Seymour Jane, Clark David, Hughes Philippa, Bath Peter, Beech Nicola, Corner Jessica, Douglas Hannah-Rose, Halliday Deborah, Haviland Jo, Marples Rachael, Normand Charles, Skilbeck Julie, Webb Tom
Sheffield Palliative Care Studies Group, University of Sheffield, UK.
Palliat Med. 2002 Sep;16(5):386-94. doi: 10.1191/0269216302pm586oa.
The remit and boundaries of the Macmillan Nursing role in the UK have been called into question recently by a number of policy-driven changes. The rapid appointment of tumour site-specific nurses and the development of posts for palliative medicine, stemming originally from the Calman-Hine recommendations for reorganizing cancer services, have created unparalleled challenges of adaptation to new working practices and procedures. The extent to which Macmillan Nurses are adapting to these new demands was addressed as part of a major evaluation study of UK Macmillan Nursing in 12 sites commissioned by the UK charity Macmillan Cancer Relief. This paper draws upon semi-structured interviews with Macmillan Nurses (n = 44) and their key colleagues (n = 47). We found that differences of expectation between Macmillan Nurses and their managers about the appropriate focus of their work lead to problems of role ambiguity and role conflict; that Macmillan Nurses lack resources with which to develop an educative and consultative role and yet substitute for inadequacies in skills and knowledge of other health care staff; and that problems are associated in co-working with newly appointed cancer site-specific nurses and palliative medicine colleagues. Macmillan Nursing has a crucial role to play in meeting the objectives in the NHS Cancer Plan. However, in order to ensure that their expertise is used efficiently and effectively, there is an urgent need to clarify the nature and scope of the Macmillan Nurse role, to attend to issues of team working and to improve the skills of nonspecialist staff in palliative care.
近期，一系列政策驱动的变革对英国麦克米伦护士角色的职责范围和界限提出了质疑。最初源于卡尔曼 - 海因癌症服务重组建议的肿瘤部位特定护士的迅速任命以及姑息医学岗位的设立，给适应新的工作实践和程序带来了前所未有的挑战。作为英国慈善机构麦克米伦癌症救助会委托开展的一项对英国12个地点麦克米伦护理的重大评估研究的一部分，探讨了麦克米伦护士适应这些新要求的程度。本文借鉴了对麦克米伦护士（n = 44）及其关键同事（n = 47）的半结构化访谈。我们发现，麦克米伦护士与其管理者对工作适当重点的期望差异导致了角色模糊和角色冲突问题；麦克米伦护士缺乏用于发展教育和咨询角色的资源，却要弥补其他医护人员技能和知识的不足；并且在与新任命的肿瘤部位特定护士和姑息医学同事合作中存在问题。麦克米伦护理在实现国民健康服务体系癌症计划的目标方面可发挥关键作用。然而，为确保其专业知识得到有效利用，迫切需要明确麦克米伦护士角色的性质和范围，关注团队协作问题，并提高非专科医护人员在姑息治疗方面的技能。
