MacDonald L D, Addington-Hall J M, Anderson H R
Department of Public Health Sciences, St George's Hospital Medical School, University of London, England.
J Adv Nurs. 1994 Aug;20(2):337-43. doi: 10.1046/j.1365-2648.1994.20020337.x.
As part of a randomized controlled trial of a new district co-ordinating service for the care of terminally ill cancer patients, the activities of the nurse co-ordinators and the acceptability and perceived effectiveness of the service were assessed. Co-ordinators' activities were self-recorded; professional caregivers completed a postal questionnaire; and family carers were interviewed at home. Thirty-eight per cent of patients allocated to the co-ordinators were not visited at home. Overall, 41% of professionals had heard of the co-ordinating service and 20% had been contacted. A third of relatives, whether allocated or not to the co-ordinating service, felt that terminal care of their patient was not well co-ordinated and that they did not know how to get the help they needed for their dying relative. It may be that the nurse co-ordinators were unwilling or unable to relinquish their skills in order to provide a 'broker' style of co-ordination. Perhaps less skilled co-ordinators would have been more successful. Moreover, the co-ordinating service had no budgetary responsibility. Those concerned with quality assurance in co-ordination of terminal care might consider the skill mix and professional training of the co-ordinators as well as their budgetary responsibilities and authority.
作为一项针对晚期癌症患者护理的新区协调服务随机对照试验的一部分，对护士协调员的活动以及该服务的可接受性和感知有效性进行了评估。协调员的活动由其自行记录；专业护理人员填写了邮寄问卷；家庭护理人员则在家中接受了访谈。分配给协调员的患者中有38%未接受过家访。总体而言，41%的专业人员听说过该协调服务，20%曾与协调员联系过。三分之一的亲属，无论其患者是否被分配到协调服务，都认为其患者的临终护理协调不佳，并且他们不知道如何为其濒死的亲属获得所需的帮助。可能是护士协调员不愿意或无法放弃其技能，以提供“经纪人”式的协调。或许技能稍逊的协调员会更成功。此外，协调服务没有预算责任。那些关注临终护理协调质量保证的人可能会考虑协调员的技能组合、专业培训以及他们的预算责任和权力。
