Norwegian study identifies structural and cultural barriers to patient involvement in nursing education

A recent qualitative study published in BMC Medical Education explores the complex dynamics surrounding the integration of patients and family members into undergraduate nursing education in Norway. The research, led by Catrine Buck Jensen and colleagues, investigates why active patient involvement remains inconsistent despite the growing recognition of its value in enhancing patient-centered care. The study highlights that while the potential benefits of including lived experience in health professions education are widely acknowledged, the practical implementation faces significant hurdles that prevent it from becoming a standard component of nursing curricula.

The study was conducted using a collaborative research methodology that emphasized co-creation and multiple perspectives. The research team organized three digital workshops and one co-creation workshop to gather insights from a diverse group of stakeholders. Participants included six nurse educators, three senior nursing students, and six patients or family members. This mixed-group approach allowed the researchers to examine the issue from the viewpoints of those who teach, those who are being taught, and those whose experiences are intended to be shared within the educational setting.

One of the primary findings identified by the researchers was a pervasive hesitation toward experiential knowledge, which was described as a fundamental barrier to effective patient involvement. Participants in the workshops highlighted a perceived hierarchy within the educational environment that tends to undervalue the expertise derived from personal health experiences. This cultural dynamic creates an atmosphere where patient knowledge is not always seen as equivalent to academic or clinical knowledge, making it difficult to integrate patient voices into the formal curriculum in a meaningful way.

The study also pointed to a significant lack of formal requirements, systems, and structures as a major limitation. In Norway, there are currently no mandatory regulations requiring patient involvement in nursing education. Consequently, the inclusion of patients often depends on the individual initiatives and enthusiasm of specific educators rather than being embedded in the institutional framework. This reliance on individual effort leads to an inconsistent implementation across different programs and institutions, leaving many students without regular exposure to patient perspectives during their training.

Training and competency development emerged as a dual factor, serving as both an enabler and a barrier. Participants emphasized that for patient involvement to be effective, both the patients or family members and the educators need specific training. Without proper preparation, patient contributors may feel ill-equipped to share their experiences in an educational context, while educators may lack the skills to facilitate these interactions in a way that is respectful and pedagogically sound. The study suggests that developing faculty development programs and training for patient contributors is essential to ensure that these interactions are meaningful and beneficial for all parties involved.

The researchers noted that addressing what they termed epistemic injustice is critical for advancing patient involvement in health professions education. Epistemic injustice refers to the unfair treatment of individuals as knowers, where their knowledge is dismissed or undervalued. By fostering a culture that genuinely values experiential knowledge alongside academic expertise, nursing programs can create a more inclusive and effective learning environment. This cultural shift is seen as a prerequisite for structural changes to have a lasting impact on how nursing education is delivered.

The study underscores the need for structural changes in Norwegian nursing education to move beyond ad-hoc initiatives. The authors argue that formal requirements for patient involvement should be established to ensure consistency and equity across all programs. Additionally, the development of robust systems to support these interactions is necessary to reduce the burden on individual educators. By institutionalizing patient involvement, the education system can better prepare future nurses to engage with patients as partners in their care, rather than merely as recipients of treatment.

The findings of this study contribute to the broader discourse on patient-centered education in healthcare. By identifying specific barriers and enablers, the research provides a roadmap for educators and policymakers seeking to improve the integration of patient perspectives into nursing curricula. The collaborative nature of the study itself serves as a model for how such changes can be developed, involving all relevant stakeholders in the process of defining and implementing new educational practices. The results suggest that while challenges exist, they are not insurmountable, and with deliberate effort, patient involvement can become a standard and valued part of nursing education.

As the field of health professions education continues to evolve, the emphasis on patient-centered care is becoming increasingly prominent. This study highlights that achieving this goal requires more than just a change in attitude; it demands structural and cultural transformation. By addressing the identified barriers and leveraging the enablers, nursing programs in Norway and potentially other countries can enhance the quality of their education and better prepare graduates to meet the needs of the patients they will serve. The study serves as a call to action for educators to move beyond passive waiting and actively shape the future of nursing education through inclusive and collaborative practices.

Subject of Research: Nursing Education

Article Title: “We cannot sit and wait for these things to happen by themselves”: a qualitative study of barriers and enablers for active patient involvement in Norwegian undergraduate nursing education

Article References: Jensen, C. B., Karlsson, B. E., Oterholt, F., Fangen, K., & de Presno, Å. K. (2026). “We cannot sit and wait for these things to happen by themselves”: a qualitative study of barriers and enablers for active patient involvement in Norwegian undergraduate nursing education. BMC Medical Education. https://doi.org/10.1186/s12909-026-10498-y

Image Credits: AI Generated

DOI: 10.1186/s12909-026-10498-y

Keywords: Nursing Education, Patient Involvement, Health Professions Education, Qualitative Research, Norway, cannot, wait, things, happen, themselves, qualitative, barriers