The Role of the Community Clinical Nurse Specialist in Palliative Care in the South of Ireland

  • Eileen Gobnait O'Leary

Student thesis: Doctoral ThesisDoctor of Health (DHealth)


ABSTRACTClinical Nurse Specialism was established in Ireland in 2001. As this new role has become embedded in practice over the past decade it has faced a number of challenges. The unsatisfactory articulation of the nature of the work at the level of clinical nurse specialist was described by Seymour et al (2002). The aim of this study was to establish a clear insight and understanding of the role of the Community Clinical Nurse Specialist in Palliative Care (CNSPC) in the South of Ireland. As many studies have examined the CNS role from within the profession, of particular importance here were the perspectives held by patients, family members, and other healthcare professionals. A qualitative approach through a combination of focus group and semi-structured interviews were held with a range of health care professionals including five focus groups of CNSPC, two General Practitioners (GPs), three focus groups of Public Health Nurses (PHNs) and a nurse representative of the National Council for the Professional Development of Nursing and Midwifery (NCNM) was used. Through purposive sampling four patients and three family members consented to participate in face to face semi-structured interviews on invitation by their CNSPC. Non participant observation was conducted at two team meetings. Thematic analysis (Braun and Clarke, 2006) of the data was undertaken in an attempt to understand the perception of the patients, family members and healthcare professionals. Three themes emerged following analysis. These were journey as a metaphor, aspects of care and role. From the time of referral to palliative care in the community the CNSPC accompanied the patient on their journey. The CNSPC joined the GPs and PHNs to establish a connection in an effort to guide the patient and family members on the path to their destination. Aspects of care featured the concern, regard and mindfulness of the CNSPC through caring and supporting the patient and family members. In addition, these aspects of care incorporated the team and were delivered through teamwork. The final theme was role, including the elements of role structure and role model. Though role structure captured both the expected and enacted role of the CNSPC, role ambiguity was also encountered. Role conflict and strain were represented as an expressive role but were also accompanied by the interpersonal contact essential to individual relationships.Recommendations of this study included the clarification of the role of the CNSPC and subsequent dissemination to relevant personnel. By considering solutions that can be achieved will assist the CNSPC in addressing areas of the role that are not being realised. This also included the establishment of a link with academic departments. In conjunction with the PHN service the examination of a “shared plan of care”.
Date of Award2 Nov 2015
Original languageEnglish
Awarding Institution
  • University of Bath
SupervisorPaula Smith (Supervisor)

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