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Clinical nurse specialists in palliative care. Part 2. Explaining diversity in the organization and costs of Macmillan nursing services

Sheffield Palliative Care Studies Group, Sheffield

Jane Seymour

Hannah-Rose Douglas

Peter Bath

Department of Information Studies, University of Sheffield, Sheffield

Nicola Beech

Institute of Cancer Research, London

Jessica Corner

Institute of Cancer Research, London

Deborah Halliday

Centre for Cancer and Palliative Care Studies, Institute of Cancer Research, London

Philippa Hughes

Sheffield Palliative Care Studies Group, University of Sheffield, Sheffield

Jo Haviland

Centre for Cancer and Palliative Care Studies, Institute of Cancer Research, London

Charles Normand

London School of Hygiene and Tropical Medicine, London

Rachael Marples

Julie Skilbeck

Sheffield Palliative Care Studies Group, University of Sheffield, Sheffield

Tom Webb

Centre for Cancer and Palliative Care Studies, Institute of Cancer Research, London

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.

Key Words: clinical nurse specialists • costs • Macmillan Nurses • palliative care organization

Palliative Medicine, Vol. 16, No. 5, 375-385 (2002)
DOI: 10.1191/0269216302pm585oa


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