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The participation of service users and the public in the development of clinical guidelines is increasingly valued in international guideline programmes. This paper extends the findings of Harding et al.'s (2010) exploration of the views of service users who participated in developing NICE mental health guidelines. This analysis considered the relative value of personal versus professional knowledge and experience, the barriers to service users contributing effectively in guideline development, the unspoken 'rules' concerning decision making, and issues of power and group dynamics. We combine these insights with observations from research in guideline development and with advances in the recovery movement and in the shared decision-making clinical model to suggest areas of improvement in guideline development, notably: translating evidence to recommendations, optimizing the acceptability of treatment recommendations to service users, and reconciling different types of knowledge. [ABSTRACT FROM AUTHOR]

Background and aims: Although the National Institute of Health and Clinical Excellence (NICE) mandates service user involvement in developing treatment guidelines, questions arise concerning appropriate mechanisms of involvement and its impact. This study sought to elicit users' perceptions of their involvement. Method: Grounded theory was used to analyse transcripts from interviews with 10 service user guideline development group representatives. Results: Four categories emerged suggesting that participants drew upon expertise developed through experience and impact upon the process and product of guideline development. Unwritten rules and social comparisons influence deliberations. Conclusions: Service users reported making a useful contribution despite intrinsic barriers. [ABSTRACT FROM AUTHOR]

‘Your ears become your eyes’: managing the absence of visibility in NHS Direct Aims. To identify and describe nurses’ perceptions of interactional practices they use to manage the absence of visual cues in telephone consultations with callers at an NHS Direct site. Background. A routine activity in telephone consultations is visualizing the patient and the situation from which the call is made, that is, ‘building a picture of the patient’. Little is known about interactional practices between nurse and caller that contribute to shaping a conception of the caller, or other activities that nurses do to manage the absence of visibility in the consultation. Methods. Qualitative analysis of semi-structured interviews conducted with nurses new to NHS Direct telephone consultations, the first immediately prior to the NHS Direct site’s opening, and the second 6 months later. Findings. The activity of visualizing patients and their environment is closely linked to interactional practices carried out between nurse and caller. Nurses described a range of interactional activities that they perceive help callers to describe with more precision what the nurse cannot see. Nurses also tailor interaction to a nonvisual environment in order to manage the more emotional aspects of telephone consultations, such as delivering information, advice, reassurance, and building trust and rapport. Conclusions. Nurses developed skills to manage interaction with callers in order to compensate for the absence of visibility. Skills were based on their professional backgrounds and experience and developed in an ad hoc way. Further research could examine the efficacy of these strategies, and be a prerequisite to adding them to training programmes. [ABSTRACT FROM AUTHOR]