Willard Carole, Luker Karen
School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK.
J Clin Nurs. 2007 Apr;16(4):716-24. doi: 10.1111/j.1365-2702.2006.01560.x.
This paper describes the strategies used by cancer nurse specialists in the UK to implement their role within the multiprofessional team.
The prevalence of cancer increasingly preoccupies the developed world causing concern about the effective use of healthcare resources. The demand to contain healthcare costs and meet the complex needs of patients has led to the development of new and different types of nurse specialist roles. In the UK, these initiatives have been supplemented by reorganizing cancer services to ensure care is delivered by collaborative multiprofessional teams: nurse specialists are considered core team members. While role ambiguity and conflict are acknowledged as barriers to the successful introduction of new roles, little is known about the strategies used by individuals to facilitate role implementation.
A grounded theory design using purposive and theoretical sampling.
Twenty-nine cancer nurse specialists from five hospitals participated in observation and semistructured interviews. The data were analysed concurrently using the constant comparative method.
Acceptance, especially by doctors, was the main problem facing cancer nurse specialists. In addition, they experienced insufficient organizational support for their role. Difficulties with acceptance impaired nurses' ability to provide supportive care to cancer patients. Nurse specialists responded by employing several strategies including building relationships and establishing role boundaries.
Some strategies used by nurse specialists are more successful than others in facilitating role implementation. While recommendations exist to assist the introduction of new roles in practice, their implementation by healthcare organizations may be limited. Future approaches should focus on helping nurses develop awareness of the problems they face, why they arise and effective mechanisms for their resolution.
The findings highlight the mismatch between cancer policy aspirations and reality and the actions taken by nurse specialists to overcome the problems they encounter.
本文描述了英国癌症专科护士在多专业团队中履行其职责所采用的策略。
癌症的流行日益困扰着发达国家，引发了对医疗资源有效利用的关注。控制医疗成本和满足患者复杂需求的要求促使了新型且不同类型的专科护士角色的发展。在英国，这些举措因癌症服务的重组而得到补充，以确保由多专业协作团队提供护理：专科护士被视为核心团队成员。虽然角色模糊和冲突被认为是成功引入新角色的障碍，但对于个人用于促进角色履行的策略却知之甚少。
采用目的抽样和理论抽样的扎根理论设计。
来自五家医院的29名癌症专科护士参与了观察和半结构化访谈。使用持续比较法对数据进行同步分析。
尤其是来自医生的认可，是癌症专科护士面临的主要问题。此外，她们在履行职责时还经历了组织支持不足的情况。认可方面的困难削弱了护士为癌症患者提供支持性护理的能力。专科护士通过采用多种策略做出回应，包括建立关系和确立角色界限。
专科护士采用的一些策略在促进角色履行方面比其他策略更成功。虽然有建议协助在实践中引入新角色，但医疗保健组织对这些建议的实施可能有限。未来的方法应侧重于帮助护士认识到她们面临的问题、问题产生的原因以及解决问题的有效机制。
研究结果凸显了癌症政策期望与现实之间的差距，以及专科护士为克服所遇到问题而采取的行动。
