A comparison of nurse-related behaviour, philosophy of care and job satisfaction in team and primary nursing

Chilean midwives' experiences while providing induced abortion care after the enactment of a law decriminalising abortion

INTRODUCTION

The recent change in Chilean legislation towards abortion enabled midwives to include the care of women having an induced abortion within their scope of practice. However, midwives' identity could be strained by induced abortion care provision as it is contrary to midwives' traditional role. Considering this, the aim of the study was to elucidate how Chilean midwives understand and provide abortion care.

METHODS

A constructivist grounded theory study was conducted using online semi-structured in-depth interviews. Midwives were purposively sampled considering maximum variation criteria and then theoretical sampling occurred. Saturation was achieved with fifteen interviews. Interviews were conducted in Spanish and then translated into English. Constant comparison analysis generated categories. Data were managed using NVivo 12. All interviewees provided their consent to be part of this study.

RESULTS

This article reports on the experiences of nine midwives who had provided lawful induced abortion care in Chile. The experiences of these midwives were grouped into two major categories: 'Defining a position towards abortion' and 'Abortion care is emotional labour'.

CONCLUSION

Midwives can successfully provide abortion care despite being challenged by certain areas of it. Considering the high demand for emotional labour in abortion care, efforts should be made to increase midwives' emotional self-regulation skills. Likewise, organisations should strengthen and implement their offer of well-being and emotional self-care support to midwives.

A taxonomy of nursing care organization models in hospitals

BACKGROUND

Over the last decades, converging forces in hospital care, including cost-containment policies, rising healthcare demands and nursing shortages, have driven the search for new operational models of nursing care delivery that maximize the use of available nursing resources while ensuring safe, high-quality care. Little is known, however, about the distinctive features of these emergent nursing care models. This article contributes to filling this gap by presenting a theoretically and empirically grounded taxonomy of nursing care organization models in the context of acute care units in Quebec and comparing their distinctive features.

METHODS

This study was based on a survey of 22 medical units in 11 acute care facilities in Quebec. Data collection methods included questionnaire, interviews, focus groups and administrative data census. The analytical procedures consisted of first generating unit profiles based on qualitative and quantitative data collected at the unit level, then applying hierarchical cluster analysis to the units' profile data.

RESULTS

The study identified four models of nursing care organization: two professional models that draw mainly on registered nurses as professionals to deliver nursing services and reflect stronger support to nurses' professional practice, and two functional models that draw more significantly on licensed practical nurses (LPNs) and assistive staff (orderlies) to deliver nursing services and are characterized by registered nurses' perceptions that the practice environment is less supportive of their professional work.

CONCLUSIONS

This study showed that medical units in acute care hospitals exhibit diverse staff mixes, patterns of skill use, work environment design, and support for innovation. The four models reflect not only distinct approaches to dealing with the numerous constraints in the nursing care environment, but also different degrees of approximations to an "ideal" nursing professional practice model described by some leaders in the contemporary nursing literature. While the two professional models appear closer to this ideal, the two functional models are farther removed.

Effects of resident-oriented care on quality of care, wellbeing and satisfaction with care

In a resident-oriented care model applied in nursing homes, the residents are assigned to primary nurses. These primary nurses are responsible for the total care of the residents assigned to them. The purpose of the present study, using a pretest, post-test and control group quasi-experimental design, was to evaluate the effects of the implementation of resident-oriented care on the following aspects of quality of care: coordination of care, instrumental aspects, expressive aspects, resident wellbeing and satisfaction with care, and family satisfaction with care. The study was carried out on somatic and psycho-geriatric wards in three nursing homes in the Netherlands. Data were collected by questionnaires, interviews and observations. The results of the study showed that the intervention was partly successful in the experimental group. Some aspects of the resident-oriented care model were not clearly evident. Moreover, the effects on quality-of-care aspects were limited. The results revealed that the 'coordination of care' increased on half of the experimental wards. Furthermore, there was an indication that 'expressive aspects' changed in favour of the experimental wards. The implementation of resident-oriented care had no effect on resident wellbeing and satisfaction or on family satisfaction. Finally, the results are discussed in the light of some methodological limitations that often go together with intervention studies in the real world.

Job satisfaction in relation to change to all-RN staffing

BACKGROUND

A university hospital clinic changed from a mixed to only registered nurse staffing, to reduce the staff and to encourage a philosophy of patient centred care. The aim was to maintain the same level of service and quality of care at a lower cost.

AIM

The main purpose of the study was to examine job satisfaction in relation to the change from mixed to only registered nurse staffing and reduction in number of staff.

METHODS

Data were collected by an established questionnaire measuring job satisfaction. Non-parametric statistics were used to analyse the data. The questionnaire was distributed to 22 nurses on the ward on three occasions, covering a period of 3 years.

RESULT

The experience of having time to plan patient care changed during the investigation period, from 'sometimes' to 'most often having time'. Nurses with longer work experience gave more verbal information to patients and perceived less stress. Information about job performance was more important to newcomers on the ward and became less important with time. However, quite a few have had regrets over choice of work and had considered non-caring work, nevertheless the results show no significant changes in overall job satisfaction.

Traditional models of care delivery: what have we learned?

Traditional models of patient care delivery include total patient care and functional, team, and primary nursing. These models differ in clinical decision making, work allocation, communication, and management, with differing social and economic forces driving the choice of model. Studies regarding quality of care, cost, and satisfaction for the models provide little evidence for determining which model of care is most effective in any given situation. Despite lack of evidence, newer models continue to be implemented. This article compares the advantages and disadvantages of models, critiques the existing studies, and offers recommendations regarding the evidence needed to make informed decisions regarding care delivery models.

Burnout and AIDS care‐related factors in HIV community Clinical Nurse Specialists in the North of England

Burnout in Acquired Immune Deficiency Syndrome (AIDS) care nursing is well described in the literature from a hospital based perspective. No studies into the effects of AIDS care and burnout have been carried out within the community setting. A two-stage, mixed method study was carried out. In Stage one 30 Clinical Nurse Specialists in human immunodeficiency virus (HIV)/AIDS from the North of England completed the Maslach Burnout Inventory (MBI) and the AIDS Impact Scale. For Stage two five practitioners were selected randomly for semi-structured interview. Burnout morbidity was significant. Sixty-six per cent of informants scored as moderate or high burnout cases on the emotional Exhaustion and Personal Accomplishment subscales of the MBI. Only three per cent scored as cases on the depersonalization subscale. Links between the close involvement of practitioners with clients, death of clients, isolation, stigma and discrimination and the availability of support and supervision were identified as significant factors in AIDS care within this population that contributed to stress and burnout. Paradoxically, informants found the close relationships with clients, the autonomy of isolation and the exclusive nature of AIDS care positive aspects of their practice. The role of support and supervision in facilitating the continuance of a close empathic and therapeutic relationship and the prevention of an over-involved, isolated and stressful relationship is proposed as a way forward.

Perceptions and experiences of primary nursing in an ICU: a combined methods approach

With the introduction of the Patient's Charter, greater emphasis has been placed on 'named nursing' (Department of Health 1991). While there is much literature extolling the benefits of this method of delivering care to patients (Reed 1988; Manley 1989; Macguire 1991); there is a dearth of empirical studies exploring primary nursing in an adult intensive care unit (ICU). In addition, little is known about how nurses feel about being a 'primary nurse'. The aim of this study was to determine qualified nurses' perceptions and experiences of the effect of primary nursing on patient care in an intensive care environment (ICU) and to explore nurses' experiences of being a primary nurse. This study was carried out in an ICU in Northern Ireland. Primary team nursing was the system of organizing care within this unit. This system consisted of teams of 'primary' and 'associate' nurses. A total of 65 qualified nurses were surveyed. Sixteen nurses took part in focus group interviews. A combined methods approach comprising a questionnaire and focus group interviews was employed for the study. Part one of the questionnaire provided data on professional and demographic details. Part two facilitated nurses to elaborate on their feelings and perceptions of the concept of primary nursing. The focus groups facilitated in-depth exploration of the respondents' personal feelings and experiences about their role as a primary nurse. The data obtained from the two-part questionnaire were analysed using descriptive statistic and content analysis. The data obtained from the focus groups were analysed using content analysis and the development of emerging themes. Analysis of the data revealed that the nurses' views were similar to those highlighted in the existing literature. Nurses perceived primary nursing to relate to the responsibility for the care of one patient, from admission to discharge with the primary nurse assessing, planning, implementing and evaluating care and the associate nurse assisting in the delivery of this care. Thus, continuity of care was seen as the major advantage of primary nursing. The findings, however, suggested that further teaching on the concept of primary nursing was required. In addition, many of the nurses admitted they experienced considerable stress, particularly in relation to their close proximity over a long period of time, with patients and their relatives. This is an important finding and highlights the need for primary nurses in ICU to have the opportunity (in some instances), to be relieved of their responsibility for a named patient, thereby reducing some of the potential for stress. It is acknowledged that the findings of this study may not be generalized beyond the identified sample. Further empirical studies exploring nurses' perceptions and experiences of primary nursing in an ICU are therefore needed.

Changing to primary nursing in a nursing home in Finland: experiences of residents, their family members and nurses

AIM

The aim of the study was to find out how nursing home residents, their families and nurses experienced the change to primary nursing in the nursing home.

BACKGROUND

This study was carried out in a nursing home in Finland. Following years of functional nursing, the change to primary nursing had started 18 months prior to data collection. The transition was preceded by staff training, planning for the change to primary nursing and discussions with staff members. Meetings were also arranged with family members to inform them of what was happening and why. Staff implemented the changeover independently with the support of the institution's management.

METHODS

The data were gathered in focused interviews. There were five interview themes: change in the nursing home, the position of the resident in the nursing home, the relationship between the resident and nurse, the relationship between family member and nurse, and the role of the nurse as provider of nursing care.

FINDINGS

Residents reported no major changes in nursing care or in their relationship with nurses. However, family members had noticed changes in the behaviour of the nursing staff. Staff members had become friendlier, spent more time with the residents and showed a strong job motivation. Cooperation between nurses and family members had changed very little. Some nurses in the early stages of the change tended to show signs of resistance. Others said that there had been many changes during the past year, that they acted more independently and could use their own decision-making authority more freely than before. They treated residents as individuals and gave them a greater say in decision-making. They felt responsible for the development of the workplace as a collectivity.

CONCLUSIONS

Primary nursing is one way in which nurses and family members can work more closely in the best interests of older residents. The findings of this study speak in favour of making the change from functional to primary nursing and at the same time highlight certain problems and possibilities in this process.

Evaluating the impact of primary nursing practice on the quality of nursing care: a Nigerian study

This paper is abstracted from an action research project on promoting family-centred care in Nigeria through the practice of Nigerian Primary Nursing (NMPN). This article will present results of comparative evaluation of the impact of primary nursing on the quality of care received by patients in a 37-bedded acute medical-surgical, mixed sex ward in a specialist hospital in eastern Nigeria. A total of 44 nurses' interactions with 10 patients in the pre-NMPN period and 58 nurses' interactions with eight patients in the post-NMPN period were assessed using QUALPACS (Quality Patient Care Scale.). Results showed a significant improvement in the quality of nursing care with primary nursing practice. The greatest improvement in quality of nursing appeared to be in the elements that address the individual needs of the patient, while the smallest improvements were in the area of physical care--elements of routine, technical nursing care. Implications of the study and recommendations for further studies are made.

Named nursing: in whose best interest?

This paper explores certain influences and issues surrounding the implementation and application of the named nurse concept. The author critically examines the proposals that primary nursing increases job satisfaction, cost effectiveness and quality of care, and suggests that as primary nursing appears to be the template for named nursing, these are factors which may have influenced the former British government's decision to implement the concept of named nursing. Owing to problems regarding the reliability and validity of much of the research, the author draws the conclusion that the direct extrapolation from one concept (such as primary nursing) to another (such as named nursing) is perhaps open to question. The author also analyses other issues related to the implementation and use of the named nurse concept including advocacy and accountability, and proposes that the introduction of individualized care, and in particular named nursing, perhaps serves the drive towards the professionalization of nursing first, and the patient second, and if so questions whether there is a need to reconsider the aim of nursing.

Developing an audit tool for primary nursing

Despite the proliferation of research on primary nursing, most studies have investigated the effects of primary nursing on quality of care, job satisfaction and collegial relationships. Few researchers have attempted to isolate the key dimensions of primary nursing in an observable and measurable form. The purpose of this exploratory study was to devise an audit tool for primary nursing that builds on Mead's research and incorporates views of patients/clients, relatives, nurses and other members of the multidisciplinary team. Preliminary findings suggest that the audit is a useful indicator of the extent to which the crucial elements of primary nursing are present or absent in any clinical setting. Furthermore it suggests that while many wards claim to practise primary nursing there is a considerable variation in the extent to which this is actually carried out.

Nursing organizational practice and its relationship with other features of ward organization and job satisfaction

This paper describes a new classification of ward organizational practice in nursing. Data related to aspects of ward nursing practice were collected by postal survey from a nationally representative sample of 74 acute hospital wards, and subjected to hierarchical cluster analysis. The model which was deemed to best 'fit' the data, provided three types of ward practices, which have been named: 'devolved', 'two tier' and 'centralized' nursing. The distinguishing features of the three classifications are similar but not identical to accepted 'ideal types' of primary, team and functional systems. The relationships between wards in each of the three identified categories and other ward organizational practice processes of nursing care and job satisfaction are described.

Perceptions of job stress

The experiences of the first graduate children's nurses to qualify on Part 15 of the UKCC Register were drawn on for this study. The literature shows that stress is more prevalent in newly qualified staff nurses. In order to provide optimum support, awareness of the particular factors that create stress at this time is vital. There was a chronological dimension to the stress experience of the children's nurses', which began with an initial feeling of survival and ended with a sense of equilibrium. Situations which would have initially evoked stress were no longer perceived as stressful as their confidence grew. Towards the end of the year, any specific stressful events were associated with increased managerial responsibilities or beginning a new job. The nurses consistently reported increased stress when dealing with a number of specific situations.

Clinical specialty and organizational features of acute hospital wards

Ward clinical specialty is a variable which has been largely ignored in studies of nursing organization and effectiveness. Analysis of data collected from a nationally representative sample of 83 acute medical, surgical and orthopaedic hospital wards demonstrates that while wards had similar staffing resources, differences exist in the likelihood of adopting a nursing organizational system with devolved authority, in nurses' views of prevailing hierarchical attitudes, and their perceived influence over a range of organizational features of the ward. Medical wards were more likely to have developed organizational practices associated with increasing nursing autonomy.

Primary nursing and quality of care: a Dutch study

In an 850-bed Dutch hospital a study was carried out to compare the quality-of-care scores of a Primary Nursing group and a lagged experimental group. Process as well as outcome aspects of quality of care were investigated. The study consisted of three measuring moments: one pre-intervention at t1, March 1992, and two post-intervention moments at t2, November 1992 and t3, May 1993. The intervention was formed by the implementation of Primary Nursing in two experimental units after t1; this is the experimental group. After t2, Primary Nursing was also implemented in the three control units; this is the lagged experimental group. The process aspects of quality of care were covered by three dimensions: coordination of care, instrumental aspects of care and expressive aspects of care. The outcome aspects of quality of care were measured by evaluating four patient variables: self-care, initiative, patient stress and patient satisfaction. ANOVAs were used to test for significant differences between the experimental and lagged experimental group. The only significant difference in favour of the Primary Nursing group was found on the variable instrumental aspects of care. On the other variables no expected changes were observed. Finally, the implications of the findings are discussed.

Satisfaction of nurse managers in long-term care

Nurse managers control quality and cost of the principal service provided by long-term care agencies. Job satisfaction was higher for long-term care nurse managers in metropolitan than in rural or suburban agencies. Findings suggest that continuing education may increase task satisfaction, as well as job knowledge of diploma-prepared nurse managers.

Advantages of primary nursing in geriatric day hospitals

This article presents a rationale for the introduction of primary nursing as the most suitable method of organisation in geriatric day hospitals. Working conditions, the status of the nurse within the multidisciplinary team and the opportunities afforded by primary nursing for enhancing the nurse-patient relationship are examined.

Job enrichment, work motivation, and job satisfaction in hospital wards: testing the job characteristics model

This study investigated work motivation and job satisfaction at hospital wards with high and low levels of job enrichment. Primary nursing was assumed to represent a highly enriched job, whereas functional nursing represented a job with a low level of enrichment. Five surgical wards were divided into these two categories based on the structured interviews with head nurses. Work motivation and job satisfaction among ward personnel were assessed by a questionnaire. The ward personnel occupying highly enriched jobs reported significantly higher work motivation and satisfaction with the management than the personnel occupying jobs with a low level of enrichment.

Changes of nursing organization in a surgical department: effects on work satisfaction and quality of care

The aim of the study was to evaluate the effects of an organizational change programme in a surgical department in Sweden (the introduction of modular nursing) on the nursing staff's perception of job satisfaction and quality of care, and to identify factors which promote or hinder this organizational change. Planning and implementation of the change programme took about 1 year and comprised structural changes and staff training. Assessments of job satisfaction and quality of care were made immediately before, and 1 year after, implementation of the change programme. Data were collected from the staff of two wards. Virtually no statistically significant changes were found when looking at the department as a whole. However, considerable differences were noted between the two wards, particularly in the following areas: relationships with colleagues, identification and commitment, and perceived quality of care. The quality of the interpersonal relationships, and the leadership of the wards' head nurses, appeared to be crucial determinants of the outcome.

Management review of nursing systems

This paper describes the systems of nursing operating at a major cancer centre in the United Kingdom. The review was undertaken over a period of 8 weeks and 11 wards were included. The systems being implemented were primary nursing, team nursing and patient allocation. Methods of enquiry included questionnaires, non-participative observation and interviews. The results of the review found the nursing systems to be at various stages of implementation, and that in reality, not all wards were operating the system they said they were. A pragmatic mixture of team nursing and primary nursing as described by Hegyvary (1982) was being practised on some of the wards. The report makes recommendations for change, and concludes by discussing the future implications for cancer nursing at the centre.

One year later: using role theory to evaluate a new delivery system

This is the second part of a two-part article that presents findings from a staff nurse survey one year after the implementation of primary nursing on four medical and surgical pilot units in a tertiary teaching hospital. The introduction of primary nursing was one phase of a project to develop theory-based nursing practice within the institution. The researchers hoped that obtaining the staff nurse perspective on the change to primary nursing would provide evaluative information and suggestions to provide additional support in the project. Role theory (Hardy, 1978) provides the theoretical framework for this study. While the previous article discussed issues related to the change process, this article focuses on evaluation of role transitions.

Qualified nurse and nursing auxiliary perceptions of their work environment in primary, team and functional nursing wards

The way in which nursing work is organized has major implications for the role of different staff grades. This paper describes how qualified nurses and nursing auxiliaries perceived their work in primary, team and functional nursing wards. The Work Environment Scale was distributed to 12 qualified nurses and 12 nursing auxiliaries within each organizational mode, and a response rate of 97% was achieved. While differences were found between organizational modes, there was no difference in work perceptions between qualified nurses and nursing auxiliaries within organizational mode. It is argued that this is due to cultures existing within organizational types which transcend staff grade.

A case study identifying nursing staffs' perception of the delivery method of nursing care in practice on a particular ward

The research describes how nursing staff on a general surgical ward in a district general hospital perceived the delivery method of nursing care in practice. The study design was based on ethnographic methods and data were collected by diary keeping and semi-structured interviews. An organizational method based on the principles of primary nursing had been implemented on the ward for 2 years prior to the study commencing. As well as talking in general terms about primary nursing, the nursing staff talked at some length about specific issues related to their practice.

The development of a measure of job satisfaction for use in evaluating change in the system of care delivery

The aim of the study was to produce a reliable, valid measure of job satisfaction in order to monitor the effect of a change in the method of care delivery. Principal components analysis of questionnaire responses by 121 nurses yielded two scales labelled "Intrinsic Job Satisfaction" and "Patient Focus". Cronbach's alpha was 0.88 and 0.82 respectively. Further analyses revealed significant differences in scores on both scales for different grades of staff and significant differences in scores on "Patient Focus" for nurses working in different specialties. Significant increases in scores on both scales were found for registered nurses following changes in organisation on a surgical ward. This increase was maintained over time. For enrolled nurses an increase in "Intrinsic Job Satisfaction" was less well maintained and no differences were found over time on "Patient Focus". The two scales are reliable and sufficiently sensitive to monitor the relationship between job satisfaction and system of care delivery for different grades of staff working in different specialties.

Quality of care assessed: using the Senior Monitor index in three wards for the elderly before and after a change to primary nursing

Assessments of quality of care using Senior Monitor in three matched wards for elderly patients were carried out on three occasions. The first assessment was carried out in June 1987 as a trial of the measurement tool. The instrument allows for a maximum score of 100. All three wards scored above 60, with two wards scoring above 70. Primary nursing was introduced in one of the wards in January 1988 and the assessment was repeated in June 1988. All ward scores were above 70, with one ward, not the primary nursing ward, scoring above 80. A third assessment was carried out in June 1989. Again, all three wards scored above 70 but this time the primary nursing ward scored 86; the highest ward score of the series. The results for the sub-sections of the assessment are explored in the paper and issues about validity, reliability and inter-rater reliability are discussed. It is argued that Senior Monitor is a useful tool for assessing changes in the quality of care delivered to patients in wards for the elderly but that its full value only becomes apparent with repetition over an extended time period. It may be less appropriate for assessing the impact of a change in the organization of care, not because of any inherent fault in the test but because the very process of using it makes staff look at their practice more critically. It is this critical re-appraisal rather than the change in organization per se which stimulates the improvement in the quality of care.

Outcomes of nursing care: the case of primary nursing

Using primary nursing as a 'case study', this paper reviews research literature which attempts to measure the effectiveness of a mode of nursing using outcome measures. Previous research, it is argued, is hampered by a lack of conceptualization of structure and process and inadequate research design, with consequent uncertain findings. A shift in emphasis is suggested from an evaluation of global concepts, such as primary nursing, to an identification of the features of structures and processes of nursing care which interrelate with patient and nurse outcomes. For this purpose, multivariate research design and investment in methodological research are recommended.

The development of a classification system for nurses' work methods

This study describes the development of a classification system for the clarification, understanding and measurement of nurses' work methods. The theoretical basis of the classification system is described. The system offered distinguishes between three common work methods: primary, team and task nursing; the strength of opportunity for nurse-patient interaction in each method being determined as either 'strong', 'moderate' or 'weak', according to how effectively they are practised. Preliminary testing of the system on 32 wards in 13 hospitals is described. It is concluded that further testing and possible refinement is required for validation of the system.

The use of the Ethnograph program to identify the perceptions of nursing staff following the introduction of primary nursing in an acute medical ward for elderly people

Interviews with a small group of nurses working in a primary nursing ward were content analysed using the Ethnograph computer program. In response to some very general questions about their views of primary nursing, the respondents talked at some length about their improved knowledge of patients, about better communication, about their relationships with patients and relatives and about personal responsibility. They did not talk spontaneously about controlling their own practice, decision-making, autonomy or accountability. Such terms did not form part of their vocabulary in describing their work though these issues were raised obliquely in the conversations. The value of the change in the way of organizing the delivery of nursing care was seen more in terms of its potential for developing therapeutic relationships rather than in terms of personal professional development. Increased knowledge of and responsibility for specific patients coupled with the greater continuity of care they were able to provide, gave them greater job satisfaction than they had previously experienced.

Towards defining the organization of nursing care in hospital wards: an empirical study

The method of organizing nursing care known as 'primary nursing' is increasingly being introduced into hospital wards on the assumption that it will have beneficial effects for both patients and staff. Operational definitions of primary nursing, essential to provide replicable research into the organization of nursing care, are, however, lacking in available research literature. This study describes the development of a questionnaire intended to identify and discriminate between three methods of organizing nursing staff and nursing work: task allocation or functional nursing, team nursing and primary nursing. The questionnaire was distributed to 36 ward sisters on 27 acute and rehabilitation care of the elderly wards. Questionnaires were returned from 17 wards, a response rate of 63%. Findings indicate that few wards meet five or more criteria for classification as a particular method of nursing organization. The findings illustrate the difficulties in matching and discriminating between wards in order to conduct research in which organizational modality is an independent variable.

The work style of students of mental health nursing undertaking the Project 2000 schemes of training: a logical analysis

The work methods of students of mental health nursing are analysed to see which are best suited to facilitate the central educational aims of the Project 2000 schemes of training. Supervised primary nursing is found to be best because it engenders a professional cognitive style and a heightened sensitivity to the empirical, research-based culture. It is argued that team nursing causes, in its practitioners, a bureaucratic cognitive style, which acts as a structural constraint upon the learning and mastery of the process skills advocated by the Project 2000 authors.