Kaufman Gerri
University of Huddersfield, Queensgate, West Yorkshire HD1 3DH, UK.
J Nurs Manag. 2002 Mar;10(2):83-94. doi: 10.1046/j.0966-0429.2001.00289.x.
This study set out to investigate nurses', doctors' and managers' perceptions of the nursing contribution to commissioning in primary health-care.
The study was undertaken in the light of the proposal in the government's White Paper The new NHS, Modern, Dependable that community nurses should play a lead role in commissioning health services as members of the new primary care groups.
Semistructured taped interviews were conducted, with seven community nurses, two community midwives, seven managers and four general practitioners, covering three geographical locations in the UK. The data were transcribed and analysed using a template approach, where text is analysed through the use of an analysis guide, or codebook, consisting of categories, or themes, relevant to the research questions.
The main themes to emerge were that nurses had an important contribution to make to commissioning on the basis of their clinical knowledge, their awareness of health need and their knowledge of health promotion. Additionally, the ability of nurses to negotiate at different levels across professional groups and with the public was perceived as an important skill in a commissioning role. However, findings also indicated that nurses need additional knowledge and skills if they are to perform their role effectively. Being sidelined from the commissioning arena, poor interprofessional collaboration and the potential for resistance from some general practitioners and managers were identified as constraints on the nursing contribution to commissioning. Combining clinical caseloads with commissioning responsibilities and a lack of support systems for nurses in commissioning were also identified as constraints.
Nurses' commissioning-related knowledge and skills will have to be developed and constraints on the commissioning role of nurses challenged if the perspectives and values of nursing are to help to reshape our healthcare system.
本研究旨在调查护士、医生和管理人员对初级卫生保健中护理工作在委托服务方面贡献的看法。
本研究是根据政府白皮书《新国民健康服务体系，现代、可靠》中的提议开展的，该提议指出社区护士应作为新的初级保健团体成员，在委托卫生服务方面发挥主导作用。
进行了半结构化录音访谈，访谈对象包括7名社区护士、2名社区助产士、7名管理人员和4名全科医生，覆盖英国的三个地理位置。数据采用模板分析法进行转录和分析，即通过使用由与研究问题相关的类别或主题组成的分析指南或编码手册来分析文本。
出现的主要主题是，护士凭借其临床知识、对健康需求的认识以及健康促进知识，对委托服务能做出重要贡献。此外，护士在不同专业群体之间以及与公众进行不同层面协商的能力，被视为在委托服务角色中的一项重要技能。然而，研究结果还表明，护士若要有效履行其职责，还需要更多知识和技能。被排除在委托服务领域之外、跨专业协作不佳以及一些全科医生和管理人员可能存在的抵触情绪，被确定为护理工作在委托服务方面贡献的制约因素。将临床工作量与委托服务职责相结合以及在委托服务方面缺乏对护士的支持系统，也被确定为制约因素。
如果要借助护理的观点和价值观来重塑我们的医疗体系，就必须发展护士与委托服务相关的知识和技能，并应对护士委托服务角色所面临的制约因素。
