The effects of the primary nursing care model: A systematic review

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 J Nu s Ca e 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 J Nu s Ca e 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 Page 4 o 12 J Nu s Ca e 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 Page 5 o 12 J Nu s Ca e ISSN:2167-1168 JNC, an open access jou nal Volume 3 • Issue 6 • 1000205 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 Page 6 o 12 J Nu s Ca e ISSN:2167-1168 JNC, an open access jou nal Volume 3 • Issue 6 • 1000205 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 Page 7 o 12 J Nu s Ca e ISSN:2167-1168 JNC, an open access jou nal Volume 3 • Issue 6 • 1000205 - 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 Page 8 o 12 J Nu s Ca e 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 J Nu s Ca e ISSN:2167-1168 JNC, an open access jou nal Volume 3 • Issue 6 • 1000205