Aranda Kay, Jones Andrea
University of Brighton, East Sussex, UK.
Nurs Inq. 2008 Mar;15(1):3-10. doi: 10.1111/j.1440-1800.2008.00393.x.
Attempts to 'modernize' the English National Health Service (NHS) have included significant workforce re-design, including the development of new, advanced roles in nursing. There is a wealth of evidence documenting and evaluating such roles in hospital and, to a lesser extent, in community settings. This paper builds on this work, drawing on recent post structural and sociological analyzes to theorize these roles, locating them within broader social and cultural changes taking place in healthcare and exploring how understandings of new roles in community nursing are in the process of being constructed. Building on a literature review, the paper draws out what an analysis of new advanced nursing roles in the community reveals about competing conceptualizations of the nursing mandate, the ambivalence and ambiguity that practitioners experience in shaping 'new' identities (the shaping of subjectivities), and the often implicit ideological positions that underpin such developments.
对英国国民医疗服务体系（NHS）进行“现代化”的尝试包括对劳动力进行重大重新设计，其中包括在护理领域发展新的高级角色。有大量证据记录和评估了这些角色在医院环境中的情况，在社区环境中的相关证据则相对较少。本文基于这项工作，借鉴近期的后结构主义和社会学分析，对这些角色进行理论化，将其置于医疗保健领域正在发生的更广泛的社会和文化变革之中，并探讨社区护理新角色的理解是如何在构建过程中的。在文献综述的基础上，本文揭示了对社区新高级护理角色的分析所揭示的关于护理使命的相互竞争的概念化、从业者在塑造“新”身份（主体性的塑造）过程中所经历的矛盾心理和模糊性，以及支撑此类发展的往往隐含的意识形态立场。
