The Effects of the Primary Nursing Care Model: A Systematic Review | OMICS International
Originated in by staff nurses at the University of Minnesota, Primary Nursing is a system of This is distinguished from the practice of team nursing, functional nursing, or total . Marie Manthey tells this story about the origins of primary nursing in the book Relationship-Based Care: A Model for Transforming Practice: . Relationship Based Care (RBC) is an operational blueprint for improving safety, team member's ability to provide attuned, compassionate, high quality care. MARTY: How does Relationship-Based care differ from Primary. Nursing? MARIE : I move out of team nursing, and they created the system of all ^^Vs were.
This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Nursing care models provide the infrastructure for organizing and delivering care to patients and families. Over the decades, different models have waxed and waned. Since the s, the primary nursing model has gained increasing prominence. However, there is no systematic research evidence on the effects of this model for patients, their family members, nursing staff or the care organization.
This subject has much current relevance because of the requirement to develop evidence-based nursing care. To describe the effects of the primary nursing model for patients, their family members, nursing staff and the care organization. A systematic literature review.
The research data were collected from four databases from January to March Research on the effects of the primary nursing model has largely been restricted to the effects for patients and nursing staff.
The preliminary evidence suggests that the primary nursing model may have beneficial effects for patients in the context of maternity care.
However, it is possible that the model contributes to an increased sense of job control and autonomy. Further research is also needed into the effects of the primary nursing model on numerically measurable outcomes, such as medication errors during hospital care and the length of treatment periods.
Care model; Evaluation;, Primary nursing; Systematic review Introduction Health care around the world is under mounting pressure to improve efficiency, to manage costs, to document the methods used and to demonstrate the effectiveness of those methods [ 1 ]. Hospitals, for instance, are having to work to improve patient flows, reduce the amount of time that patients spend in hospital and to use more bedside technology [ 2 ].
It is also required that evidence be produced of the methods that are used in health care [ 3 ]. Patients are better informed about their care and medication than before, and they expect to receive high quality and effective care [ 36 ]. Nursing staff, for their part, expect to have a high level of job autonomy and to be able to put their skills and competencies to the best possible use. The need to appraise nursing care delivery models is further underscored by problems with the availability of nursing staff and the challenges of staff retention [2, 6 ].
Nursing care models provide the infrastructure for organizing and delivering care to patients and families [ 7 ]. They also reflect the philosophical foundation of patient care as well as the prevailing organizational culture [ 89 ].
Nursing care is based on the changing needs and situation of each individual patient [ 6 ].
- Relationship-Based Care and Primary Nursing
- Relationship-based care: customized primary nursing. Interview by Marty Lewis-Hunstiger.
- Relationship-Based Care
The focus of adult patient care has shifted increasingly from the individual patient to also involving their family members [ 10 ].
Patient care requires increased planning, interaction and multi professional collaboration [ 611 ]. However, we still have no firm evidence about the effects of these models for patients, their family members, nursing staff and the care organization or about the outcomes of nursing [ 14 ]. This means that the planning and implementation of care primarily takes place between the patient and named nurse [ 15 - 17 ]. However, the named nurse does not work alone but works closely with colleagues and other professional groups [ 1819 ].
Relationship-based care: customized primary nursing. Interview by Marty Lewis-Hunstiger.
Wards organized on the principles of primary nursing have a flat organizational structure because patient care is equally shared between nurses [ 6 ]. The primary nursing model is widely implemented since it has been considered to be an ideal way of organizing nursing care delivery.
The key is that nurses are driven to address patient needs in their work, rather than perform specific job tasks under given functional structures. The primary nursing model has continued to be rolled out widely since it was first developed in the United States in the late s [ 18 ]. It has been implemented, for example, in Canada [ 21 ], China [ 22 ], the United Kingdom [ 8 ], the Netherlands [ 23 ] and Finland [ 24 ].
In the United States, the model is particularly favoured in hospitals with magnet status [ 25 ]. Findings from Previous Studies The evidence from earlier research into primary nursing is largely descriptive and much of it is outdated. Some of the results are contradictory. A previous systematic review covered studies published between and [ 26 ].
In these studies were considerable variations in the definition of the primary care concept and the way primary care was implemented. Also, the measures used to assess the effect of primary care model differed a lot. Thus, making reliable conclusions, or finding a generalizing result, was not possible [ 26 ]. However, the consensus seems to be that primary nursing care is beneficial to patients in that it is conducive to more individually tailored care and to the continuity of care.
It also gives patients more chance to take part in the planning and implementation of care [ 172728 ]. Furthermore, the model supports increased communication between the people involved in patient care as well as more accurate information about the patient [ 272930 ].
It has also been shown that primary nursing correlates positively with patient experiences of access to support [ 31 — 33 ] and a sense of individual care and attention [ 34 ]. Earlier research has also shown a positive correlation between primary nursing and nurse experiences of job autonomy and independent decision-making [ 27303839 ], job satisfaction, professional growth, improved professional cooperation in the workplace [ 1639 ] and reduced work-related stress [ 4041 ].
On the other hand, it has also been reported that primary nursing actually increases work-related stress [ 30 ]. Furthermore, the evidence is that nurses working in primary nursing contexts spend more time talking with patients and colleagues than nurses in other care delivery settings [ 2742 ]. Many studies have indicated that primary nurses have more job autonomy and are more committed to their work than task-oriented and team working nurses [ 283043 ].
A recent review suggests that the primary nursing model increases levels of staff retention in the work unit [ 44 ]. The previously mentioned literature review covered studies on the effects of the primary nursing model that were published between [ 26 ]. To the best of our knowledge, after there exists no systematic review of the research evidence on the effects of primary nursing for patients, their family members, nursing staff and the care organization.
Given the current commitment to developing evidence-based nursing, this is a subject of much current interest.
Get the Job
This study reviews the earlier literature and on this basis discusses the effects achieved with the use of the primary nursing model. Purpose of the study This study reviews the scientific literature on the effects of the primary nursing care model for patients, their family members, nursing staff and the care organization.
Methods Search strategy The literature was searched in two stages.
This search was undertaken to find additional keywords. Criteria for inclusion Study types Randomized controlled trials, non-randomized controlled trials and before-and-after studies were selected for inclusion in the review. Only texts written in English and published between January and March were considered. The search period was restricted to the last 23 years in which the primary nursing model has been rolled out internationally [ 828 ] and during which time there have been major fundamental changes in health care delivery [ 4546 ].
It was furthermore required that the database included an abstract of the article. Interventions The review focused on studies that evaluated primary nursing as a care model. Under this model caring is based on a one-to-one relationship where each patient is assigned a specific primary nurse who assumes hour responsibility and accountability for patients during their stay in care [ 1314 ]. Outcomes All outcomes concerning patients, their family members, staff and the care organization were considered.
Studies that were clearly not relevant based on their title were excluded. In cases where it was not entirely clear whether the study described interventions relevant to this review, the study was included.
Finally, studies rated as relevant or uncertain were read in full and screened based on the inclusion criteria. Doubtful titles, abstracts and full articles were discussed among the authors Figure 1. These data included specific details about interventions, study methods, participants and outcomes of significance to the review.
Based on the total scores from these perspectives, the quality of each study was classified as strong, moderate or weak. Quality was assessed for eleven articles that met the inclusion criteria. Two of the three researchers AR, EM, KLu independently assessed the quality of each study before the appraisals were compared.
In cases where total scores differed, the researchers discussed their assessments until they reached agreement on the most appropriate score. Based on the EPHPP criteria, three of the articles reviewed were rated as strong in quality [ 212247 ],six as moderate in quality [ 23283948 — 50 ] and two as weak in quality [ 5152 ].
Nine articles were included in the systematic literature review Table 1. Instead, content analysis of the interventions was based on a descriptive method [ 54 ]. Description of the data Studies focusing on patients were conducted in surgical, medical, orthopaedic and maternity contexts [ 2122394950 ], while studies concerned with nursing staff were conducted on surgical, medical and orthopaedic wards [ 2339 ], as well as psychiatric wards [ 2847 ]. The cost included the salaries and fringe benefits for the direct care providers and support persons.
Primary Nursing Vs. Team Nursing | Career Trend
In addition, the diagnosis related group DRG cost was calculated by length of stay. Three of the studies used RCT designs [ 212249 ], the remaining four were intergroup pre-post measurements with control groups [ 284750 ] or without them [ 223948 ].
Sample sizes in experimental groups ranged from 49 to and in control groups from 50 to Two studies [ 4950 ] did not report the duration of the intervention Table 2. The mean age of the people taking part in the studies was between 20 and 60, and most of them were women. The mean age of nursing staff was between 31 and 35, and their mean period of work experience was 10—13 years.
The primary nurse does all of the bedside care. Obvious barriers to singular care by a primary nurse include shortened length of patient stay; escalating patient acuity levels; complex, multifaceted care requirements, and the cyclical nursing shortage. Primary nursing eliminates teamwork. Everyone works individually and therefore is not aware of patients other than their own.
In a primary nursing model, care providers do not help each other. Teamwork is critical to the primary nursing care delivery system. It has been demonstrated that the best utilization of ancillary staff is in relationship with one RN— at least within a given shift —not assigned to help many.
Primary nursing supports collaborative interdisciplinary practice through communication and coordination. Complex scheduling requirements prohibit continuity of the nurse-patient relationship central to the primary nurse model.
They also report a perceived increase in productivity through more consistent co-worker assignments.