Clinical nurse specialists in palliative care. Part 2. Explaining diversity in the organization and costs of Macmillan nursing services.
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.
Clark
David
D
Sheffield Palliative Care Studies Group. d.clark@sheffield.ac.uk
Seymour
Jane
J
Douglas
Hannah-Rose
HR
Bath
Peter
P
Beech
Nicola
N
Corner
Jessica
J
Halliday
Deborah
D
Hughes
Philippa
P
Haviland
Jo
J
Normand
Charles
C
Marples
Rachael
R
Skilbeck
Julie
J
Webb
Tom
T
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