Clark David, Seymour Jane, Douglas Hannah-Rose, Bath Peter, Beech Nicola, Corner Jessica, Halliday Deborah, Hughes Philippa, Haviland Jo, Normand Charles, Marples Rachael, Skilbeck Julie, Webb Tom
Sheffield Palliative Care Studies Group.
Palliat Med. 2002 Sep;16(5):375-85. doi: 10.1191/0269216302pm585oa.
In the UK, the work of Macmillan clinical nurse specialists in palliative care is now well established. There has been little research, however, into the organizational context in which these nurses operate and the implications for the services they deliver. We report on a major evaluation of the service delivery, costs, and outcomes of Macmillan nursing services in hospital and community settings. The study was based on eight weeks of fieldwork in each of 12 selected services. Data are presented from semi-structured interviews, clinical records, and cost analysis. We demonstrate wide variation across several dimensions: location and context of the services; activity levels; management patterns; work organization and content; links with other colleagues; and resource use. We suggest that such variation is likely to indicate the existence of both excellent practice and suboptimal practice. In particular, our study highlights problems in how teamwork is conceptualized and delivered. We draw on recent organizational theories to make sense of the heterogeneous nature of Macmillan nursing services.
在英国，麦克米伦姑息治疗临床护理专家的工作现已得到充分确立。然而，对于这些护士开展工作的组织环境以及对其提供的服务所产生的影响，却鲜有研究。我们报告了一项对麦克米伦护理服务在医院和社区环境中的服务提供、成本及结果的重大评估。该研究基于对12项选定服务中每项服务为期八周的实地考察。数据来自半结构化访谈、临床记录及成本分析。我们展示了在多个维度上的广泛差异：服务的地点和背景；活动水平；管理模式；工作组织与内容；与其他同事的联系；以及资源利用。我们认为这种差异可能表明既存在卓越实践，也存在次优实践。特别是，我们的研究突出了团队合作在概念化和实施方式上存在的问题。我们借鉴近期的组织理论来理解麦克米伦护理服务的异质性。
