Nursing and public participation in health: an ethnographic study of a patient council.

BACKGROUND Conceptualisations of the nurse-patient relationship tend to view nursing as embodying an empowering approach to patients, one that places the service user perspective at the centre of decision-making. However, the relationship of nursing to public participation in health service planning and development has been under examined. AIMS The aim is to explore the relationship of the nursing profession to public participation as enacted through a UK-based patient and public council, located in an acute hospital. The council was developed by nursing staff and aimed to achieve service user participation in strategic level health care decision-making. The views and experiences of participants and the applicability of the 'nurse-patient partnership' construct to public participation are considered. METHODS The study employed integrative ethnography, involving multiple field methods: non-participant observation of council meetings, i.e. fourteen 3 h meetings (n=42 h); in-depth interviews with councillors (n=17) and with key hospital staff (n=18). A documentary review and mapping of the actions of the council was undertaken. RESULTS A nurse-patient partnership was not initially intrinsic to the operation of the council or embedded in the perspectives of the nurse or patient participants. Professional vulnerability and the organisational context constrained the nursing response. Councillors and nursing staff moved to create a shared set of understandings in order to progress change in service organisation and delivery. Nurses' repositioning vis-à-vis the credibility of user experiences and status was central to the effective progression of the council. CONCLUSIONS Partnership in public participation requires a shift by nurses' towards acceptance of members of the public functioning as informed, critical and powerful agents in health care decision-making. Equipping nurses with the skills to communicate with patient representatives in a position of interactional equality is likely to be a pre-requisite for successful engagement by nursing with public participation.