Abstract
Most healthcare contexts in which palliative care services are situated, are in a perpetual state of change. There is little time in the nurses average working day to reflect on what quality means. Recent initiatives in the British National Health Service have included; clinical governance, the National Institute for Clinical Excellence, the Commission for Health Improvements and a requirement for nurses to maintain their skills. There is little evidence yet of their effectiveness in improving standards of care (Goodman, 2000).
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