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Patient focus

This section covers the many ways that people can engage in their own health and help design health systems. Here are four areas. 

Service design – the care environment can influence people’s experience of services. Changing aspects of the service can improve dignity or provide people with better control over a situation. Patients, families, carers and staff can use a design method such as Experience Based Co-design to achieve better care. Dr Caroline Shuldham, Director of Nursing, introduced this method at the Royal Brompton and Harefield NHS Trust to improve ITU and lung cancer services.

Process design – we can improve care by looking at processes such as drug rounds, mealtimes, home visits. This may mean reviewing roles, data use or the sequence in which actions occur. The RCN published a joint report with the RCP about addressing shortcomings of traditional ward rounds. Structured interdisciplinary bedside rounds offer an alternative approach (RCP, RCN 2012).

Feedback/feedforward – systems need continuous feedback in order adjust how they perform. Michelle McLoughlin, Birmingham Children’s Hospital Chief Nurse, introduced an app that enables families to give feedback. Their anonymous comments go directly to the manager in charge.

Participatory health and patient activation – participatory health refers to a person provider partnership based on mutually acknowledged expertise. Patient activation describes the knowledge, skills and confidence a person has in managing their own health (Hibberd and Gilburt 2014). A recent study (Armstrong et al 2015) shows how NHS projects promoted this e.g. NHS Somerset CCG working with people on diabetes self management and those living with long term conditions.


Armstrong N et al (2015) Independent evaluation of the feasibility of using the Patient Activation Measure in the NHS in England Early findings. NHS England.

Hibberd J, Gilburt H (2014) Supporting people to manage their health. An introduction to patient activation. London: King’s Fund.

Royal College of Physicians, Royal College of Nursing (2012) Ward rounds in medicine: principles for best practice. London: RCP.

RCN support

Principles of Nursing Practice. The Principles of Nursing Practice describe what everyone can expect from nursing practice whether colleagues, patient, their families or carers. They provide a framework for quality improvement initiatives. Principle A focusses on dignity, equality and diversity, and humanity. Principle D encompasses themes of advocacy, empowerment, patient-centred care, and patient involvement in their care. 

Safeguarding. Safeguarding is relevant to all of nursing practice, in all settings, whether with children or adults. As a nurse, midwife, health visitor or HCA you are responsible for safeguarding those in your care and you must respond to any safeguarding concerns. The RCN has published safeguarding guidance for adults and children and young people.

Looking for articles and books on this topic?

The RCN library and heritage services provides books, e-books and e-journals on this topic.