The Impact of the Primary Nursing Model on Cultural Improvement: A Mixed-Method Study

Patientinnen- und patientenbezogene Auswirkungen von prozessverantwortlicher Pflege

Background

Since January 2022, a primary nursing system called process-responsible nursing (PP) has substituted the standard room care system in an intensive care unit (ICU) at our institution. The process of the development and implementation of PP is already being evaluated in a separate study as an actual analysis prior to implementation, as well as after 6 and 12 months.

Aim

This pilot randomized controlled trial (RCT) aims to test the feasibility of an RCT. For this purpose, the duration of delirium, among other things, will be compared in the project ICU with the results of standard care in another ICU at the university hospital. As secondary aims, the incidence of delirium, anxiety, the satisfaction of relatives, and the effects of PP on nurses will be assessed.

Methods

It is planned to recruit about 400–500 patients over a period of one year. They will be allocated to PP or standard care. Delirium will be assessed using the Confusion Assessment Method for Intensive Care Units by specifically trained nurses three times a day. Anxiety in patients, the satisfaction of relatives, and the effects of PP on nurses will be evaluated using the numeric rating scale, a standardized questionnaire, and a focus group interview, respectively.

Expected results

The primary hypothesis is that compared to usual care PP reduces the duration of delirium by at least 8 h. Additional hypotheses are that PP reduces anxiety in patients and increases the satisfaction of relatives.

[The Neumarkt concept of nursing case responsibility: A framework for consequent and person-centred realization of the nursing process]

The Neumarkt concept of nursing case responsibility: A framework for consequent and person-centred realization of the nursing process Abstract. Background: An essential requirement for the realization of person-centred practice is a practice environment, that supports the forming of professional nurse-patient-relationships. Therefore, Klinikum Neumarkt implemented in context of practice development a concept for nursing case responsibility, that offers a framework for a person-centred and systematic coordination of the nursing process. Because of the existing conflict between economic and nursing interests, it is essential to prove the effectiveness of the concept. Aim: Our aim was the exploration of the effects of the concept implementation from the patient's as well as the interprofessional team's perspective, including the economic implications. Methods: The multiperspective evaluation was conducted with individual interviews and an economic analysis of hospital routine data. Results: The patients and the interprofessional team perceive a person-centred care and coordination of the nursing process. They also point out the required resources. The economic results show a significantly increased revenue through better documentation of complex nursing situations of patients included in the concept (Odds ratio: 4.00, 95%-Confidence Interval [2.15; 8.01], p < 0.001). Discussion: The results provide evidence of the efficacy of the concept for a systematic, person-centred coordination of the nursing process and justify an increased use of resources needed. Limitations and transfer: The implementation of the concept is a drastic change for everyone involved and needs to be embedded in a strategic practice development.

Exploring hospital compliance with the primary nursing care model: validating an inventory using the Delphi method

Background

The primary nursing care model is considered a personalized model of care delivery based on care continuity and on the relationship between the nurse and patient. Primary nursing checklists are not often mentioned in the literature; however, they represent a valid instrument to develop, implement, and evaluate primary nursing. The aim of this study was to create a structured checklist to explore hospital compliance in primary nursing.

Methods

The Delphi method was used to develop and validate a checklist. The preliminary version was created and sent to three experts for their opinions. Their comments were ultimately used in the first version, which included four components with 19 items regarding primary nursing characteristics. A two-round Delphi process was used to generate consensus items. The Delphi panel consisted of six experts working in primary nursing contexts and/or teaching or studying primary nursing. Data were collected using a structured questionnaire from July 2020 to January 2021. These experts were asked to rate each element for relevance using a 4-point Likert-type scale. Furthermore, the consensus among the panel of experts was set at ≥78%, with selected items being voted “quite relevant” and “highly relevant”. Content validity index (I-CVI) and modified kappa statistic were also calculated. Following expert evaluation, the first version of the checklist was modified, and the new version, constituting 17 items, was sent to the same experts.

Results

The first version of the checklist demonstrated a main relevance score of 3.34 (SD = 0.83; range = 1.3–4; mean I-CVI = 0.84; range: 0.83–1), but three items did not receive an adequate I-CVI score, that is, lower than 0.78. After the second round, the I-CVIs improved. The main score of relevance was 3.61 (SD: 0.35; range = 2.83–4; mean = I-CVI: 0.93). The S-CVI/UA was 0.58, and the S-CVI/Ave was 0.93.

Conclusion

Measuring primary nursing compliance should be implemented to provide continuous feedback to nurses. Moreover, utilizing valid checklists could permit comparing different results from others’ research. Future research should be conducted to compare the results from the checklist with nursing outcomes.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12912-021-00712-1.

Work Methods for Nursing Care Delivery

This article analyzes the work methods based on care design, identification of needs, care organization, planning, delivery, evaluation, continuity, safety, and complexity of care, and discharge preparation. It describes the diagnosis of the situation, goal setting, strategy selection, implementation, and outcome evaluation that contribute to adopting a given work conception and/or method for nursing care delivery. Later, the concepts underlying the several methods—management theories and theoretical nursing concepts—are presented, with reference to relevant authors. The process of analysis and selection of the method is explained, highlighting the importance of diagnosis of the situation, goal setting, strategy selection, implementation, and outcome evaluation. The importance of various elements is highlighted, such as structural aspects, nature of care, target population, resources, and philosophy of the institution, which may condition the adoption of a method. The importance of care conceptualization is also underlined. The work methods are presented with a description of the key characteristics, advantages, and disadvantages of the task-oriented method (functional nursing) and patient-centered methods: individual, team nursing, and primary nursing. A critical and comparative analysis of the methods is then performed, alluding to the combination of person-centered methods.

The Impact of Health Human Resources Policies in Primary Care Nursing: A Qualitative Study

BACKGROUND

Organizational culture plays a key role regarding organizational outcomes and determining strategies, goals, and modes of operating which is associated with higher rates of worker morale, turnover and lower adverse events related to patient quality of care issues.

AIM

to describe the impact of the relocation of nurses from hospitals and other contexts to primary care from the perspective of primary care nurses.

METHODS

A qualitative, focused ethnographic study. Site: Cantabro Health Service, Cantabria, Spain. Purposeful sampling methods were used to include nurses who were working in primary care during the study, and who had previous experience of at least one year in primary care. Observation (385 hours, 7 months) and in-depth interviews (17) were used to collect data. A thematic analysis was applied.

RESULTS

Four themes emerged from the data: a) staff policies applied, b) beliefs regarding the newly incorporated nursing staff, c) reasons for relocation to primary care, and d) concern for the future.

CONCLUSIONS

In primary care, the relocation of non-qualified nursing professionals who are at the end of their career may have a negative impact on the organizational culture. It is necessary to research the most appropriate measures for guaranteeing a satisfactory work environment based on nurses who are qualified in primary health care settings.

Adaption, benefit and quality of care associated with primary nursing in an acute inpatient setting: A cross-sectional descriptive study

AIMS

The aim of this study was to investigate the adoption of primary nursing and to determine the quality of primary nurse-led care in an acute inpatient setting.

DESIGN

Descriptive cross-sectional study.

METHODS

Participants included inpatients (N = 369) and nurses (N = 381). To assess adoption of primary nursing, patient records were analysed and an online survey of nurses was conducted from May-June 2017. To measure quality of nursing care, a structured questionnaire was administered to inpatients.

RESULTS

Patients reported high quality of individualized, responsive and proficient care, but lower levels of coordinated care. Most nurses agreed that primary nursing is beneficial for person-centred caring. However, only two-thirds found that it was practiced on their unit and only half of care planning activities were attributable to primary nurses.

CONCLUSION

While perceived as beneficial, adoption of primary nursing in clinical practice remains partial. Hence, primary nursing may not be enough to ensure continuity and coordination of acute care.

Nursing considerations and interdisciplinary coordination in the care of conjoined twins

Traditional nursing care strategies may require modification to meet the unique needs of conjoined twins. Here we discuss the strategies found to be useful in planning for and responding to distinctive circumstances encountered throughout hospitalization, as well as lessons learned. Areas of focus include ensuring privacy, designing adequate unit accommodations to meet space and equipment needs, staffing considerations and adaptations to typical neonatal intensive care nursing interventions. The utility of a team-based approach to interdisciplinary care coordination is also discussed. With adequate preparation and thoughtful innovation, most tertiary neonatal intensive care units can readily adapt to the unique needs of conjoined twins.