Diversity and Scope of Senior Nurses’ Informal and Formal Experiences of Patient and Public Involvement in England


Patient and public involvement (PPI) has been recognized internationally. In England, NHS policies have increasingly emphasized the importance of patient-centered services, but limited evidence exists about the implementation of PPI policies and strategies within organizations. Few studies have explored health professionals perceptions of PPI and comparatively little is known about the experience of senior nurses. A national consultation utilising three focus groups aimed to explore senior nurses’ PPI experience. 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. Focus groups were digitally recorded and transcribed verbatim; anonymised transcripts were validated by participants and analysed with thematic analysis. Sixteen categories emerged within five sub-themes of PPI experience: provision of information and raising awareness (1 category), informal generic PPI-activities not perceived as PPI (3 categories), formal generic PPI (3 categories), involvement of specific groups (5 categories) and PPI in commissioning and strategy (4 categories). Findings provided new insights into senior nurses’ experiences and evidence that progress towards meaningful, effective PPI remains slow. Nurses performed PPI in a pragmatic sense, by virtue of the nature of nursing, but they did not recognise or label these activities as such. However, a plethora and variety of innovative activities formally recognised as patient and public involvement were undertaken, together with specific networks and groups’ involvement, and involvement linked to commissioning and strategy. Enhancing awareness of nurses through education, together with monitoring and feedback mechanisms could support the PPI implementation and effectiveness at organisations.

Share and Cite:

Boudioni, M. and McLaren, S. (2014) Diversity and Scope of Senior Nurses’ Informal and Formal Experiences of Patient and Public Involvement in England. Open Journal of Nursing, 4, 198-210. doi: 10.4236/ojn.2014.43024.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] World Health Organisation (1986) Ottawa Charter for Health Promotion. The Move towards a New Public Health. WHO, Ottawa.
[2] World Health Organisation (1997) The Jakarta Declaration on Leading Health Promotion into the 21st Century. 4th International Conference on Health Promotion. WHO, Jakarta. www.who.int/hpr/NPH/docs/jakara_declaration_en.pdf.
[3] World Health Organisation (2009) The European Health Report 2009: Health and Health Systems. WHO Regional Office for Europe, Copenhagen.
[4] Fallberg, L. and Mackenney, S. (2004) Conclusion. In: Mackenney, S. and Fallberg, L., Eds., Protecting Patients’ Rights? A Comparative Study of the Ombudsman in Healthcare, Radcliffe, Oxon.
[5] Department of Health (2003) Strengthening Accountability: Involving Patients and the Public. DH, London.
[6] Department of Health (Farrell, C.) (2004) Patient and Public Involvement in Health: The Evidence for Policy Implementation. DH, London.
[7] Department of Health (2004) “Getting over the Wall” How the NHS Is Improving the Patients’ Experience. DH, London.
[8] Department of Health (2010) Equity and Excellence: Liberating the NHS. The Stationary Office, London.
[9] Department of Health (2007) World Class Commissioning: Vision Summary. DH, London.
[10] Department of Health (2008) High Quality Care for All: NHS Next Stage Review Final Report. DH, London.
[11] Kelson, M. (1997) User Involvement: A Guide for Developing Effective User Involvement Strategies in the NHS. College of Health, London.
[12] Involve (2005). People & Participation: How to Put Citizens at the Heart of Decision-Making. Involve, London.
[13] International Association for Public Participation (2007) The Spectrum of Public Participation.
[14] Department of Health (2008) Real Involvement: Working with People to Improve Services. DH, London.
[15] Coulter, A. and Ellins, J. (2006) Patient Focused Interventions: A Review of Evidence. Quest for Quality and Improved Performance (QQUIP). The Health Foundation, London.
[16] Coulter, A. and Ellins, J. (2007) Effectiveness of Strategies for Informing, Educating and Involving Patients. British Medical Journal, 335, 24-27. http://dx.doi.org/10.1136/bmj.39246.581169.80
[17] Nilsen, E.S., Johansen, M., Oliver, S. and Oxman, A.D. (2010) Methodological Considerations Involved in Developing Healthcare Policy and Research, Clinical Practice Guidelines and Patient Information Material. Cochrane Collaboration, John Wiley & Sons, New Jersey.
[18] Sang, B. (2009) Chapter 22. User Involvement: The Involved and Involving Community Health Care Nurse. In: Sines D., Saunders, M. and Forbes-Burford, J., Eds., Community Health Care Nursing, Wiley-Blackwell, Oxford, 352-362.
[19] National Centre for Involvement (2007) A Baseline Assessment of the Current State of Patient and Public Involvement in English NHS Trusts. NCI, Warwick.
[20] National Centre for Involvement (2008) The Current State of Patient and Public Involvement in NHS Trusts across England; Findings of the National Survey Full Report. NCI, Warwick.
[21] Picker Institute Europe (2007) Patient and Public Involvement in Primary Care Commissioning. Picker Institute Europe, Oxford.
[22] National Audit Office (2007) Improving Quality and Safety Progress in Implementing Clinical Governance in Primary Care: Lessons for the New Primary Care Trusts. The Stationery Office, London.
[23] Healthcare Commission (2009) Listening, Learning, Working Together? A National Study of How Well Healthcare Organisations Engage Local People in Planning and Improving their Services. Commission for Healthcare Audit and Inspection, London.
[24] Chishold, A., Redding, D., Cross, P. and Coulter, A. (2007) Patient and Public Involvement in PCT Commissioning: A Survey of Primary Care Trusts. Picker Institute Europe, Oxford.
[25] Fudge, N., Wolfe, C.D.A. and McKevitt, C. (2008) Assessing the Promise of User Involvement in Health Service Development: Ethnographic Study. British Medical Journal, 336, 313-318.
[26] Picker Institute Europe (2009) Patient and Public Engagement. The Early Impact of World Class Commissioning: A Survey of Primary Care Trusts. Picker Institute Europe, Oxford.
[27] Boudioni, M. and McLaren, S. (2009) Nurses and Patient and Public Involvement: A Consultation in Four Strategic Health Authorities in England. London South Bank University, London.
[28] Boudioni, M. and McLaren, S. (2013) Challenges and Facilitators for Patient and Public Involvement in England; Focus Groups with Senior Nurses. Open Journal of Nursing, 3, 472-480. http://dx.doi.org/10.4236/ojn.2013.37064
[29] Barbour, R.S. and Kitzinger, J. (1998) Developing Focus Group Research: Politics, Theory and Practice. Sage, London.
[30] Darlington, Y. and Scott, D. (2002) Qualitative Research in Practice: Stories from the Field. Open University Press, Buckingham.
[31] Boyatzis, R.E. (1998) Transforming Qualitative Information: Thematic Analysis and Code Development. Sage, London.
[32] Braun, V. and Clarke, V. (2006) Using Thematic Analysis in Psychology. Qualitative Research in Psychology, 3, 77-101. http://dx.doi.org/10.1191/1478088706qp063oa
[33] Richards, N. and Coulter, A. (2007) Is the NHS Becoming More Patient-Centred? Trends from the National Surveys of NHS Patients in England 2002-2007. Picker Institute, Oxford.
[34] Coulter, A. and Magee, H. (2004) United Kingdom. The European Patient of the Future. Open University Press, Berkshire.

Copyright © 2023 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.