title: Clinical nurse specialists in palliative care. Part 2. Explaining diversity in the organization and costs of Macmillan nursing services.
abstract: In the UK, the work of Macmillan clinical nurse specialists in palliative care is now well established. There has been little research, however, into the organizational context in which these nurses operate and the implications for the services they deliver. We report on a major evaluation of the service delivery, costs, and outcomes of Macmillan nursing services in hospital and community settings. The study was based on eight weeks of fieldwork in each of 12 selected services. Data are presented from semi-structured interviews, clinical records, and cost analysis. We demonstrate wide variation across several dimensions: location and context of the services; activity levels; management patterns; work organization and content; links with other colleagues; and resource use. We suggest that such variation is likely to indicate the existence of both excellent practice and suboptimal practice. In particular, our study highlights problems in how teamwork is conceptualized and delivered. We draw on recent organizational theories to make sense of the heterogeneous nature of Macmillan nursing services.
authors.affiliation: Sheffield Palliative Care Studies Group. d.clark@sheffield.ac.uk
authors.forename: David
authors.initials: D
authors.lastname: Clark
authors.forename: Jane
authors.initials: J
authors.lastname: Seymour
authors.forename: Hannah-Rose
authors.initials: HR
authors.lastname: Douglas
authors.forename: Peter
authors.initials: P
authors.lastname: Bath
authors.forename: Nicola
authors.initials: N
authors.lastname: Beech
authors.forename: Jessica
authors.initials: J
authors.lastname: Corner
authors.forename: Deborah
authors.initials: D
authors.lastname: Halliday
authors.forename: Philippa
authors.initials: P
authors.lastname: Hughes
authors.forename: Jo
authors.initials: J
authors.lastname: Haviland
authors.forename: Charles
authors.initials: C
authors.lastname: Normand
authors.forename: Rachael
authors.initials: R
authors.lastname: Marples
authors.forename: Julie
authors.initials: J
authors.lastname: Skilbeck
authors.forename: Tom
authors.initials: T
authors.lastname: Webb
mesh_terms: D003152:Community Health Nursing / Q000458:organization & administration*; D003365:Costs and Cost Analysis; D004739:England; D006801:Humans; D009369:Neoplasms / Q000191:economics / Q000451:nursing*; D009720:Nurse Clinicians / Q000191:economics / Q000458:organization & administration*; D009738:Nursing Service, Hospital / Q000458:organization & administration*; D019982:Organizational Case Studies; D017063:Outcome Assessment, Health Care; D010166:Palliative Care / Q000191:economics / Q000458:organization & administration*; D010348:Patient Care Team