Faculty of Health and Social Care, Kingston University and St. George's University of London, London, UK.
J Clin Nurs. 2011 Oct;20(19-20):2948-57. doi: 10.1111/j.1365-2702.2010.03643.x. Epub 2011 Apr 26.
To examine the factors affecting the extent to which English policy on the introduction of community matrons for people with chronic conditions was implemented.
Improving health services for people with chronic diseases (long-term conditions) is an international priority. In England, the new post of community matron, a case management role, was introduced. A target was set for 3000 community matrons to be in post by 2008, but this was not achieved.
A realist, pragmatic evaluation of the introduction of community matron posts.
The study used mixed methods at multiple levels: an analysis of national and local strategy and planning documents, a national survey and a stakeholder analysis using semi-structured interviews in three primary care organisation case study sites.
National policy established targets for the introduction of community matron posts, but there was local variation in implementation. Pragmatic decisions reflected the history of local service configurations, available finance, opportunities or challenges created by other service redesigns and scepticism about the value of the community matron role. There was resistance to 'bolt on' nursing roles in primary care.
The implementation of the community matron role is an example of how a policy imperative that valued the clinical skills and expertise of nurses was reinterpreted to fit with local patterns of service delivery. Before new nursing roles are introduced through national policies, a more nuanced understanding is required of the local factors that resist or support such changes.
There is a need for consultation and understanding of local conditions before the implementation of workforce initiatives. For clinicians, it is important to understand how the context of care shapes priorities and definitions of new nursing roles and how their expertise is recognised and used.
研究影响引入社区护士长为慢性病患者提供服务的政策实施程度的因素。
改善慢性病患者的卫生服务是国际优先事项。在英国，引入了社区护士长这一新的病例管理角色。设定了到 2008 年有 3000 名社区护士长上岗的目标，但并未实现。
对引入社区护士长岗位的实际情况进行务实评估。
该研究采用了多层面的混合方法：对国家和地方战略规划文件进行分析，进行全国性调查，并在三个初级保健组织案例研究地点使用半结构化访谈进行利益相关者分析。
国家政策为引入社区护士长岗位设定了目标，但实施情况存在地方差异。务实的决策反映了当地服务配置的历史、可用资金、其他服务重新设计带来的机会或挑战，以及对社区护士长角色价值的怀疑。在初级保健中抵制“附加”护理角色。
社区护士长角色的实施是一个例子，说明如何重新解释重视护士临床技能和专业知识的政策要求，以适应当地的服务提供模式。在通过国家政策引入新的护理角色之前，需要更细致地了解抵制或支持此类变革的地方因素。
在实施劳动力计划之前，需要进行协商并了解当地情况。对于临床医生来说，重要的是要了解护理环境如何塑造新护理角色的优先事项和定义，以及他们的专业知识如何得到认可和利用。
