The Effects of the Primary Nursing Care Model: A Systematic Review

Abstract

Background: 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 1980s, 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. Objective: To describe the effects of the primary nursing model for patients, their family members, nursing staff and the care organization. Design: A systematic literature review. The studies selected for review (n=9) were appraised for quality using the Quality Assessment Tool for Quantitative Studies, as developed by the Effective Public Health Practice Project. Data sources: The research data were collected from four databases from January 1990 to March 2013. Results: Research on the effects of the primary nursing model has largely been restricted to the effects for patients and nursing staff. No data are available on how it affects the patient's family members or the care organization. The preliminary evidence suggests that the primary nursing model may have beneficial effects for patients in the context of maternity care. There is less evidence of the primary nursing model's positive effects for nursing staff. However, it is possible that the model contributes to an increased sense of job control and autonomy. Conclusion: The existing body of research has methodological shortcomings, and more RCT studies are needed to establish the effects of the primary nursing model, for instance on the organization's costs, nurses' job satisfaction and staff retention. 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.

Nurses’ views on hospital organizational characteristics

“…Although it is a patient-centered model and supports nurse professionalism and autonomy, nurses dislike the primary nursing system. 31 Nurses in this study reported their limited autonomy, which could explain why they dislike the primary nursing system. Nurses dislike the total patient care and team nursing systems.…”

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

“…Models of care delivery, such as primary nursing, which allow nurses to engage in relationshipbased interactions with patients to plan and coordinate care over time, are considered essential to fight fragmentation and to achieve quality, person-centred nursing care (Manthey, 2003;Tiedeman & Lookinland, 2004). While primary nursing has been utilized in many different care settings around the globe over several decades, its research base remains relatively modest, with most studies published in the last century (Hoffmann Kusk & Groenkjaer, 2016;Mattila et al, 2014). Consequently, there is a need to extend research-based insights into the way primary nursing has been implemented in acute inpatient settings and to discern its association with quality of person-centred nursing care.…”

“…Primary nursing has been linked with quality and satisfaction with care, improved job satisfaction and reduced cost of care (Hoffmann Kusk & Groenkjaer, 2016;Hongwei, Senqi, Thobaben, Yanwen, & Tao, 2011;Mattila et al, 2014). For instance, research reports greater nurse understanding of patients, more concern and communication with families, increased information giving, greater considerations for discharge planning and higher contribution to overall positive hospitalization experience on units utilizing primary nursing versus control units or baseline (Frohlich, Becker, Handel, & Spirig, 2013;Sellick, Russell, & Beckmann, 2003).…”

“…Primary nurses have found their work to be more meaningful and satisfying (Dal Molin et al, 2018;Ferrua et al, 2016;Nadeau, Pinner, Murphy, & Belderson, 2017). However, research-based evidence around primary nursing remains controversial and inconclusive (Choi et al, 2013;Hoffmann Kusk & Groenkjaer, 2016;Mattila et al, 2014). Given the widespread use and acceptance of primary nursing as a model of care delivery that ensures person-centred, coordinated and continuous care, its evidence base is relatively limited (Fernandez, Johnson, Tran, & Miranda, 2012).…”

“…Moreover, uptake of primary nursing in acute settings has been reported to be inconsistent and unstructured (Goode & Rowe, 2001;Korhonen & Kangasniemi, 2013). Given the rapid changes in the way health care is delivered today to meet patients' and their families' needs, the conception of primary nursing has been surprisingly constant (Jost, Bonnell, Chacko, & Parkinson, 2010;Mattila et al, 2014). Thus, research that investigates the implementation of primary nursing in acute care settings and its relationship to person-centred quality of care, including achieved coordination and continuity of care, is necessary.…”