The impact of contextual factors on nursing outcomes and the role of placebo/nocebo effects: a discussion paper

INTRODUCTION: Placebo and nocebo effects represent one of the most fascinating topics in the health care field. OBJECTIVES: the aims of this discussion paper were (1) to briefly introduce the placebo and nocebo effects, (2) to elucidate the contextual factors able to trigger placebo and nocebo effects in the nursing field, and (3) to debate the impact of contextual factors on nursing education, practice, organisation, and research. METHODS: a narrative review was conducted based on the available evidence. RESULTS: Placebo responses (from Latin “I shall please”) are a beneficial outcome(s) triggered by a positive context. The opposite are the nocebo effects (from Latin “I shall harm”), which indicates an undesirable outcome(s) caused by a negative context. Both are complex and distinct psychoneurobiological phenomena in which behavioural and neurophysiological changes arise subsequent to an interaction between the patient and the health care context. CONCLUSION: Placebo and nocebo concepts have been recently introduced in the nursing discipline, generating a wide debate on ethical issues; however, the impact on nursing education, clinical practice, nursing administration, and research regarding contextual factors triggering nocebo and placebo effects has not been debated to date.