PDF(Sci-hub)
Abstract：
BACKGROUND: The number of patients requiring ambulatory chemotherapy is increasing year on year, creating problems with capacity in outpatient clinics and chemotherapy units. Although nurse-led chemotherapy clinics have been set up to address this, there is a lack of evaluation of their effectiveness. Despite a rapid expansion in the development of nursing roles and responsibilities in oncology, there is little understanding of the operational aspects of nurses\' roles in nurse-led clinics.
OBJECTIVE: To explore nurses\' roles within nurse-led chemotherapy clinics.
METHODS: A focused ethnographic study of nurses\' roles in nurse-led chemotherapy clinics, including semi-structured interviews with nurses.
METHODS: Four chemotherapy units/cancer centres in the UK PARTICIPANTS: Purposive sampling was used to select four cancer centres/units in different geographical areas within the UK operating nurse-led chemotherapy clinics. Participants were 13 nurses working within nurse-led chemotherapy clinics at the chosen locations.
METHODS: Non-participant observation of nurse-led chemotherapy clinics, semi-structured interviews with nurse participants, review of clinic protocols and associated documentation.
RESULTS: 61 nurse-patient consultations were observed with 13 nurses; of these 13, interviews were conducted with 11 nurses. Despite similarities in clinical skills training and prescribing, there were great disparities between clinics run by chemotherapy nurses and those run by advanced nurse practitioners. This included the number of patients seen within each clinic, operational aspects, nurses\' autonomy, scope of practice and clinical decision-making abilities. The differences highlighted four different levels of nurse-led chemotherapy clinics, based on nurses\' autonomy and scope of clinical practice. However, this was heavily influenced by medical consultants. Several nurses perceived they were undertaking holistic assessments, however they were using medical models/consultation styles, indicating medicalization of nurses\' roles.
CONCLUSIONS: Four different levels of nurse-led chemotherapy clinics were identified, illustrating disparities in nurses\' roles. Although clinics are run by nurses they are often controlled by medical consultants, which can reduce nurses\' autonomy and negatively impact on patient care.
OBJECTIVE: To explore nurses\' roles within nurse-led chemotherapy clinics.
METHODS: A focused ethnographic study of nurses\' roles in nurse-led chemotherapy clinics, including semi-structured interviews with nurses.
METHODS: Four chemotherapy units/cancer centres in the UK PARTICIPANTS: Purposive sampling was used to select four cancer centres/units in different geographical areas within the UK operating nurse-led chemotherapy clinics. Participants were 13 nurses working within nurse-led chemotherapy clinics at the chosen locations.
METHODS: Non-participant observation of nurse-led chemotherapy clinics, semi-structured interviews with nurse participants, review of clinic protocols and associated documentation.
RESULTS: 61 nurse-patient consultations were observed with 13 nurses; of these 13, interviews were conducted with 11 nurses. Despite similarities in clinical skills training and prescribing, there were great disparities between clinics run by chemotherapy nurses and those run by advanced nurse practitioners. This included the number of patients seen within each clinic, operational aspects, nurses\' autonomy, scope of practice and clinical decision-making abilities. The differences highlighted four different levels of nurse-led chemotherapy clinics, based on nurses\' autonomy and scope of clinical practice. However, this was heavily influenced by medical consultants. Several nurses perceived they were undertaking holistic assessments, however they were using medical models/consultation styles, indicating medicalization of nurses\' roles.
CONCLUSIONS: Four different levels of nurse-led chemotherapy clinics were identified, illustrating disparities in nurses\' roles. Although clinics are run by nurses they are often controlled by medical consultants, which can reduce nurses\' autonomy and negatively impact on patient care.
摘要：
背景：需要门诊化疗的患者人数逐年增加，在门诊诊所和化疗单位造成能力问题。尽管已经建立了由护士主导的化疗诊所来解决这个问题，缺乏对其有效性的评估。尽管肿瘤学中护理角色和职责的发展迅速扩大，在护士主导的诊所中，对护士角色的操作方面了解甚少。
目的：探讨护士在护士主导的化疗诊所中的角色。
方法：对护士主导的化疗诊所中护士角色的重点人种学研究，包括对护士的半结构化访谈。
方法：英国的四个化疗单位/癌症中心参与者：目的抽样用于选择英国护士主导的化疗诊所内不同地理区域的四个癌症中心/单位。参与者是在选定地点的护士领导的化疗诊所工作的13名护士。
方法：护士主导化疗门诊的非参与者观察，与护士参与者的半结构化访谈，临床方案和相关文件的审查。
结果：对13名护士进行了61次护患咨询，其中对11名护士进行了访谈。尽管在临床技能培训和处方方面有相似之处，化疗护士经营的诊所和高级护士经营的诊所之间存在很大差异。这包括在每个诊所看到的患者数量，操作方面，护士的自主权，实践范围和临床决策能力。差异突出四个不同级别的护士主导化疗诊所,基于护士的自主性和临床实践范围。然而,这受到医疗顾问的严重影响。几位护士认为他们正在进行整体评估，然而，他们使用的是医学模型/咨询方式，表明护士角色的医学化。
结论：确定了四个不同级别的护士主导化疗诊所，说明护士角色的差异。尽管诊所由护士管理，但它们通常由医疗顾问控制，这会降低护士的自主性，并对患者护理产生负面影响。
目的：探讨护士在护士主导的化疗诊所中的角色。
方法：对护士主导的化疗诊所中护士角色的重点人种学研究，包括对护士的半结构化访谈。
方法：英国的四个化疗单位/癌症中心参与者：目的抽样用于选择英国护士主导的化疗诊所内不同地理区域的四个癌症中心/单位。参与者是在选定地点的护士领导的化疗诊所工作的13名护士。
方法：护士主导化疗门诊的非参与者观察，与护士参与者的半结构化访谈，临床方案和相关文件的审查。
结果：对13名护士进行了61次护患咨询，其中对11名护士进行了访谈。尽管在临床技能培训和处方方面有相似之处，化疗护士经营的诊所和高级护士经营的诊所之间存在很大差异。这包括在每个诊所看到的患者数量，操作方面，护士的自主权，实践范围和临床决策能力。差异突出四个不同级别的护士主导化疗诊所,基于护士的自主性和临床实践范围。然而,这受到医疗顾问的严重影响。几位护士认为他们正在进行整体评估，然而，他们使用的是医学模型/咨询方式，表明护士角色的医学化。
结论：确定了四个不同级别的护士主导化疗诊所，说明护士角色的差异。尽管诊所由护士管理，但它们通常由医疗顾问控制，这会降低护士的自主性，并对患者护理产生负面影响。
