It's time for updating primary nursing in pediatric oncology care: qualitative study highlighting the perceptions of nurses, physicians and parents

The work of nurses to provide good and safe services to children receiving hospital-at-home: A qualitative interview study from the perspectives of hospital nurses and physicians

AIM

To explore and describe the work performed by the nurses providing hospital-at-home care to children and their families from the perspectives of hospital nurses and physicians.

BACKGROUND

To reduce capacity pressure on hospitals, various ambulatory services combining hospital and home treatment have emerged. Studies have shown that children and their families are satisfied with hospital-at-home when the parents experienced the professionals possessed the necessary competences. Knowledge is limited about nurses and physicians' perspectives on the work performed and competence needed when children receive hospital treatment in the family's home.

DESIGN

A qualitative descriptive design with semi-structured interviews was used. Sixteen nurses and physicians from two hospitals in Norway working in hospital-at-home for children were recruited to interview. Data were analysed using systematic text condensation. In preparing the manuscript, we applied the COREQ guidelines. The theory on 'expert nursing' supported the discussion of results.

RESULTS

We identified three categories through analysis; building a trustful relationship with the family and the sick child; performing essential skills in paediatric nursing care in hospital-at-home; and nurses serving as the 'hub' between the different parties.

CONCLUSION

The results demonstrate the complexity of the work performed by hospital nurses when children received hospital-at-home. Building a trustful relationship and alliance with the child and the family formed the cornerstone of accomplishing good and safe paediatric care. The nurses became a coordinating and collaborating 'hub' for actors involved, taking care of patient safety on a daily basis.

RELEVANCE TO CLINICAL PRACTICE

The way the nurses approached the children and their families, was the core element of the paediatric nursing expertise and important for the service quality and patient safety. The importance of building a trustful relationship needs to be more acknowledged, and the services would benefit to organise this through continuity of care.

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.

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.

Effectiveness of primary nursing in the care and satisfaction of adult inpatients: a systematic review protocol

REVIEW OBJECTIVE

The objective is to identify the best available evidence on the effectiveness of primary nursing in the care and satisfaction of adult inpatients.

Perceptions of a Primary Nursing Care Model in a Pediatric Hematology/Oncology Unit

The primary nursing care model optimizes relationship-based care. Despite using a primary nursing model on a pediatric hematology/oncology inpatient unit, it was hypothesized patients and nurses were dissatisfied with the structure of primary care teams and inconsistency of primary assignments. The purpose of this study was to evaluate patient/family and nurse perceptions of our current care model through assessing gaps in its operationalization and satisfaction. This study used a descriptive cross-sectional design featuring patient/family and nurse surveys. Of the 59 patient/family respondents, 93.2% prefer to have a primary nurse care for them and 85% are satisfied with how often they are assigned a primary care team member. Similarly, 63% of the 57 nurse respondents are satisfied with the current implementation of our primary nursing model and 61% state the model reflects good continuity of care. Yet 80.7% of nurses believe safety would improve for a patient whose nurse works shifts consecutively even if not a primary nurse. Overall, patients, families, and nurses value care continuity and meaningful nurse-patient relationships, which is fundamental to primary nursing.

Nurses' narratives on termination of primary nursing relationship with parents in neonatal intensive care

BACKGROUND

Primary nursing working model in the neonatal intensive care unit enables a long-lasting caring relationship with the infants and their parents. Terminating this kind of relationship is seldom discussed.

AIM

The aim of the study was to describe nurses' experiences of terminating the primary nursing relationship with the parents in neonatal intensive care.

METHODS

Qualitative design using narrative method was used because there is a little knowledge relating to the topic. The data were collected with active interviews and analysed with narrative analysis. Seven nurses with experience of neonatal intensive care and primary nursing were recruited by convenience sampling. The approval was granted according to the hospital guidelines.

RESULTS

The results gave rise to the three narratives that described the relationship between the primary nurse and the parents as the nursing relationship ends. All narratives shared a common plot, 'regulation of the closeness on nursing relationship', but it was manifested in different ways in each narrative. The plot in the narratives changed on a closeness-distance axis according to how the primary nurse regulated the nursing relationship and its termination. In the first narrative, the regulation of the relationship promoted distance, in the second connection and in the third closeness and connection.

CONCLUSIONS

The long-lasting nature of the primary nursing working model may allow different caring relationships which will be revealed in terminating phase of care. This phenomenon is poorly recognised. It is important to study the caring relationship between the primary nurse and the parents of a hospitalised child, because the caring relationship is the core of nursing and needs to be considered in research and supported in practice.