually satisfy their partners and maintaining a sense of sexual attractiveness in the absence of sexual desire. Participants responded to these challenges in various ways, often renegotiating their identities as women. The findings are discussed in relation to theorizing women's sexuality and their implications for health care.
Structural constraints and opportunities for CAM use and referral by physicians, nurses, and midwives.
Hirschkorn KA, Bourgeault IL
Health (London) · 2008 Apr · PMID 18400829 · Publisher ↗
This article examines the attitudes and reported behaviors of physicians, nurses, and midwives regarding complementary and alternative medicine (CAM), with respect to one key theme that emerged from a broader qualitative...
This article examines the attitudes and reported behaviors of physicians, nurses, and midwives regarding complementary and alternative medicine (CAM), with respect to one key theme that emerged from a broader qualitative study. Of central interest are the structural influences identified by study participants that either act as constraints or opportunities for their professional use of or referral for CAM. In an effort to interpret these results, the analysis is situated within the sociology literature that documents the influences of professional socialization, practice philosophy, regulation, and organizations on professional behavior. These influences are classified as either professional-level structures or work/organizational structures. The main conclusion is that future research should pay more attention to such structural dimensions that may be exerting influence on the decisions of providers about whether or not to professionally use or refer for CAM. This article is offered as a conceptual starting point for doing so.
Health seeking behaviours among Chinese-Australian women: implications for health promotion programmes.
Kwok C, Sullivan G
Health (London) · 2007 Jul · PMID 17606701 · Publisher ↗
Preventive medicine is an important element of the Australian health care system. An essential aspect of the biomedical model of health care is screening for the early detection of disease in otherwise asymptomatic peopl...
Preventive medicine is an important element of the Australian health care system. An essential aspect of the biomedical model of health care is screening for the early detection of disease in otherwise asymptomatic people. There is ample evidence that acceptance levels of western medicine vary and that a variety of health epistemologies and health practices coexist. To examine the extent to which Chinese-Australian women integrate western medicine practices in their health seeking behaviour, a qualitative study was conducted, which involved in-depth interviews in Cantonese with 20 women. Although adherence to western health beliefs and practices varied, in general these Chinese-Australian women sought medical help only after they felt unwell. Commonly, they first tried traditional remedies for minor diseases. Many saw no reason to participate in screening when they were asymptomatic. Direct communication with health care providers who speak the same language appears to be important to many Chinese-Australian women when seeking health care services. It is recommended that ethnic health workers should participate in screening programmes and other health promotion activities.
'Not living life in too much of an excess': lay men understanding health and well-being.
Robertson S
Health (London) · 2006 Apr · PMID 16513659 · Publisher ↗
While research on lay perspectives of health now has a well established history, specific empirical data on male lay perspectives of health and well-being are largely absent. Drawing on focus group data and in-depth inte...
While research on lay perspectives of health now has a well established history, specific empirical data on male lay perspectives of health and well-being are largely absent. Drawing on focus group data and in-depth interviews with 20 lay men (including sub-samples of gay men and disabled men), and seven health professionals, this article explores how the men conceptualized 'health' and the gendered nature of such conceptualizations. Specific emphasis is given to considering notions of 'control' and 'release', and the associated issues of 'risk' and 'responsibility', in the participants' health narratives. A conceptual model for understanding 'masculinity' and 'health' is presented.
Giving birth, going home: influences on when low-income women leave hospital.
Lichtenstein B, Brumfield C, Cliver S … +3 more , Chapman V, Lenze D, Davis V
Health (London) · 2004 Jan · PMID 15018719 · Publisher ↗
The US Newborns' and Mothers' Health Protection Act of 1996 ('The Two-Day Law') mandates insurance coverage for women who have just given birth to remain in hospital for two days post-partum. However, many women are bein...
The US Newborns' and Mothers' Health Protection Act of 1996 ('The Two-Day Law') mandates insurance coverage for women who have just given birth to remain in hospital for two days post-partum. However, many women are being discharged from hospital after 24 hours. To assess why early discharge is still occurring, a study of 406 new mothers was conducted at an urban metropolitan hospital in the USA. The women were aware of the new law (95%) but decision making was often relinquished to hospital authorities. Patients who stayed longer tended to be more assertive in decision making, and used the Two-Day Law as leverage in discussions about going home. The study concluded that the nurses were authoritative and often influential agents in the decision-making process, and that patients were likely to interpret specific interactions with hospital staff as a signal to leave.
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