The impact of primary nursing care pattern: Results from a before-after study

Abstract

Aims and objectives: To explore the effect of "Primary Nursing" on nursing-sensitive patient outcomes, staff-related outcomes and organisation-related outcomes.

Background: Primary nursing is one example of a care pattern that has recently been implemented in many countries.

Design: Before-after study.

Methods: This study was conducted in an Italian hospital. We observed patient-related outcomes (pressure ulcers, falls, urinary tract infection and venous catheter infection) in 2,857 inpatients before the implementation of primary nursing and in 3,169 inpatients after its implementation. Staff-related outcomes (nursing competence and diagnostic thinking) and organisation-related outcomes (empowerment and team climate) were collected from 369 nurses. From a subgroup of inpatients, we collected data regarding their satisfaction with the care provided.

Results: After the implementation of primary nursing, some nursing competencies and diagnostic thinking were improved, so were organisation-related outcomes. Our data showed that the number of inpatients with urinary catheter infections (5.5% vs. 4.3%) and venous catheter infections (peripheral: 2.2% vs. 1%; central: 5.6% vs. 1%) was significantly decreased; also, the numbers of falls (2.4% vs. 1.9%) and pressure ulcers (4.8% vs. 4%) decreased, although these decreases were not statistically significant. Overall, the implementation of primary nursing increased patient satisfaction with nursing care (193.57 vs. 210.21).

Conclusions: Primary nursing improved staff-related outcomes, nursing-sensitive patient outcomes and organisation outcomes.

Relevance to clinical practice: Our results show that primary nursing has the potential to positively impact on inpatients, nurses and organisations. Moreover, the implementation of this care pattern is feasible.

Keywords: nursing care pattern; nursing-sensitive patient outcomes; primary nursing; satisfaction with care; staff-related outcomes.