Background: The patient is observed to acquire a passive role and the nurse an expert role with a maternalistic attitude. This relationship among others determines the capacity for autonomy in the decision making of patients. Objectives: The aim of this study is to analyse the nurse-patient relationship and explore their implications for clinical practice, the impact on quality of care, and the decision-making capacity of patients. Design: A phenomenological qualitative study was conducted. Settings and participants: Thirteen in-depth interviews with nurses and 61,484 nursing records from internal medicine and specialties departments in a general hospital from 2015–2016. Methods: A discourse analysis and triangulation for these sources were conducted. Results: The category elaborated from nursing records was defined according to the following codes: Good Patient, Bad patient, and Social Problem. Analysis of the interviews resulted in a category defined as Patient as a passive object. Discussion: A good nurse-patient relationship reduces the days of hospital stay and improves the quality and satisfaction of both. However, in contrast, the good relationship is conditioned by the patient’s submissive role. Conclusion: An equal distribution of power allows decisions about health and disease processes to be acquired by patients, autonomously, with the advice of professionals. The nurse-patient relationship should not pursue the change in values and customs of the patient, but position the professional as a witness of the experience of the health and illness process in the patient and family.

Interprofessional relationships may impact the decision making of patients in a clinical setting. The objective of this study was to analyse the decision-making capabilities of patients from nurses’ perspectives of interprofessional relationships using Foucauldian ethics. This qualitative study was based on poststructuralist Foucault references with in-depth interviews of nurses working in internal medicine and specialties in a general hospital. The patients constantly appeared in the definition of teamwork, but also as a passive element used by every professional to communicate with others. Nurses continue modelling a type of patient passivity, or what Foucault called passive subjectivity in relation to oneself, because the patient is guided and directed to take charge of a truth provided by professionals. Nurses must break the rigid design of sections or professional skills, and adopt a model of teamwork that meets the needs of the patient and increases their decision-making power. The quality of care will increase to the extent that professionals establish a relationship of equality with the patient, allowing the patient to make real decisions about their care. An egalitarian model of teamwork is beneficial to the patient, abandoning the idea of a team where the patient and family are constantly excluded from decisions about their care.

Most current management systems of healthcare institutions correspond to a model of market ethics with its demands of competitiveness. This approach has been called managerialism and is couched in terms of much-needed efficiencies and effective management of budgetary constraints. The aim of this study was to analyse the decision-making of nurses through the impact of health institution management models on clinical practice. Based on Foucault's ethical theory, a qualitative study was conducted through a discourse analysis of the nursing records in a hospital unit. The results revealed that the health institution standardises health care practice, which has an impact on professional and patient autonomy as it pertains to decision-making. The results of this research indicate that resistance strategies in the internal structures of health organisations can replace the normalisation and instrumentalisation of professional practice aimed at promoting patient self-determination. K E Y W O R D Sbioethics, Foucault, health system, personal autonomy, professional practice

It is currently acknowledged that older people prefer to live in their own home, even if they are lonely or disabled in some way. The factors that condition aging among older people members of the population living alone include the following: the existence or absence of a social network, gender, the home or place where they live, their capacity to function, and welfare and health resources. The main goal of this study was to explore the perceptions of older peoples over 75 years old about adaptation strategies and the social, gender, physical autonomy, and socio-health resource factors that determine their permanence at home. The authors used a qualitative methodology, within a critical social framework, based on the theories of Pierre Bourdieu. When the interviewees’ discourse was analyzed, four main categories were evident: (a) “A desire to stay at home”, (b) “Changes and every-day aspects of domestic life”, (c) “Reliance on social and family assistance”, and (d) “The use of social services and resources”. In synthesis, the participants questioned the benefits of the type of home life offered by members of the family. They believed that, in some cases, this option did not overcome the problem of loneliness or the need to hire assistance. The findings of the study revealed that one needs to dispel the notion of geriatric care as a form of charity, and to distinguish between the activities of caring, providing support, and offering companionship to someone. It is important to identify products designed for older people who might live for a long time.

ObjectiveThis study aimed to assess the attitudes and beliefs of Spanish families regarding their elderly family members aged 75 years and over who live alone, with consideration of gender and educational differences among the family members.MethodsThis qualitative study was based on the critical social paradigm, the theory of constructivist structuralism and Bourdieu’s theory of sociology of action. Four discussion groups were created with the following distribution of family members based on their gender and educational level: women with higher education, women with basic or secondary education, men with higher education and men with basic or secondary education. Participants were selected using purposive and snowball sampling. Announcements inviting voluntary participation were posted at primary health care facilities, social centres and neighbourhood associations in Mallorca, Spain.ResultsAnalyses of the group discussions and a field journal revealed that families believe that elderly individuals prefer to live alone to retain their freedom and individual identities.ConclusionsFamilies held two main views regarding elderly individuals living alone: a more traditional one in which elderly care is considered a moral duty associated with women, and a more modern view in which elderly care is considered a personal option that can be delegated. Sociomedical resources were considered insufficient and not easily accessible.