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Pre-determined programme EssayThe relationship formed by nursing professionals with those who utilized healthcare wait ons goes a long itinerary in determining how satisfactory the users are. The nurses are in direct contact with patients and users of healthcare services, more often than the doctors are. They carry egress the administration of drugs convinced(p) by doctors and go the whole length of checking the condition of the patients and acting as an intermediary between the doctor and the patients.Thus, this prominent role goes a long way to determine the level of satisfaction that is derived by users of healthcare services. It is argued that it is spirit that cure not the administration of medicine medicine gives relief and leaves the curative process for nature to handle. Nurses tend to handle patients and be close to them to help the curative process through nature to take place. According to Mckenna (1997), Nurses could be actively involved in this process of putt ing the patients in the best condition for nature to act upon him if given appropriate training.With the aid of the service users, nurses would be able to manage more effectively in the professional duties of assisting patients to be in the right condition for the curative process to take place through nature. Effective elaborateness in healthcare service requires looking beyond national institutions to enhancing the capacities of citizens to influence supranational, as well as national policy on health.Croft Beresford (1996), point out a more radical version of peoples participation, one that would go beyond the more paternalistic versions of welfare state and the narrow consumerist approaches to users involvement. emergence from the struggles of the disability rights movement and another(prenominal)s, this approach began to talk about participation not only in terms of having a say and being involved in the delivery of existing programmes, but also about more active participa tion in provisioning and in policy construction.This approach sees the users as having fundamental claims to polished rights rather than being subjected to the discretion of the amicable service producer. In recent times, there has been a convergence of concern with citizen engagement in policy formulation and implementation and with good institution, broadening political participation to include a search for freshly, more direct, ways through which citizens may influence governments and hold them accountable (Gaventa Valderama, 1999).During the late 1960s, and the 1970s, there was a growing demand in many parts of the world for citizens to be involve in decision-making processes which affected their lives, including in the affectionate policy arena. The form of participation that emerged focused largely on establishing, consultative mechanisms, often in the form of user committees. The spread of this new approach was rapid and far-reaching. Citizens became involve in thous ands of community health councils, parents committees in schools, tenant councils, and countless other beneficiary committees.(Cornwall Gaventa, 19995) By participating in decision, making pertaining to the provision of social services citizens uses this medium as an avenue to seek responsibility from those representing them in a democratic government. By seeing themselves as actors rather than simply peaceful beneficiaries, user group may be more able to assist their citizenship in a third sense through seeking greater accountability from service providers. One form of greater accountability is through increased dialogue and consultation of its leaders with forum of user involvement.In this avenue, questions can be raised to the extent to which any group is being marginalized and ways to articulate their concerns and this will determine the form that the dialogue takes (ibid 10). According to Gaventa Valderama (1999), increasingly discussion of governance and accountability focu s on forms of broader interaction of public and private social actors, especially at the local level. Citizen participation in this sense involves direct ways in which citizens influence and exercise control in governance, not only through the more traditional forms of indirect representationCitizen participation in service delivery in healthcare has increasingly been used to enable citizens to express their concerns more directly to those with the power to influence the policy process. While a deed of participatory methods focus on enhancing direct participation of citizens in the governance process, others are focusing on maintaining accountability of elected officials and government agencies to the citizenry, through new forms of citizen monitoring and evaluating (Cornwall Gaventa, 1999)Citizenship participation in decision of healthcare service avail them the opportunity in demanding and negotiating directly with government for greater performance and accountability other than they relying on self-provisioning through civil society. Through such participation, users of services can potentially shape social policy not only as beneficiaries or consumers in pre-determined programmes, but as citizens exercising rights of agency, voice and participation (ibid 18).