ABSTRACT
The
concepts of patient and public involvement (PPI) have been recognized and
linked with quality in health services internationally and in Europe. In
England, for more than a decade, NHS policies have increasingly quoted
patient-centred services. Limited evidence exists about the implementation of
PPI policies and strategies within organisations; three studies only have
explored health professionals’ perceptions of PPI. Although nurses’ positive
support for patient and public involvement has been noted, comparatively little
is known about senior nurses’ experiences of embedding PPI. A national
consultation utilising three focus groups aimed to explore senior nurses’
perceptions of challenges and facilitators for PPI implementation. Four Strategic Health Authorities (SHAs) and eleven
Primary Care Trusts (PCTs) in England, with fifteen senior nurses with
leadership roles and direct PPI experience, participated. Nurses’ perceptions
on patient and public involvement, challenges and facilitators for its
implementation were discussed. Focus groups were digitally recorded and
transcribed verbatim; anonymised transcripts were validated by participants and
analysed with thematic analysis. Limited resources, patient representation and
recruitment, complexities of implementing PPI and national policy changes
were challenging. Commissioning limitations, lack of feedback on patient
experience, limited staff awareness, negative attitudes, management of
patients and public expectations constituted further challenges. Nursing role
characteristics and informal involvement activities, PPI policy and cultural
change, commissioning PPI competencies, related service frameworks, providing
feedback on patient experiences to staff and recognition of involvement
benefits were recognised as facilitators. Findings provided new insights into
senior nurses’ experiences
and evidence that progress towards meaningful, effective PPI remains slow.
However, recognition of existing nursing role characteristics and potential
delivery problems created by expanded nursing roles, informal PPI practice
and internal organisational sharing of patient feedback may bring an “emerging
productive partnership” with nurses enabling and contributing to effective
PPI.