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Title: A study of the early implementation of the community matron policy in three Primary Care Trusts in England
Author: Savage, Susan
ISNI:       0000 0004 2733 8917
Awarding Body: University of Manchester
Current Institution: University of Manchester
Date of Award: 2012
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This thesis presents a qualitative multiple case study which examines the early implementation of the community matron policy in three primary care trusts in England. The community matron was a new role in nursing, introduced by the Department of Health in 2004, as part of its strategy for the management of long term conditions (DH, 2005e). There was a paucity of research literature underpinning the policy and the implementation of the community matron role in England. A descriptive multiple case study was used as it generates a richness of data using multiple data collection methods, ideally positioned to investigate phenomena in context and contemporaneously. In addition to documentary material, 49 participants were recruited across the three case study sites, from community matrons, active case managers, health and social care colleagues and patients. A total of 30 interviews, 33 observations and one focus group were undertaken between 2006 and 2008. Framework Analysis was used to interpret the data and critical sensemaking was applied as a heuristic to gain insight into the findings.This study explored the early role implementation from the perspective of the community matron. It found that the community matron role had been adopted with regard to the national model but there was variation in its implementation between case study sites, seen in service structures, eligibility criteria and caseload management. Practitioners had exercised professional discretion to flex local service models to fit their ways of practice and professional decision making, although this may not have been conscious behaviour. They also expanded the role to include psychosocial support, beyond the nationally defined functions. Advanced practice was integral to the role; whilst there appeared to be a medical influence on this aspect of role development; practitioners had adopted traditionally medical tasks and incorporated them into nursing practice, making such roles their own. Community matrons described experiencing resistance to the role initially from some district nurses and GPs, outlining how they adopted strategies to address these and promote acceptance of the role. As such, individual community matrons were the key change agents. They experienced dissonance between organisational values and professional values, which they addressed by reinterpreting collective targets such as reducing hospital admissions into individual patient outcomes related to improved quality of life. Critical sensemaking gives a unique perspective on the implementation of national policy, through the lens of the community matron, highlighting the experience of nursing role development at an individual and team level, and the ways in which variation can occur. Further research is needed into nursing policy implementation to better understand the processes at play nationally and organisationally. Critical sensemaking might be used to inform how implementation can be effective and sustainable.
Supervisor: Attree, Moira; Hallett, Christine Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available
Keywords: community matron ; case study ; policy implementation ; nursing role ; long term conditions ; critical sensemaking