Community nurses play a key part in palliative care for patients and their families, yet there is relatively little research examining how their role is understood by nurses themselves. This paper presents findings from a qualitative study exploring how district nursing teams and community matrons (CMs) understood their own and each other's roles in palliative care. Twenty-four district nurses (DNs), 15 CMs and seven other key stakeholders were interviewed. DNs saw themselves as having a pivotal role, often coordinating other services as well as providing hands-on care. CMs agreed with the importance of the DN role, but had doubts about whether DNs had the capacity or skills to provide genuine case management. Both sets of nurses varied in their views of the CM role in palliative care, from seeing it as negligible to extensive and valuable. Organizational change contributed to the defensiveness of many DNs about their role, and to CMs' experiences of suspicion towards theirs.
Advancing Qualitative Methods Collaborative working is a commonplace of contemporary health and social care. In almost all settings-be it primary, secondary, or tertiary health care, community or institutional social care-the provision of good-quality services is reliant on different professional groups working effectively with each other and with service users. When things go drastically wrong, the failure of professionals to work well together is often a major contributory factor, as can be seen in high-profile cases such as that in the United Kingdom of 17-month-old "Baby Peter," who died after prolonged physical abuse and neglect by his mother and two other adults, despite the involvement of multiple health and social care agencies (Haringey Local Safeguarding Children Board, 2009). Even when the consequences are less tragic, failings in collaborative working might be costly (for instance, through sickness absenteeism;
The Midhurst Macmillan Specialist Palliative Care Service (MMSPCS) is a UK, medical consultant-led, multidisciplinary team aiming to provide round-the-clock advice and care, including specialist interventions, in the home, community hospitals and care homes. Of 389 referrals in 2010/11, about 85% were for cancer, from a population of about 155 000. Using a mixed method approach, the evaluation comprised: a retrospective analysis of secondary-care use in the last year of life; financial evaluation of the MMSPCS using an Activity Based Costing approach; qualitative interviews with patients, carers, health and social care staff and MMSPCS staff and volunteers; a postal survey of General Practices; and a postal survey of bereaved caregivers using the MMSPCS. The mean cost is about 3000 GBP (3461 EUR) per patient with mean cost of interventions for cancer patients in the last year of life 1900 GBP (2192 EUR). Post-referral, overall costs to the system are similar for MMSPCS and hospice-led models; however, earlier referral avoided around 20% of total costs in the last year of life. Patients and carers reported positive experiences of support, linked to the flexible way the service worked. Seventy-one per cent of patients died at home. This model may have application elsewhere.
Background:Collaborative working between professionals is a key component of integrated care. The academic literature on it largely focuses either on integration between health and social care or on the dynamics of power and identity between doctors and nurses. With the proliferation and extension of nursing roles, there is a need to examine collaborative working amongst different types of nurses.Method:This study explored experiences of collaborative working amongst generalist and specialist nurses, in community and acute settings. We carried out semi-structured interviews, incorporating the Pictor technique, with 45 nurses, plus 33 other key stakeholders. Transcripts were analysed using Template Analysis. This article focuses on one major thematic area that emerged from the analysis: the significance of interpersonal relationships amongst nurses, and between them and other professionals, patients and carers.Results:Relationship issues were ubiquitous in participants’ accounts of collaborative working. Good personal relationships facilitated collaboration; face-to-face interaction was especially valued. Relationships were recognized as requiring effort, especially in new roles. Organisational changes could disrupt productive personal networks.Conclusion:Relationship issues are integral to successful collaborative working. Policy and practice leaders must take this into account in future service developments. Further research into collaborative relationships in different settings is needed.
PurposeThe study explores the relational encounters of five higher education tutors and programme leaders, working in collaboration across contrasting institutions: one, a modern, civic university in the Global North, and the other, a parastatal institution in the Global South. The purpose of the study is to deepen the understanding of evolving collegiality within a transnational partnership, stimulated by the COVID-19 pandemic related shift to online teaching and learning.Design/methodology/approachThe inquiry is informed conceptually by the concept of narrative encounter as a site of learning, with inductive, meta-analysis undertaken across our individual reflective narratives.FindingsThe narratives reveal three emergent themes: shared purpose, shared responsibility – through focus, routinised dialogue and concreteness; collective and individual risk-taking – through negotiated decision-making; and trust in self and in peers – through reciprocity, caring, duality and building on stable practices.Research limitations/implicationsThe data from which this paper is developed and its related central thesis of collegial capital are limited and partial. However, when agility within higher education partnerships is at a premium, this paper is a useful touchstone for further reflection.Originality/valueThe paper seeks to further the concept of collegiality and collegial capital, a dialogical affordance which enabled the partnership to build on previous collaborative successes.
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