The E ec s o he P ima y Nu sing Ca e Model: A Sys ema ic Re iew
Elina Ma ila1*, Anneli Pi känen2, Seija Alanen3, Kaija Leino4, Ka ja Luojus5, Anja Ran anen6 and Pi jo Aal o7
1Di ec o o Nu sing, Tampe e Uni e si y Hospi al, Tampe e, Finland.
2Di ec o o Nu sing, Pi kanmaa Hospi al Dis ic , Tampe e Uni e si y Hospi al, Tampe e, Finland.
3Di ec o o Nu sing, Depa men o Neu osciences and Rehabili a ion, Tampe e Uni e si y Hospi al, Tampe e, Finland.
4Di ec o o Nu sing, Di ision o Su ge y, Gas oen e ology and Oncology, Tampe e Uni e si y Hospi al, Tampe e, Finland.
5P ojec Manage , TAITO p ojec , Pi kanmaa Hospi al Dis ic , Tampe e Uni e si y Hospi al, Tampe e, Finland.
6Pos doc o al esea che , School o Heal h Sciences, Nu sing Science, Uni e si y o Tampe e, Tampe e, Finland.
7Chie Nu sing Di ec o , Adminis a ion Cen e , Pi kanmaa Hospi al Dis ic , Tampe e Uni e si y Hospi al, Tampe e, Finland.
*Co esponding au ho : Elina Ma ila, PhD, Di ec o o Nu sing, Di ision o Su ge y, Gas oen e ology and Oncology, Tampe e Uni e si y Hospi al, POB 33610
Tampe e, Finland; Tel: +358 50 3130373, Fax: +358 3 31164358, E-mail: [email p o ec ed]
Recei ed da e: Ap il 16, 2014, Accep ed da e: Sep embe 24, 2014, Publica ion da e: Sep embe 26, 2014
Copy igh : © 2014 Ma ila E, e al. This is an open-access a icle dis ibu ed unde he e ms o he C ea i e Commons A ibu ion License, which pe mi s un es ic ed
use, dis ibu ion, and ep oduc ion in any medium, p o ided he o iginal au ho and sou ce a e c edi ed.
Abs ac
Backg ound: Nu sing ca e models p o ide he in as uc u e o o ganizing and deli e ing ca e o pa ien s and
amilies. O e he decades, di e en models ha e waxed and waned. Since he 1980s, he p ima y nu sing model
has gained inc easing p ominence. Howe e , he e is no sys ema ic esea ch e idence on he e ec s o his model
o pa ien s, hei amily membe s, nu sing s a o he ca e o ganiza ion. This subjec has much cu en ele ance
because o he equi emen o de elop e idence-based nu sing ca e.
Objec i e: To desc ibe he e ec s o he p ima y nu sing model o pa ien s, hei amily membe s, nu sing s a
and he ca e o ganiza ion.
Design: A sys ema ic li e a u e e iew. The s udies selec ed o e iew (n=9) we e app aised o quali y using he
Quali y Assessmen Tool o Quan i a i e S udies, as de eloped by he E ec i e Public Heal h P ac ice P ojec .
Da a sou ces: The esea ch da a we e collec ed om ou da abases om Janua y 1990 o Ma ch 2013.
Resul s: Resea ch on he e ec s o he p ima y nu sing model has la gely been es ic ed o he e ec s o
pa ien s and nu sing s a . No da a a e a ailable on how i a ec s he pa ien ’s amily membe s o he ca e
o ganiza ion. The p elimina y e idence sugges s ha he p ima y nu sing model may ha e bene icial e ec s o
pa ien s in he con ex o ma e ni y ca e. The e is less e idence o he p ima y nu sing model’s posi i e e ec s o
nu sing s a . Howe e , i is possible ha he model con ibu es o an inc eased sense o job con ol and au onomy.
Conclusion: The exis ing body o esea ch has me hodological sho comings, and mo e RCT s udies a e needed
o es ablish he e ec s o he p ima y nu sing model, o ins ance on he o ganiza ion’s cos s, nu ses’ job sa is ac ion
and s a e en ion. Fu he esea ch is also needed in o he e ec s o he p ima y nu sing model on nume ically
measu able ou comes, such as medica ion e o s du ing hospi al ca e and he leng h o ea men pe iods.
Keywo ds: Ca e model; E alua ion;, P ima y nu sing; Sys ema ic
e iew
In oduc ion
Heal h ca e a ound he wo ld is unde moun ing p essu e o
imp o e e iciency, o manage cos s, o documen he me hods used
and o demons a e he e ec i eness o hose me hods [1]. Hospi als,
o ins ance, a e ha ing o wo k o imp o e pa ien lows, educe he
amoun o ime ha pa ien s spend in hospi al and o use mo e
bedside echnology [2]. I is also equi ed ha e idence be p oduced o
he me hods ha a e used in heal h ca e [3]. The de elopmen o
e idence-based nu sing equi es c i ical app aisal o he esea ch
e idence and in eg a ion o ha e idence wi h nu ses’ clinical
expe ience and pa ien expec a ions. The o ganiza ion’s cu en
inancial posi ion also comes in o play [4,5]. Pa ien s a e be e
in o med abou hei ca e and medica ion han be o e, and hey expec
o ecei e high quali y and e ec i e ca e [3,6]. Nu sing s a , o hei
pa , expec o ha e a high le el o job au onomy and o be able o pu
hei skills and compe encies o he bes possible use. The need o
app aise nu sing ca e deli e y models is u he unde sco ed by
p oblems wi h he a ailabili y o nu sing s a and he challenges o
s a e en ion [2,6].
Nu sing ca e models p o ide he in as uc u e o o ganizing and
deli e ing ca e o pa ien s and amilies [7]. They also e lec he
philosophical ounda ion o pa ien ca e as well as he p e ailing
o ganiza ional cul u e [8,9]. Nu sing ca e is based on he changing
needs and si ua ion o each indi idual pa ien [6]. The ocus o adul
pa ien ca e has shi ed inc easingly om he indi idual pa ien o also
in ol ing hei amily membe s [10]. Pa ien ca e equi es inc eased
Nu sing and Ca e Ma ila e al., J Nu s Ca e 2014, 3:6
h p://dx.doi.o g/10.4172/2167-1168.1000205
Resea ch A icle Open Access
J Nu s Ca e
ISSN:2167-1168 JNC, an open access jou nal Volume 3 • Issue 6 • 1000205
planning, in e ac ion and mul i p o essional collabo a ion [6,11]. The
model o ca e deli e y also a ec s nu sing s a numbe s, he lexible
use o s a esou ces and he e o e he o ganiza ion’s cos s [6]. O e
he decades, he nu sing models applied ha e anged om
Nigh ingale’s case me hod o he cu en ly a ou ed p ima y nu sing
and ela ionship-based ca e models [9,12,13]. Howe e , we s ill ha e
no i m e idence abou he e ec s o hese models o pa ien s, hei
amily membe s, nu sing s a and he ca e o ganiza ion o abou he
ou comes o nu sing [14].
Unde he p ima y nu sing model, pa ien ca e is he esponsibili y
o a named nu se o he du a ion o he pa ien ’s hospi al s ay. This
means ha he planning and implemen a ion o ca e p ima ily akes
place be ween he pa ien and named nu se [15-17]. The same nu se
assumes o e all esponsibili y o pa ien ca e and is answe able o he
pa ien , he pa ien ’s amily and o he colleagues [15,18]. Howe e ,
he named nu se does no wo k alone bu wo ks closely wi h
colleagues and o he p o essional g oups [18,19]. The p ima y nu se
delega es he esponsibili y o he pa ien ’s ca e o associa e nu ses
when o du y [14,20]. Wa ds o ganized on he p inciples o p ima y
nu sing ha e a la o ganiza ional s uc u e because pa ien ca e is
equally sha ed be ween nu ses [6].
The p ima y nu sing model is widely implemen ed since i has been
conside ed o be an ideal way o o ganizing nu sing ca e deli e y. I is
g ounded in a pa ien -cen ed app oach and i suppo s nu ses’
p o essionalism, au onomy, b oad job desc ip ions and independen
decision-making [8,15]. The key is ha nu ses a e d i en o add ess
pa ien needs in hei wo k, a he han pe o m speci ic job asks
unde gi en unc ional s uc u es.
The p ima y nu sing model has con inued o be olled ou widely
since i was i s de eloped in he Uni ed S a es in he la e 1960s [18].
I has been implemen ed, o example, in Canada [21], China [22], he
Uni ed Kingdom [8], he Ne he lands [23] and Finland [24]. In he
Uni ed S a es, he model is pa icula ly a ou ed in hospi als wi h
magne s a us [25].
Findings om P e ious S udies
The e idence om ea lie esea ch in o p ima y nu sing is la gely
desc ip i e and much o i is ou da ed. Some o he esul s a e
con adic o y. A p e ious sys ema ic e iew co e ed s udies published
be ween 1975 and 1990 [26]. In hese s udies we e conside able
a ia ions in he de ini ion o he p ima y ca e concep and he way
p ima y ca e was implemen ed. Also, he measu es used o assess he
e ec o p ima y ca e model di e ed a lo . Thus, making eliable
conclusions, o inding a gene alizing esul , was no possible [26].
Howe e , he consensus seems o be ha p ima y nu sing ca e is
bene icial o pa ien s in ha i is conduci e o mo e indi idually
ailo ed ca e and o he con inui y o ca e. I also gi es pa ien s mo e
chance o ake pa in he planning and implemen a ion o ca e
[17,27,28]. Fu he mo e, he model suppo s inc eased
communica ion be ween he people in ol ed in pa ien ca e as well as
mo e accu a e in o ma ion abou he pa ien [27,29,30]. I has also
been shown ha p ima y nu sing co ela es posi i ely wi h pa ien
expe iences o access o suppo [31–33] and a sense o indi idual ca e
and a en ion [34]. Finally, he e idence sugges s ha p ima y nu sing
is posi i ely associa ed wi h pa ien s’ men al well-being and hei
sa is ac ion wi h he ca e p o ided [29,35,36]. On he o he hand, i is
epo ed ha p ima y nu sing does no imp o e pa ien s’ pe cep ions
o he quali y o ca e [37].
Ea lie esea ch has also shown a posi i e co ela ion be ween
p ima y nu sing and nu se expe iences o job au onomy and
independen decision-making [27,30,38,39], job sa is ac ion,
p o essional g ow h, imp o ed p o essional coope a ion in he
wo kplace [16,39] and educed wo k- ela ed s ess [40,41]. On he
o he hand, i has also been epo ed ha p ima y nu sing ac ually
inc eases wo k- ela ed s ess [30]. Fu he mo e, he e idence is ha
nu ses wo king in p ima y nu sing con ex s spend mo e ime alking
wi h pa ien s and colleagues han nu ses in o he ca e deli e y se ings
[27,42]. Many s udies ha e indica ed ha p ima y nu ses ha e mo e
job au onomy and a e mo e commi ed o hei wo k han ask-
o ien ed and eam wo king nu ses [28,30,43]. The p ima y nu sing
model also educes nu ses’ expe iences o s ess and seems o be
conduci e o a mo e posi i e wo kplace communi y [16,38–40]. A
ecen e iew sugges s ha he p ima y nu sing model inc eases le els
o s a e en ion in he wo k uni [44].
The p e iously men ioned li e a u e e iew co e ed s udies on he
e ec s o he p ima y nu sing model ha we e published be ween
1975-1990 [26]. To he bes o ou knowledge, a e 1991 he e exis s
no sys ema ic e iew o he esea ch e idence on he e ec s o p ima y
nu sing o pa ien s, hei amily membe s, nu sing s a and he ca e
o ganiza ion. Gi en he cu en commi men o de eloping e idence-
based nu sing, his is a subjec o much cu en in e es . This s udy
e iews he ea lie li e a u e and on his basis discusses he e ec s
achie ed wi h he use o he p ima y nu sing model.
Pu pose o he s udy
This s udy e iews he scien i ic li e a u e on he e ec s o he
p ima y nu sing ca e model o pa ien s, hei amily membe s,
nu sing s a and he ca e o ganiza ion.
Me hods
Sea ch s a egy
The li e a u e was sea ched in wo s ages. Fi s , a limi ed sea ch o
CINAHL used he ollowing sea ch e ms: p ima y nu sing, p ima y
nu se and named nu se. This sea ch was unde aken o ind addi ional
keywo ds. A second sea ch using all he iden i ied keywo ds (p ima y
nu sing, p ima y nu se, named nu se, own ca e wo ke , designa ed
nu se) and he sea ch e m “ andom alloca ion”, “ andom sample”,
“ andomized con olled”, “quasi expe imen al”, “clinical ial”,
“e alua ion s udy”, “ alida ion s udy” o “p e es –pos - es ”, was hen
unde aken by he e iewe (AP) oge he wi h an in o ma ion
specialis ac oss he ollowing elec onic bibliog aphic da abases:
CINAHL, he Coch ane Lib a y and Medline(Figu e 1).
Ci a ion: Ma ila E, Pi känen A, Alanen S, Leino K, Luojus K e al. (2014) The E ec s o he P ima y Nu sing Ca e Model: A Sys ema ic Re iew. J
Nu s Ca e 3: 205. doi:10.4172/2167-1168.1000205
Page 2 o 12
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ISSN:2167-1168 JNC, an open access jou nal Volume 3 • Issue 6 • 1000205
Figu e 1: Flowcha o he li e a u e selec ion p ocess.
C i e ia o inclusion
S udy ypes
Randomized con olled ials, non- andomized con olled ials and
be o e-and-a e s udies we e selec ed o inclusion in he e iew. Only
ex s w i en in English and published be ween Janua y1990 and
Ma ch 2013 we e conside ed. The sea ch pe iod was es ic ed o he
las 23 yea s in which he p ima y nu sing model has been olled ou
in e na ionally [8,28] and du ing which ime he e ha e been majo
undamen al changes in heal h ca e deli e y [45,46]. I was
u he mo e equi ed ha he da abase included an abs ac o he
a icle.
In e en ions
The e iew ocused on s udies ha e alua ed p ima y nu sing as a
ca e model. Unde his model ca ing is based on a one- o-one
ela ionship whe e each pa ien is assigned a speci ic p ima y nu se
who assumes 24-hou esponsibili y and accoun abili y o pa ien s
du ing hei s ay in ca e [13,14].
Ou comes
All ou comes conce ning pa ien s, hei amily membe s, s a and
he ca e o ganiza ion we e conside ed.
S udy selec ion
A e he emo al o duplica es, wo au ho s (AP, KLe/SA)
independen ly sc eened he i les o he s udies. S udies ha we e
Ci a ion: Ma ila E, Pi känen A, Alanen S, Leino K, Luojus K e al. (2014) The E ec s o he P ima y Nu sing Ca e Model: A Sys ema ic Re iew. J
Nu s Ca e 3: 205. doi:10.4172/2167-1168.1000205
Page 3 o 12
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ISSN:2167-1168 JNC, an open access jou nal Volume 3 • Issue 6 • 1000205
clea ly no ele an based on hei i le we e excluded. Nex , he
abs ac s o he emaining s udies we e a ed as ei he “ ele an ”,
“unce ain” o “i ele an ”, based on he inclusion c i e ia. In cases
whe e i was no en i ely clea whe he he s udy desc ibed
in e en ions ele an o his e iew, he s udy was included. Finally,
s udies a ed as ele an o unce ain we e ead in ull and sc eened
based on he inclusion c i e ia. Doub ul i les, abs ac s and ull
a icles we e discussed among he au ho s (Figu e 1).
Da a ex ac ion
Da a we e ex ac ed om each pape included in he e iew by wo
au ho s (AR, EM/KLu) independen ly. These da a included speci ic
de ails abou in e en ions, s udy me hods, pa icipan s and ou comes
o signi icance o he e iew.
Quali y app aisal
The a icles we e assessed o quali y using he E ec i e Public
Heal h P ac ice P ojec (EPHPP) Quali y Assessmen Tool o
Quan i a i e S udies c i e ia (h p://www.ephpp.ca/ ools.h ml), which
conside quali y om six pe spec i es: 1) selec ion bias, 2) s udy
design, 3) con ounde s, 4) blinding, 5) he da a collec ion me hod and
6) wi hd awals and d opou s. Based on he o al sco es om hese
pe spec i es, he quali y o each s udy was classi ied as s ong,
mode a e o weak.
Quali y was assessed o ele en a icles ha me he inclusion
c i e ia. Two o he h ee esea che s (AR, EM, KLu) independen ly
assessed he quali y o each s udy be o e he app aisals we e compa ed.
In cases whe e o al sco es di e ed, he esea che s discussed hei
assessmen s un il hey eached ag eemen on he mos app op ia e
sco e. Based on he EPHPP c i e ia, h ee o he a icles e iewed we e
a ed as s ong in quali y [21,22,47],six as mode a e in quali y
[23,28,39,48–50] and wo as weak in quali y [51,52].Nine a icles we e
included in he sys ema ic li e a u e e iew (Table 1).
A icle Selec ion
bias
S udy
Design
Con ounde s Blinding Da a collec ion
me hod
Wi hd awals and
d opou s
Final decision
A mi age e al. [51] 2 2 2 3 3 3 3
Boumans and
Landewee d[23]
2 2 1 3 2 2 2
Gagnon e al. [21] 2 1 1 2 2 1 1
Ga dne [29] 2 2 2 2 2 3 2
Ga dne and Tilbu y [48] 2 2 2 2 2 3 2
McPhail e al. [52] 3 2 3 3 3 2 3
Melchio e al. [47] 2 1 2 1 1 1 1
Melchio e al. [28] 1 2 2 3 1 2 2
Shields e al. [49] 2 1 2 2 1 2 2
Spu geon e al. [50] 2 2 2 2 3 2 2
Wan e al. [22] 1 1 1 2 2 2 1
Table 1: EPHPP quali y app aisal.
1 = s ong, 2= mode a e, 3= weak
Da a analysis
Because o he wide di e si y o ypes o in e en ions and ou come
measu es, i was decided ha a quan i a i e syn hesis o he da a would
no be jus i ied and migh be misleading [53]. Ins ead, con en analysis
o he in e en ions was based on a desc ip i e me hod [54].
Desc ip ion o he da a
S udies ocusing on pa ien s we e conduc ed in su gical, medical,
o hopaedic and ma e ni y con ex s [21,22,39,49,50], while s udies
conce ned wi h nu sing s a we e conduc ed on su gical, medical and
o hopaedic wa ds [23,39], as well as psychia ic wa ds [28,47].In
s udies which ha e ocused on he o ganiza ion [39,48], p ima y
nu sing and eam nu sing we e compa ed by each model`s nu sing
cos s pe pa ien , pe day. The cos included he sala ies and inge
bene i s o he di ec ca e p o ide s and suppo pe sons. In addi ion,
he diagnosis ela ed g oup (DRG) cos was calcula ed by leng h o
s ay. None o he s udies deal wi h pa ien s’ amily membe s. Th ee o
he s udies used RCT designs [21,22,49], he emaining ou we e
in e g oup p e-pos measu emen s wi h con ol g oups [28,47,50] o
wi hou hem [22,39,48]. Sample sizes in expe imen al g oups anged
om 49 o 917 and in con ol g oups om 50 o 651. Response a es
anged om 41 o 100%, and he in e en ions las ed om se en
mon hs o ou yea s. Two s udies [49,50] did no epo he du a ion
o he in e en ion (Table 2). The mean age o he people aking pa
in he s udies was be ween 20 and 60, and mos o hem we e women.
The mean age o nu sing s a was be ween 31 and 35, and hei mean
pe iod o wo k expe ience was 10–13 yea s.
Desc ip ion o he in e en ions
The p ima y nu sing models examined in he s udies, and he
in e en ions h ough which hey we e implemen ed, we e qui e
he e ogeneous. In one s udy he impac o he p ima y nu sing model
Ci a ion: Ma ila E, Pi känen A, Alanen S, Leino K, Luojus K e al. (2014) The E ec s o he P ima y Nu sing Ca e Model: A Sys ema ic Re iew. J
Nu s Ca e 3: 205. doi:10.4172/2167-1168.1000205
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ISSN:2167-1168 JNC, an open access jou nal Volume 3 • Issue 6 • 1000205
was examined in a gene al hospi al [23] and in wo s udies in
psychia ic hospi als [28,47] in he Ne he lands. The emaining six
s udies [21,22,39,48–50] we e conduc ed in Canada, he USA,
Sco land, England and China, in di e en nu sing con ex s.
In an ea lie s udy p ima y nu sing was implemen ed in a Du ch
model whe e p ima y nu sing uni s we e di ided in o wo eams, each
o which had wo egis e ed nu ses esponsible o a g oup o abou six
pa ien s [23]. This alloca ion o pa ien s las ed o one wo k shi , i e
days a week. Acco ding o he au ho s, he nu sing p ocess was he
basis o p ac ice. Implemen a ion o his p ima y nu sing model was
based on in-se ice aining, on- he-job aining and s a
de elopmen ac i i ies aimed a imp o ing nu ses’ skills in planning,
coo dina ion, e alua ion and ca e p o ision [23].
In he US s udy he in e en ion consis ed o he implemen a ion o
he nu sing models o p ima y uni s ( wo) and eam uni s ( wo) in
medical ca e con ex s. The concep s o p ima y nu sing we e
ope a ionalized using exis ing li e a u e [39]. P ima y nu sing and
eam nu sing models we e also implemen ed in a medical ca e con ex
[48].
In wo s udies [28,47] p ima y nu sing was implemen ed in a
psychia ic ca e con ex . The con en o p ima y nu sing was
desc ibed o be based on he gene al p inciples o p ima y nu sing. In
his case bo h psychia ic and p ac ical nu ses we e assigned as named
nu ses o pa ien s based on he complexi y o ca e. Nu se manage s o
quali y ca e co-o dina o s we e ac i ely in ol ed in o de o p o ide
eedback, suppo and ad ice, and o p omo e communica ion
be ween p ima y nu ses and o he heal h ca e specialis s. P ima y
nu ses we e also en olled in a aining p og amme ocusing on
communica ion skills [28,47].
The ou models applied in he con ex o midwi e-led ca e di e ed
om each o he mos pa icula ly in he leng h o he ca e p ocess. In
wo models [49,50] he named midwi e o associa e nu se was
esponsible o ca e p o ision om he an ena al o pos na al pe iods,
and in he o he wo models [21,22] only du ing hospi aliza ion. In he
wo s udies, midwi es wo ked o a sha ed philosophy emphasizing
con inui y o ca e, in o ma ion and choice, and in o med ca e
planning [49,50]. In he o he s udy he usual one- o-one nu sing ca e
was en iched by he p o ision o physical com o , emo ional suppo ,
and ins uc ion on elaxa ion o women and suppo o a he s.
Nu ses we e in cha ge o con ac ing a physician o anes hesiologis
when app op ia e [21]. One s udy claimed ha he con inuous
p ima y nu sing ca e hey implemen ed is based on, and goes beyond,
p ima y nu sing since i con inues wo weeks a e discha ge [22]. The
p ac ical implemen a ion o he in e en ions is only desc ibed in one
s udy [21]. In ha s udy, nu ses had a 30-hou aining pe iod and
qua e ly e eshe wo kshops [21].
Resul s
E ec s o pa ien s
Sa is ac ion wi h ca e
Th ee o he s udies e iewed we e conce ned wi h he associa ions
be ween p ima y nu sing and pa ien s’ sa is ac ion wi h ca e. These
s udies ocused on p egnan , childbea ing and newly deli e ed
mo he s [22,49,50].
Pa ien sa is ac ion was assessed based on pa ien –nu se
ela ionships, in o ma ion ans e , social suppo , con inui y o ca e,
in ol emen in decision-making and chances o choose di e en ca e
op ions. Pa ien s in bo h he expe imen al and con ol g oups we e
sa is ied wi h he ca e hey ecei ed [49]. Howe e , pa ien s in he
expe imen al g oup, whe e ca e deli e y was based on he p ima y
nu sing model, we e a all s ages signi ican ly mo e sa is ied wi h hei
ca e on all dimensions. Expe imen al g oup pa ien s we e signi ican ly
mo e sa is ied han con ol g oup pa ien s wi h he ca e hey ecei ed
du ing p egnancy weeks 34–35 (p<0.0001), du ing deli e y
(p=0.0005), a e deli e y, in hospi al (p=0.002), a e discha ge om
hospi al (p<0.0001) and du ing he se en-mon h ollow-up (p<0.0001)
(49) (Table 2).
S udy Se ing and
pa icipan s
S udy design In e en ion Du a ion Ou come a iables,
Ins umen s
Resul s
Boumans and
Landewee d,
[23]
An 850-bed hospi al,
59 (n=145) nu ses
who pa icipa ed in all
h ee measu emen s.
P e-pos
(wi hou con ol g oup)
Implemen a ion o a
Du ch o m o p ima y
nu sing: uni s we e
di ided in o wo eams
whe e wo RNs we e
esponsible o six
pa ien s.
14 mon hs:
Ma ch 1992–
May 1993
Job sa is ac ion:
- ques ionnai e (42 i ems)
¹
No signi ican
di e ences.
Expe ienced job
signi icance
- ques ionnai e (11 i ems)
¹
No signi ican
di e ences due o
implemen a ion.
Expe ienced job
signi icance dec eased
be o e implemen a ion.
Heal h complain s:
- Du ch VOEG scale
(21 i ems)
No signi ican
di e ences.
F equency and du a ion
o absence om wo k
- Sel - epo ed
No signi ican
di e ences.
Gagnon e al. [21] A 637-bed e ia y
ca e hospi al,
RCT Implemen a ion o one-
o-one nu sing ca e by
a 30-hou ini ial
15 mon hs:
Janua y 1993–
July 1994
Clinical ou comes:
- Cesa ean sec ion a e
Reduced isk o
oxy oxin s imula ion bu
Ci a ion: Ma ila E, Pi känen A, Alanen S, Leino K, Luojus K e al. (2014) The E ec s o he P ima y Nu sing Ca e Model: A Sys ema ic Re iew. J
Nu s Ca e 3: 205. doi:10.4172/2167-1168.1000205
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209 women in he
expe imen al g oup
and 204 in he con ol
g oup.
11 d op-ou s in he
expe imen al g oup.
aining pe iod and
qua e ly e eshe
wo kshops o nu ses
- Cesa ean sec ion due o
cephalopel ic
disp opo ion o ailu e o
p og ess
- epidu al analgesia
- oxy ocin s imula ion
- admission o neona al
ICU
- du a ion o labou
- ins umen al deli e y
- pe ineal auma
Re iew o medical
eco ds
no o he signi ican
di e ences.
Ga dne [39] Medical uni s in a
526-bed u ban e ia y
ca e eaching
hospi al,
n=386 pa ien s,
n=138 nu ses
Cos analysis 13681
pa ien s
P e-pos
3measu emen s
(wi h con ol g oup)
The in e en ion
consis ed o he
implemen a ion o
p ima y and eam
nu sing.
4 yea s Quali y o nu sing ca e:
- quali y o nu sing ca e
- pa ien hospi al s ess
- nu sing suppo
- nu ses’ s ess
- di ec ca e ac i i ies
- nu sing e en ion
Quali y Pa ien Ca e
Scale (68 i ems)
Hospi al S ess Ra ing
Scale (49 i ems)
Nu sing Suppo Scale
(52 i ems)
Nu sing S ess Scale (44
i ems)
Pe cen o di ec ca e
ac i i ies
Cos :
- nu sing cos (sala ies
and inge bene i s)
- nu sing cos pe pa ien
pe day
- DRG cos analysis,
pa ien leng h o s ay
The e was signi ican
highe quali y in nu sing
ca e in p ima y nu sing
uni s.
Pa ien s and nu ses
s ess
- no signi ican
di e ences.
Nu sing suppo
- no signi ican
di e ences.
Di ec ca e ac i i ies
- no signi ican
di e ences.
Nu sing e en ion
- nu ses on p ima y
nu sing uni s we e
e ained signi ican ly
longe han he nu ses
on he eam uni s.
The p ima y nu sing
ca e model was less
cos ly han eam
nu sing.
The p ima y nu sing
cos s we e lowe o
113 DRGs (o a o al
201 DRGs), while eam
nu sing cos we e lowe
o 88 DRGs
Ga dne and
Tilbu y
[48]
Gene al medical uni s
in a 526-bed e ia y
ca e eaching
hospi al.
P e-pos
3measu emen s
(wi h con ol g oup)
The use o he p ima y
nu sing model o wo
uni s and eam nu sing
o he o he wo uni s.
4 yea s Cos s:
- nu sing cos pe pa ien
pe day
- nu sing cos s pe DRG
The p ima y nu sing
ca e model was less
cos ly han eam
nu sing.
Melchio e al. [47]
Melchio e al.
[28]
Fi e psychia ic
hospi als,
n=161nu ses (60 in
an in e en ion and
101 in a con ol
g oup) who
pa icipa ed in all
h ee measu emen s.
Response a e 49.4%.
Fi e psychia ic
hospi als,
P e-pos
3 measu emen s
(wi h con ol g oup)
P e-pos
3 measu emen s
(wi h con ol g oup)
Implemen a ion o
p ima y nu sing
consis ed o assigning
nu ses o pa ien s as
p ima y nu ses,
suppo , ad ice on he
skills needed and he
p omo ion o
communica ion
be ween nu ses and
o he heal h ca e
p o ide s by manage s
The implemen a ion o
p ima y nu sing
2.5 yea s
2.5 yea s
Bu nou :
- emo ional exhaus ion
- depe sonaliza ion
- pe sonal
accomplishmen
Maslach Bu nou
In en o y (22 i ems)
No signi ican
di e ences.
Job u no e
Wo k en i onmen :
- asks o he nu se
No signi ican
di e ences.
The equency o
pe o ming pe sonal
Ci a ion: Ma ila E, Pi känen A, Alanen S, Leino K, Luojus K e al. (2014) The E ec s o he P ima y Nu sing Ca e Model: A Sys ema ic Re iew. J
Nu s Ca e 3: 205. doi:10.4172/2167-1168.1000205
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n=176 nu ses (64 in
an in e en ion and
112 in a con ol
g oup).
Response a e 54%.
consis ed o assigning
nu ses o pa ien s as
p ima y nu ses,
suppo , ad ice on he
skills needed, and he
p omo ion o
communica ion
be ween nu ses and
o he heal h ca e
p o ide s by manage s
Task In en o y (77 i ems)
and in e iews
-job cha ac e is ics
Ques ionnai e (48 i ems)¹
-leade ship s yle
Leade ship Beha iou
Ques ionnai e (21 i ems)
- nu sing ca e model
Ques ionnai e (? i ems)¹
-nu sing p ocess
Ques ionnai e (19 i ems)¹
ca e asks dec eased in
he in e en ion and
inc eased in he con ol
sub-g oups wi h a lowe
le el o pe sonal ca e
asks in he p e- es .
The complexi y o wo k
dec eased mo e in he
in e en ion sub-g oup
wi h a high deg ee o
complexi y.
Au onomy inc eased
mo e in he in e en ion
sub-g oup wi h a low
le el o au onomy.
No signi ican
di e ences.
No signi ican
di e ences.
No signi ican
di e ences.
Shields e al. [49] Glasgow Royal
Ma e ni y Hospi al,
648 women in a
midwi e-managed
ca e g oup and 651 in
a sha ed ca e g oup.
Response a es
a ied om 68.5–
85.3% s. 63.1–
78.2%.
RCT Each woman had a
named midwi e who
p o ided he majo i y
o planned ca e om
he i s an ena al isi
o he discha ge o he
heal h isi o
? Sa is ac ion wi h ca e:
- ela ionship wi h s a
- in o ma ion ans e
- choices and decisions
- social suppo
2 ques ionnai es (? i ems)
Sa is ac ion
signi ican ly highe in
he midwi e-managed
g oup in all ou comes.
Fo con inui y o ca e,
mo e posi i e
commen s we e gi en
by women ecei ing
midwi e-managed ca e.
Spu geon e al.
[50]
112 and 103 women
in pilo g oups and
118 women in a
con ol g oup.
No d op-ou s,
e ospec i e s udy.
Re ospec i e
be ween-g oups
Implemen a ion o
midwi e y-led ca e.
Janua y 1997
>?
Sa is ac ion wi h ca e:
- pe sonal p e e ences
Pilo g oups el hey
had mo e choice abou
whe e hey could gi e
bi h and who would
deli e he baby. They
also el hey had he
name o a con ac
pe son when ad ice
was needed. G oup A
a ed he alue o
pa en c a classes
highe han o he s.
- an ena al ca e The con ol g oup had
oo ew checks a home
and mo e o en he i s
check was a a GP
clinic a he han a
home.
Pilo g oups we e mo e
sa is ied wi h
in o ma ion and s a in
se e al a eas. They
also a ed he
impo ance o he
con inui y o ca e
highe han he con ol
g oup.
- labou and deli e y Pilo g oups we e mo e
sa is ied wi h midwi es
in se e al a eas. No
signi ican di e ences
in clinical ou comes.
Ci a ion: Ma ila E, Pi känen A, Alanen S, Leino K, Luojus K e al. (2014) The E ec s o he P ima y Nu sing Ca e Model: A Sys ema ic Re iew. J
Nu s Ca e 3: 205. doi:10.4172/2167-1168.1000205
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- pos na al ca e Pilo g oups we e mo e
sa is ied wi h midwi es
in se e al a eas.
- in o ma ion and ad ice
Ques ionnai e (? i ems)
Pilo g oups we e
signi ican ly mo e
sa is ied wi h he le el
o in o ma ion ecei ed
on some aspec s o
ca e.
Clinical ou comes:
- a e age leng h o labou
- use o pain con ol
- ype o deli e y
- incidence o pe ineal
ea ing
- bi h weigh
- APGAR sco es
Medical eco ds.
No signi ican
di e ence.
Wan e al.
[22]
Shanghai Fi s
Ma e ni y and In an
Heal h Hospi al,
230 women in he
in e en ion and 240
in a con ol g oup.
No d op-ou s.
RCT Nu ses we e ained o
p o ide consis en
con inuous nu sing
ca e.
7 mon hs:
Decembe
2008–June
2009
Sa is ac ion wi h ca e:
- en i onmen and
acili ies
- a i ude and
communica ion
- wa d adminis a ion
- p ac ice skills and abili y
- heal h educa ion
Ques ionnai e (30 i ems)¹
Sa is ac ion wi h
nu sing ca e was
signi ican ly highe in
almos all a eas in he
in e en ion g oup.
Knowledge o
b eas eeding
- ques ionnai e (17 i ems)
¹
Mo he s in he
in e en ion g oup el
signi ican ly mo e
knowledgeable in
b eas eeding.
Clinical ou comes:
- pos pa um u ina y
e en ion
- b eas eeding
- b eas discom o
Medical eco ds.
The b eas eeding a e
was highe in he
in e en ion g oup.
The occu ence o ea ly
pos pa um heal h
p oblems was lowe in
he in e en ion g oup.
Table 2: An o e iew o he s udies included in he e iew.
One s udy epo ed ha pa ien s in bo h he expe imen al and
con ol g oups we e sa is ied wi h he ca e hey ecei ed a di e en
s ages o p egnancy, deli e y and pue pe ium [50]. Howe e ,
expe imen al g oup pa ien s who had hei own designa ed midwi e
we e mo e sa is ied han con ol g oup pa ien s wi h hei chance o
choose whe e hey wan ed o gi e bi h (p<0.001) and hei midwi e
(p<0.001). Fu he mo e, pa ien s in he expe imen al g oup we e mo e
sa is ied han pa ien s in he con ol g oup wi h he in o ma ion hey
had ecei ed abou hei ca e and abou p epa ing o childbi h
(p<0.01). Du ing deli e y expe imen al g oup pa ien s we e mo e
awa e han con ol g oup pa ien s abou e en s du ing childbi h
(p<0.001), hey el hei needs we e aken in o accoun and ha hey
we e unde s ood (p<0.01–0.05), and ha hey we e no le alone o
long pe iods (p<0.01). In addi ion, expe imen al g oup pa ien s we e
mo e awa e o hei pos na al counsello whom hey could con ac o
ad ice (p<0.001), and hey a ed he alue o he an ena al/pa en c a
classes mo e highly han did pa ien s in he expe imen al g oup
(p<0.05). The expe imen al g oup pa ien s el ha hey we e o e ed
ewe checks a home han did pa ien s in he con ol g oup (p<0.05)
[50] (Table 2).
The Chinese s udy epo ed ha expe imen al g oup pa ien s
(whose ca e was deli e ed acco ding o he p ima y nu sing model)
we e mo e sa is ied wi h hei ca e en i onmen and i s acili ies
(p<0.001), nu se communica ion and a i udes (p<0.001), wa d
adminis a ion (p<0.001), p ac ice skills and abili y (p<0.001), and
wi h heal h educa ion/guidance (p<0.001) [22] (Table 2).
Nu sing suppo and pa ien hospi al s ess
The US s udy showed ha suppo om nu ses did no di e
signi ican ly be ween he pa ien s in p ima y and eam nu sing uni s.
Ci a ion: Ma ila E, Pi känen A, Alanen S, Leino K, Luojus K e al. (2014) The E ec s o he P ima y Nu sing Ca e Model: A Sys ema ic Re iew. J
Nu s Ca e 3: 205. doi:10.4172/2167-1168.1000205
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ISSN:2167-1168 JNC, an open access jou nal Volume 3 • Issue 6 • 1000205
Nei he did s ess expe ienced by pa ien s du ing he inpa ien ca e
di e signi ican ly be ween hese wo nu sing models [39] (Table 2).
Childbi h and newbo n ca e
The ma e nal con ex s udy disco e ed ha expe imen al g oup
mo he s who had he same named midwi e h oughou childbi h used
signi ican ly less oxy ocin o aid deli e y han con ol g oup mo he s,
whose midwi es changed shi du ing deli e y ( he ela i e isk o
expe imen al g oup e sus con ol g oup = 0.83; a 95% con idence
in e al = 0.67, 1.04) (Table 2).By con as , p ima y nu sing had no
posi i e e ec on he numbe o Caesa ean sec ions, he du a ion o
deli e y, pain elie o p ocedu es du ing deli e y. Likewise, p ima y
nu sing showed no associa ion wi h newbo n APGAR sco es, he need
o moni o ing o bi h weigh [21,50] (Table 2).
B eas eeding newbo n babies
Mo he s in he expe imen al g oup we e mo e awa e o
b eas eeding issues han con ol g oup mo he s (p<0.001) and
b eas ed hei baby mo e o en in hospi al (p<001) and six weeks a e
childbi h (p<0.001) [22] (Table 2).
Pos pa um heal h p oblems
The Chinese s udy epo ed ha mo he s in he expe imen al g oup
de eloped pos pa um u ina y e en ion signi ican ly less o en han
mo he s in he con ol g oup (p<0.002). In addi ion, mo he s in he
expe imen al g oup su e ed om b eas discom o less o en han
mo he s in he con ol g oup (p<0.001) [22] (Table 2).
E ec s o nu sing s a
Job cha ac e is ics
The Du ch s udy assessed job cha ac e is ics on h ee dimensions,
iz. job au onomy, eed back/cla i y and job complexi y. In e en ion
g oup nu ses who wo ked unde a p ima y nu sing model el he
complexi y o hei job dec eased mo e han did nu ses in he con ol
g oup (p<0.001). Fu he mo e, nu ses in he expe imen al g oup el
hey had mo e job au onomy han nu ses in he con ol g oup
(p<0.001) [28] (Table 2). By con as , he p ima y nu sing model had
no e ec on nu ses’ job sa is ac ion, bu nou , s ess, sense o meaning
in hei wo k, heal h complain s, absen eeism o s a e en ion in he
uni [23,28,39].Howe e , in he o he s udy [28], u no e among
nu ses in he p ima y nu sing uni s was signi ican ly lowe du ing he
h ee yea ollow-up pe iod han in he eam nu sing uni s
(p<0.01).No signi ican associa ion was disco e ed be ween p ima y
nu sing and leade ship s yle [28] (Table 2).
Tasks o he nu se
The Du ch s udy was in e es ed in s udying he ange o asks
pe o med by nu ses du ing one wo k shi . Nu sing asks we e
di ided in o ou ca ego ies, i.e. pe sonal ca e asks, psychosocial asks,
household asks and o ganiza ional asks. Acco ding o he esul s,
expe imen al g oup nu ses who wo ked as named nu ses unde a
p ima y nu sing model pe o med ewe pe sonal ca e asks han
con ol g oup nu ses (p<0.05). In o he ca ego ies no signi ican
di e ences we e disco e ed (Table 2) [28].In ano he s udy no
signi ican di e ences we e ound be ween p ima y and eam nu sing
uni s on he amoun o nu ses' ca e ac i i ies o pa ien s [39] (Table
2).
Quali y o ca e
In bo h a one-yea and 2.5-yea ollow-up, he nu ses in he
p ima y nu sing uni s assessed hei uni 's quali y o ca e o be o
signi ican ly highe quali y han did he nu ses in he eam nu sing
uni s when assessing hei own uni s (p<0.01) [39] (Table 2).
E ec s o he o ganiza ion
Cos s o he nu sing
One s udy showed ha he p ima y nu sing model was 6.5% less
cos ly han eam nu sing in 36 six-mon h ollow-up pe iods [48]. Also,
nu sing cos s pe pa ien by DRG we e 12–16% lowe in he p ima y
nu sing uni s han in he eam nu sing uni s [48]. Ano he s udy
ound ha cos s pe pa ien pe day in he p ima y nu sing uni s we e
lowe han in he eam nu sing uni s (p<0.05) [48]. When s udying
nu sing cos s o 201 DRGs by leng h o s ay, p ima y nu sing cos s
we e lowe o 113 DRGs (56% o he 201), while eam nu sing cos s
we e lowe o 88 DRGs (44% o he 201). The lowe cos s o he
p ima y nu sing model compa ed o he eam nu sing model we e
explained by lowe numbe o adminis a ion s a , a highe pa ien –
s a a io and less use o agency nu ses (39,48) (Table 2).
Discussion
Discussion o he esul s
I is clea om he esul s o ou e iew ha we s ill know e y li le
abou he e ec s o p ima y nu sing p ac ice. Resea ch so a has
ocused mos ly on pa ien s and nu sing s a , whe eas pa ien ’s amily
membe s and o ganiza ional ac o s ha e la gely been sidelined.
Howe e , he ocus o nu sing ca e oday is shi ing inc easingly om
he ea men o indi idual pa ien s o conside ing hei whole amilies
[10,55]. In his line o esea ch, he e o e, i is impo an o conside
he posi ion o amily membe s as well. F om an o ganiza ional poin
o iew, in o ma ion is needed abou he cos implica ions o nu sing
ca e deli e y models, he ou comes o di e en ca e models and wha
kinds o models a e needed o he lexible use o nu sing s a
esou ces and s a e en ion. Based on he indings o his s udy, he
p ima y nu sing model is mo e cos -e ec i e han he eam nu sing
way o ca ing o pa ien s. In he p ima y nu sing model he nu ses
ca e o pa ien s in a comp ehensi e way and he numbe o
adminis a ion s a is lowe .
The esul s indica e ha he e is a sca ci y o esea ch using RCT
and o he expe imen al designs. The e is somewha mo e desc ip i e
esea ch bu ha did no mee he inclusion c i e ia es ablished o his
e iew. I is qui e su p ising o ind such a sca ci y o e idence gi en
ha p ima y nu sing has been conside ed he ideal model o ca e
deli e y o decades [8]. Whe he o no his model eally is he bes
sys em o ca e deli e y canno be es ablished on he basis o his
e iew. Fo ha pu pose we will need o ha e mo e esea ch using
RCT designs. Howe e , i is impo an o no e ha p ima y nu sing
ca e does no jus mean a ce ain way o alloca ing pa ien s o nu ses
bu is also, impo an ly, a philosophical p emise o nu sing ca e
deli e y ha cen es a ound he pa ien . Indeed, ecen s udies ha e
used he concep o ela ionship-based nu sing, which comp ises
p ima y nu sing hinking and which s esses pa ien –nu se
in e ac ion, he nu se’s p o essional esponsibili y o pa ien ca e and
nu ses’ collabo a ion in pa ien ca e [9,12,56]. The duali y o he
p ima y nu sing concep makes he accumula ion o he necessa y
e idence a highly challenging ask. In ac , he quali y o pa ien –nu se
Ci a ion: Ma ila E, Pi känen A, Alanen S, Leino K, Luojus K e al. (2014) The E ec s o he P ima y Nu sing Ca e Model: A Sys ema ic Re iew. J
Nu s Ca e 3: 205. doi:10.4172/2167-1168.1000205
Page 9 o 12
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ISSN:2167-1168 JNC, an open access jou nal Volume 3 • Issue 6 • 1000205