This article was downloaded by: [University of Montana] On: 07 April 2015, At: 16:43 Publisher: Routledge Informa Ltd Registered in England and Wales Registered Number: 1072954 Registered office: Mortimer House, 37-41 Mortimer Street, London W1T 3JH, UK
Hospital Topics Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/vhos20
Primary Nursing Care: … as a Method for Improving the Quality of Patient Care Mary Diane Nodolny R.N. Published online: 13 Jul 2010.
To cite this article: Mary Diane Nodolny R.N. (1979) Primary Nursing Care: … as a Method for Improving the Quality of Patient Care , Hospital Topics, 57:4, 10-17, DOI: 10.1080/00185868.1979.9954242 To link to this article: http://dx.doi.org/10.1080/00185868.1979.9954242
PLEASE SCROLL DOWN FOR ARTICLE Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of the Content. This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden. Terms & Conditions of access and use can be found at http://www.tandfonline.com/page/terms-and-conditions
0 . 0
as a method for improving the quality of patient care. BY
Downloaded by [University of Montana] at 16:43 07 April 2015
Mary Diane Nodolny
R.N.
Mory Diane Nodolny, R.N. i s o graduole of Albany Medical Center-School
of Nursing, Albany, N e w York 1968. She received her B S N degree i n 1978, from the University of M o r y l o n d 4 c h o o l of Nursing, Baltimore, Maryland. She i s presently P.R.N. Nurse with the Montgomery General Hospital, 1 Ill01 Prince Phillip Drive, Olney, Maryland. Previously she was o Pediatric Nurse for six years (three
years 0 s o heod nurselunit coordinator) and a Medical/Surgical Nurse for two yeors ond o n Infection Control Nurse for two years. She i s a member of A.N.A/ M.N.A., ond in addition to her hospital nursing Ms. Nodolny i s presently an Instructor for Community Services Division, Montgomery College, Rackville, Morylond.
hat i s Primary Nursing Care? ”The primary nurse is assigned Total Nursing Care Planning Responsibility for her selected group of patients. She delivers direct nursing care each day t o these patients while on her tour of duty.”’ Associate or secondary nurses care for the patient in her absence, with a plan drawn up by the primary nurse. Either of these nurses may be assisted by an aide in tasks requiring two people.
W
10
As a student, a nurse i s taught patient-centered care. Yet when she graduates she may find her work tends to become “procedure-centered” or “task oriented” rather than “patientcentered. “ Team Nursing was devised t o provide better patient care with available staff. The team, by working closely together, was thought to be able to give better care, since the abilities of each member were utilized, and all nursing care was closely guided and supervised by a professional nurse, the team leader. Patient-centered care was implemented by the daily team conference. A written nursing care plan, used by every team member, was made and revised as the patient’s condition changed.2 If team nursing gave us more comprehensive care, why are we now looking at primary nursing care to replace the team process? Can team nursing be completely replaced? Team nursing brought better organization t o patient care, but nursing care audits, started as a result of standards imposed by public pressure, uncovered deficiencies in the quality of care. As a result, hospitals took a look at the nursing care processes and began t o consider ways to deliver an improved quality of patient care. An early search for better patient care occurred in 1968 in Minnesota. Karen L. Ciske,
R.N., M.S.N. became involved in an experimental project designed to improve the delivery of services to the patients on a small medical unit at the University of Minnesota Hospitals. The hospital was utilizing the team approach on most units, but felt that its particular brand of team nursing seemed to perpetuate deficiencies in the acceptance of responsibility for care planning and followthrough on many of the units. Ms. Ciske states, “Shared responsibility and accountability often become no responsibility and accountability.” The team leader’s goals of assessing each patient on her team and supervising the planning, implementing and evaluating of care plans for ten to twenty patients were felt to be unmet.3 It appeared t o the hospital personnel involved that expectations of team leaders were unrealistic. The team leader’s job included: (1) to be knowledgeable and
act upon the critical information of her patients in order to plan their care, using the team conference when appropriate; (2) to lead other team members, which involved assigning, supervising and teaching practical nurses, orderlies, and aides; (3) to observe and constantly evaluate the care patients received.4 The R.N.s had various work experiences, different educaContinued on page 13
HOSPITAL TOPICS
Downloaded by [University of Montana] at 16:43 07 April 2015
Conilnued from poge 10
tional backgrounds, and had been required to rotate shifts. The care from the patient’s point of view was extremely fragmented, with as many as three or four of the nursing staff caring for him during one shift.5 The hospital decided to try a pilot program in which the staff was asked to choose and provide care until discharge for a few “comprehensive care patients” on their teams. This was to be in addition to their other team leader responsibilities. The hospital found that this would not work since it overloaded the team leader, and subsequently adopted the primary nursing concept. It included:
(1) Assignment of each patient to a specific nurse, who pro-
vided care each day, on duty, until patient’s discharge or transfer. (2) Patient Assessment by the primary nurse, who plans the care t o be given when she i s not on duty, when secondary or associate nurses care for her patient. (3) Patient Involvement in the care was provided, and identification of the patient’s goals relating t o how the medical condition affects his life style. (4) Care Giver to Care Giver Communication in the nursing staff’s daily reporting methods and between disciplines. (5) Discharge Planning including patient teaching, family involvement, and appropriate referrals.6 The hospital saw an improvement in the quality of care to the patients, more clearly written instructions of evaluative efforts and communicative ability and generally positive JULY/AUGUST 1979
feelings among the nursing personnel. Other early programs included: Primary Nursing in a nephrology unit (1975) at the Rogosin Kidney Center, New York, New York, in which an increased quality of patient care was seen, as well as cost-effectiveness of equipment used and health care delivered, and an awareness of the expanded role of nurses for health manpower.? A Primary Nursing Project conducted at Children’s Hospital National Medical Center of the District of Columbia in 1973 in which primary nursing care and quality assurance eventually was to be imp lemented t h roughout the hospital before moving to the new facility in 1977.s The Big Sister Programme: A Concept of Primary Nursing Care, i s initiated at the Children’s Medical Centre Neurosurgical Unit in Montreal, Canada. The Canadian Big Sister program differs from those in the U.S. in that it i s completely voluntary. A nurse chooses a child, a child who she considers to be in special need or a family with whom she develops a close relationship. She then makes a formal request to become a Big Sister to that patient and enlists a colleague who will work opposite shifts. The scheme works ideally in this particular hospital because of the 12hour shifts worked. The full responsibility of care i s the Big Sister’s and no one i s allowed access to the little sister (the patient) without the knowledge and presence of the Big Sister. Continued on poge 14
Downloaded by [University of Montana] at 16:43 07 April 2015
The medical staff appear to be willing compliants to the system. They can now go to the Big Sister and be relieved of the frustration of finding no one who can tell them with any certainty about their patient.D In Britain, on a pediatric ward, some of the staff is encouraged to take responsibility for children with certain well-defined conditions. For example, if an experienced staff nurse took it upon herself to become an expert in diabetes, or fibrocystic diseases she could from then on be known to be responsible for any child admitted with this condition. The delegation of responsibility for particular conditions could help minimize the number of people involved in the care of any one chi1d.l” 0ne discovery, consistent throughout the various programs, is that “Continuity emerges as a predominant feature of the primary nursing concept. Accountability is also important, and easily maintained because patient assignments, once made by the head nurse, or charge nurse, remain the same throughout the patients‘ stay on that particular unit.”ll Results of research done by Verla Branch Collins, Ph.D., conducted in two acute care hospitals, indicated that primary nursing significantly improved the quality of patient care over team nursing. Differences were identified as: (1) Assessment of patient and family needs as initial preparation for care was higher in the primary nursing unit. (2) The primary nursing unit maintained a significantly better current written nursing care 14
plan for each patient, based on the patient and family physical, emotional and teaching needs. (3) Discharge planning and home care were significantly better for the primary nursing unit. (4) Documentation of collaboration between disciplines and assessment of patient progress was more complete in the primary nursing unit.12 The patient satisfaction sample was computed with a Chi Square Test for significance of difference. Again primary nursing came out significantly higher. Similarities are: (1) Nurses are held responsible for their actions in both processes. (2) A certain amount of nonprofessionals to help with care will still be utilized in both processes. Accountability is a kind of accounting of the productivity of an individual, group, or i n ~ t i t u t i 0 n .Primary l~ Nursing Care emphasizes the nurse’s individual responsibility and accountability for quality patient care. This accountability is consistent with, and essential for, an enlarged dimension of professional nursing practice. From a legal view-point, many nurse practice acts are under revision to provide for expanded practice roles. Moreover, primary nursing actually emphasizes the best of traditional nursing practice, i.e., comprehensive patient care, professional autonomy.14 Quality Assurance Programs include resources combined to give the highest quality of nursing services. Programs usually include patient history
he next issue of HOS PlTAL TOPlCS will carry “Modes of D,elivery of Patient Care.” A case history study of primary nursing and t e a m care carried out at New England Deaconess Hospital wmw, BOSton, MA, a 500 bed acute car4ehospital. The study examined the degree to which nursing care planning was personalized on a primary nursing unit operating for three years and on a team nursing unit operating for many years. Nursing records on in-hospita1 patients. Nursing assessment and Kardex forms w e r e reviewed to determine personalized care. 0
Save time for medical professionals. Record racks hang over the bed footboard, or attach to doors or wails. Seven stock types plus
Continued on pug# I7
HOSPITAL TOPICS
Downloaded by [University of Montana] at 16:43 07 April 2015
Contlnued from pogm 14
taking, P.O.R. (problemoriented records), rounds, care plans, a u d i t s and client evaluation.16 P r i m a r y N u r s i n g Care can s u r e l y be added to t h i s package. Although primary n u r s i n g care a p p e a r s to be an ideal way to improve the quality of patient care, not all hospitals, for one r e a s o n or another, are able to adopt its concepts. It is only one way to meet the goal of improved quality of patient care. Other w a y s will be s o u g h t by h o s p i t a l s who cannot follow the primary process. Other w a y s will be found, but for the present, P r i m a r y N u r s i n g Care has come into i t s own! 0 FOOTNOTES 1. Author Unknown. "Primary Nursing Core." Kansas Nurse, Volume 51, January 1976. pg. 4. 2. Thorn Kron. Nursing Team Leadership, W.B. Sounders Company, Philadelphia and London, 1966. pg. 11, 12. 3. Karen 1. Ciske. "Prlmary Nursing: A n Organization That Promotes Pmfesslonal Practice." Journol of Nursing Adminirtration, January-February, 1974, pg. 28. 4. 1810. pg. 28, 29. 5. IBID. pg. 29. 6. IBID. pg. 29. 7. Martha Leonard. "Health Issues and Primary Nursing i n Nephrology Care." Nursing Clinics of North America, Septemtember 1975. pg. 41 3. 8 . Geraldene Feltan, Eidne Frevert, Kathleen Gailigan, Mary Kathleen Neill and Lillian Williams. "Pathwoys to Accountability: implernentatlon of a Ouality Assurance Program." Journal of Nursing Administration. Volume 6, Number 1, January 1976. pg. 23. 9. June 0. Jolly. "The Big Sister Programme: A Concept of Primary Nursing Care." Nursing Times, Volume 71, October 30, 1975. pg. 2. 10. IBID. pg. 3. 11. Aufhor Unknown. pg. 4. 12. IBID. pg. 4. 13. Doris J. Froebe, and R. Joyce Bain. Quality Assumnce Programs and Controls In Nursing, It. Louis: The C.V. Mosby Cornpony, 1976. pg. 9. 14. Martha Leonard. pg. 419. IS. Froebe and Bain. pg. 55.
JULY/AUGUST 1979
BIBLIOGRAPHY ARTICLES: Anderson, Marcia. "Primary Nursing in Doyby-Day Pmrlite." American Journal of Nursing, Volume Number 5, May 1976. Ciske, Karen 1.. R.N., Ms.N. "Primary Nursing: An Organization That Promotes Professional Proctits." Journal of Nursing Administration, Volume 4, January-Febw ary, 1974.
Felton, Gemidins, R.N., Ed.D. "Increasing the Ouaiity of Nursing Care by Introducing the Concept of Primary Nursing: Model Prolect." Nursing Research, Volume 24, Number 1, January-February 1975. Felton, Geroldine; Frevert, Elaine; Goiiigan, Kalhleen; Neiil, Mary Kathleen; and Wililams, Liiiion. "Pothwoys to Attountobility: Implementation of a Quality Assurance Progrom." Journal of Nursing Administration, Volume 6, Number 1, January
1976. Frevert, Elaine I., and Galligan, Kathleen A. "Evaluation of Nurslng Care: A Prlmary Nursing Prolect. Part 2, Experiences of Non-Particlpant Nurse Observers." Supervisor Nurse, Volume 6, Janwry 1975. Jolly, June D., S.R.N.,
R.S.C.N.,
"The Big Sister
Programme: A Concept of Primary Nurslng Care," Nursing Times, Volume 71, October 30, 1975. Leonard, Martha, M.N. "Health lssurs and Primary Nursing in Nephrology Care." Nursing Ciinlcs of North America, Volume
10, Number 3, September 1975. Unknown, Author. "Primary Nursing Care.'' Kanros Nurse, Volume 51, January 1976. Williams, Lillian B., R.N., M.N., "Evaluatlon of Nurslng Care: A Primary Nursing Prolect. Part 1, Report of the Controlled Study." Supervisor Nurse, Volume 6, January 1975. BOOKS: Froebe, Doris J., R.N., Ph.0. and Bdn, R. Joyce, R.N., Ed.D. Ouallty Assumnce Programs and Controls i n Nursing, C.V. Mosby Company; St. Louis, 1976. Hodges, John C. and Whitten, Mary E., Harbrate College Handbook, Harcourt, Bmca B World, Inc.; New York, 1962, Fifth Editlon. Kmn, Thorn, R.N., B.S. Nurslng Team Lendership, W.B. Sounders Company; Philadelphia and London, 1966, Second Editlon. Marram, Gwen D., e l 01, Primary Nurzing:
A Model for Individualized Care, C.V. Morby Company; St. Louis, 1974.
Study Shows Hospital How To Improve Purchasing, Materials Management Practices Opportunities for improving hospital purchasing and materials management practices are identified in a recently published study resulting from a cooperative effort between the AHA and the U.S. General Accounting Office (GAO). The two-part study offers suggestions for achieving sound procurement and materials management practices and provides a checklist on prudent purchasing concepts and materials management principles. Part I of the study provides an assessment of existing practices and recommendations for improvement. Part II presents a checklist and audit guide for self-review and analysis of the effectiveness of materials management functions. The GAO will be sending copies of the report t o U.S. hospitals, according to the AHA. 0
1
NEW TEST
evelopment of a new test to detect carriers of the gene for cystic fibrosis was announced at the joint annual meeting of the American Lung Association, the Christmas Seal organization, and its medical section, the American Thoracic Society. Approximately 3,500 physicians, nurses and volunteer and professional health workers attended the meeting which was the beginning of a year-long observance of the American Lung Association's 75th anniversary. The new test now provides a simple means to detect carriers and provide genetic counseling when a couple contemplating marriage are both found to be carriers. It is simple to perform, inexpensive and suitable for large scale screening. Collaborators in this research with Dr. Jack Lieberman of the Sepulveda Veterans Administration Medical center and professor of medicine at the U.C.L.A. School of medicine, Los Angeles, were W. Kaneshiro, N. Costea, M.D., and the late V. Yakulis. 0 17
Hospital Topics Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/vhos20
Primary Nursing Care: … as a Method for Improving the Quality of Patient Care Mary Diane Nodolny R.N. Published online: 13 Jul 2010.
To cite this article: Mary Diane Nodolny R.N. (1979) Primary Nursing Care: … as a Method for Improving the Quality of Patient Care , Hospital Topics, 57:4, 10-17, DOI: 10.1080/00185868.1979.9954242 To link to this article: http://dx.doi.org/10.1080/00185868.1979.9954242
PLEASE SCROLL DOWN FOR ARTICLE Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of the Content. This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden. Terms & Conditions of access and use can be found at http://www.tandfonline.com/page/terms-and-conditions
0 . 0
as a method for improving the quality of patient care. BY
Downloaded by [University of Montana] at 16:43 07 April 2015
Mary Diane Nodolny
R.N.
Mory Diane Nodolny, R.N. i s o graduole of Albany Medical Center-School
of Nursing, Albany, N e w York 1968. She received her B S N degree i n 1978, from the University of M o r y l o n d 4 c h o o l of Nursing, Baltimore, Maryland. She i s presently P.R.N. Nurse with the Montgomery General Hospital, 1 Ill01 Prince Phillip Drive, Olney, Maryland. Previously she was o Pediatric Nurse for six years (three
years 0 s o heod nurselunit coordinator) and a Medical/Surgical Nurse for two yeors ond o n Infection Control Nurse for two years. She i s a member of A.N.A/ M.N.A., ond in addition to her hospital nursing Ms. Nodolny i s presently an Instructor for Community Services Division, Montgomery College, Rackville, Morylond.
hat i s Primary Nursing Care? ”The primary nurse is assigned Total Nursing Care Planning Responsibility for her selected group of patients. She delivers direct nursing care each day t o these patients while on her tour of duty.”’ Associate or secondary nurses care for the patient in her absence, with a plan drawn up by the primary nurse. Either of these nurses may be assisted by an aide in tasks requiring two people.
W
10
As a student, a nurse i s taught patient-centered care. Yet when she graduates she may find her work tends to become “procedure-centered” or “task oriented” rather than “patientcentered. “ Team Nursing was devised t o provide better patient care with available staff. The team, by working closely together, was thought to be able to give better care, since the abilities of each member were utilized, and all nursing care was closely guided and supervised by a professional nurse, the team leader. Patient-centered care was implemented by the daily team conference. A written nursing care plan, used by every team member, was made and revised as the patient’s condition changed.2 If team nursing gave us more comprehensive care, why are we now looking at primary nursing care to replace the team process? Can team nursing be completely replaced? Team nursing brought better organization t o patient care, but nursing care audits, started as a result of standards imposed by public pressure, uncovered deficiencies in the quality of care. As a result, hospitals took a look at the nursing care processes and began t o consider ways to deliver an improved quality of patient care. An early search for better patient care occurred in 1968 in Minnesota. Karen L. Ciske,
R.N., M.S.N. became involved in an experimental project designed to improve the delivery of services to the patients on a small medical unit at the University of Minnesota Hospitals. The hospital was utilizing the team approach on most units, but felt that its particular brand of team nursing seemed to perpetuate deficiencies in the acceptance of responsibility for care planning and followthrough on many of the units. Ms. Ciske states, “Shared responsibility and accountability often become no responsibility and accountability.” The team leader’s goals of assessing each patient on her team and supervising the planning, implementing and evaluating of care plans for ten to twenty patients were felt to be unmet.3 It appeared t o the hospital personnel involved that expectations of team leaders were unrealistic. The team leader’s job included: (1) to be knowledgeable and
act upon the critical information of her patients in order to plan their care, using the team conference when appropriate; (2) to lead other team members, which involved assigning, supervising and teaching practical nurses, orderlies, and aides; (3) to observe and constantly evaluate the care patients received.4 The R.N.s had various work experiences, different educaContinued on page 13
HOSPITAL TOPICS
Downloaded by [University of Montana] at 16:43 07 April 2015
Conilnued from poge 10
tional backgrounds, and had been required to rotate shifts. The care from the patient’s point of view was extremely fragmented, with as many as three or four of the nursing staff caring for him during one shift.5 The hospital decided to try a pilot program in which the staff was asked to choose and provide care until discharge for a few “comprehensive care patients” on their teams. This was to be in addition to their other team leader responsibilities. The hospital found that this would not work since it overloaded the team leader, and subsequently adopted the primary nursing concept. It included:
(1) Assignment of each patient to a specific nurse, who pro-
vided care each day, on duty, until patient’s discharge or transfer. (2) Patient Assessment by the primary nurse, who plans the care t o be given when she i s not on duty, when secondary or associate nurses care for her patient. (3) Patient Involvement in the care was provided, and identification of the patient’s goals relating t o how the medical condition affects his life style. (4) Care Giver to Care Giver Communication in the nursing staff’s daily reporting methods and between disciplines. (5) Discharge Planning including patient teaching, family involvement, and appropriate referrals.6 The hospital saw an improvement in the quality of care to the patients, more clearly written instructions of evaluative efforts and communicative ability and generally positive JULY/AUGUST 1979
feelings among the nursing personnel. Other early programs included: Primary Nursing in a nephrology unit (1975) at the Rogosin Kidney Center, New York, New York, in which an increased quality of patient care was seen, as well as cost-effectiveness of equipment used and health care delivered, and an awareness of the expanded role of nurses for health manpower.? A Primary Nursing Project conducted at Children’s Hospital National Medical Center of the District of Columbia in 1973 in which primary nursing care and quality assurance eventually was to be imp lemented t h roughout the hospital before moving to the new facility in 1977.s The Big Sister Programme: A Concept of Primary Nursing Care, i s initiated at the Children’s Medical Centre Neurosurgical Unit in Montreal, Canada. The Canadian Big Sister program differs from those in the U.S. in that it i s completely voluntary. A nurse chooses a child, a child who she considers to be in special need or a family with whom she develops a close relationship. She then makes a formal request to become a Big Sister to that patient and enlists a colleague who will work opposite shifts. The scheme works ideally in this particular hospital because of the 12hour shifts worked. The full responsibility of care i s the Big Sister’s and no one i s allowed access to the little sister (the patient) without the knowledge and presence of the Big Sister. Continued on poge 14
Downloaded by [University of Montana] at 16:43 07 April 2015
The medical staff appear to be willing compliants to the system. They can now go to the Big Sister and be relieved of the frustration of finding no one who can tell them with any certainty about their patient.D In Britain, on a pediatric ward, some of the staff is encouraged to take responsibility for children with certain well-defined conditions. For example, if an experienced staff nurse took it upon herself to become an expert in diabetes, or fibrocystic diseases she could from then on be known to be responsible for any child admitted with this condition. The delegation of responsibility for particular conditions could help minimize the number of people involved in the care of any one chi1d.l” 0ne discovery, consistent throughout the various programs, is that “Continuity emerges as a predominant feature of the primary nursing concept. Accountability is also important, and easily maintained because patient assignments, once made by the head nurse, or charge nurse, remain the same throughout the patients‘ stay on that particular unit.”ll Results of research done by Verla Branch Collins, Ph.D., conducted in two acute care hospitals, indicated that primary nursing significantly improved the quality of patient care over team nursing. Differences were identified as: (1) Assessment of patient and family needs as initial preparation for care was higher in the primary nursing unit. (2) The primary nursing unit maintained a significantly better current written nursing care 14
plan for each patient, based on the patient and family physical, emotional and teaching needs. (3) Discharge planning and home care were significantly better for the primary nursing unit. (4) Documentation of collaboration between disciplines and assessment of patient progress was more complete in the primary nursing unit.12 The patient satisfaction sample was computed with a Chi Square Test for significance of difference. Again primary nursing came out significantly higher. Similarities are: (1) Nurses are held responsible for their actions in both processes. (2) A certain amount of nonprofessionals to help with care will still be utilized in both processes. Accountability is a kind of accounting of the productivity of an individual, group, or i n ~ t i t u t i 0 n .Primary l~ Nursing Care emphasizes the nurse’s individual responsibility and accountability for quality patient care. This accountability is consistent with, and essential for, an enlarged dimension of professional nursing practice. From a legal view-point, many nurse practice acts are under revision to provide for expanded practice roles. Moreover, primary nursing actually emphasizes the best of traditional nursing practice, i.e., comprehensive patient care, professional autonomy.14 Quality Assurance Programs include resources combined to give the highest quality of nursing services. Programs usually include patient history
he next issue of HOS PlTAL TOPlCS will carry “Modes of D,elivery of Patient Care.” A case history study of primary nursing and t e a m care carried out at New England Deaconess Hospital wmw, BOSton, MA, a 500 bed acute car4ehospital. The study examined the degree to which nursing care planning was personalized on a primary nursing unit operating for three years and on a team nursing unit operating for many years. Nursing records on in-hospita1 patients. Nursing assessment and Kardex forms w e r e reviewed to determine personalized care. 0
Save time for medical professionals. Record racks hang over the bed footboard, or attach to doors or wails. Seven stock types plus
Continued on pug# I7
HOSPITAL TOPICS
Downloaded by [University of Montana] at 16:43 07 April 2015
Contlnued from pogm 14
taking, P.O.R. (problemoriented records), rounds, care plans, a u d i t s and client evaluation.16 P r i m a r y N u r s i n g Care can s u r e l y be added to t h i s package. Although primary n u r s i n g care a p p e a r s to be an ideal way to improve the quality of patient care, not all hospitals, for one r e a s o n or another, are able to adopt its concepts. It is only one way to meet the goal of improved quality of patient care. Other w a y s will be s o u g h t by h o s p i t a l s who cannot follow the primary process. Other w a y s will be found, but for the present, P r i m a r y N u r s i n g Care has come into i t s own! 0 FOOTNOTES 1. Author Unknown. "Primary Nursing Core." Kansas Nurse, Volume 51, January 1976. pg. 4. 2. Thorn Kron. Nursing Team Leadership, W.B. Sounders Company, Philadelphia and London, 1966. pg. 11, 12. 3. Karen 1. Ciske. "Prlmary Nursing: A n Organization That Promotes Pmfesslonal Practice." Journol of Nursing Adminirtration, January-February, 1974, pg. 28. 4. 1810. pg. 28, 29. 5. IBID. pg. 29. 6. IBID. pg. 29. 7. Martha Leonard. "Health Issues and Primary Nursing i n Nephrology Care." Nursing Clinics of North America, Septemtember 1975. pg. 41 3. 8 . Geraldene Feltan, Eidne Frevert, Kathleen Gailigan, Mary Kathleen Neill and Lillian Williams. "Pathwoys to Accountability: implernentatlon of a Ouality Assurance Program." Journal of Nursing Administration. Volume 6, Number 1, January 1976. pg. 23. 9. June 0. Jolly. "The Big Sister Programme: A Concept of Primary Nursing Care." Nursing Times, Volume 71, October 30, 1975. pg. 2. 10. IBID. pg. 3. 11. Aufhor Unknown. pg. 4. 12. IBID. pg. 4. 13. Doris J. Froebe, and R. Joyce Bain. Quality Assumnce Programs and Controls In Nursing, It. Louis: The C.V. Mosby Cornpony, 1976. pg. 9. 14. Martha Leonard. pg. 419. IS. Froebe and Bain. pg. 55.
JULY/AUGUST 1979
BIBLIOGRAPHY ARTICLES: Anderson, Marcia. "Primary Nursing in Doyby-Day Pmrlite." American Journal of Nursing, Volume Number 5, May 1976. Ciske, Karen 1.. R.N., Ms.N. "Primary Nursing: An Organization That Promotes Professional Proctits." Journal of Nursing Administration, Volume 4, January-Febw ary, 1974.
Felton, Gemidins, R.N., Ed.D. "Increasing the Ouaiity of Nursing Care by Introducing the Concept of Primary Nursing: Model Prolect." Nursing Research, Volume 24, Number 1, January-February 1975. Felton, Geroldine; Frevert, Elaine; Goiiigan, Kalhleen; Neiil, Mary Kathleen; and Wililams, Liiiion. "Pothwoys to Attountobility: Implementation of a Quality Assurance Progrom." Journal of Nursing Administration, Volume 6, Number 1, January
1976. Frevert, Elaine I., and Galligan, Kathleen A. "Evaluation of Nurslng Care: A Prlmary Nursing Prolect. Part 2, Experiences of Non-Particlpant Nurse Observers." Supervisor Nurse, Volume 6, Janwry 1975. Jolly, June D., S.R.N.,
R.S.C.N.,
"The Big Sister
Programme: A Concept of Primary Nurslng Care," Nursing Times, Volume 71, October 30, 1975. Leonard, Martha, M.N. "Health lssurs and Primary Nursing in Nephrology Care." Nursing Ciinlcs of North America, Volume
10, Number 3, September 1975. Unknown, Author. "Primary Nursing Care.'' Kanros Nurse, Volume 51, January 1976. Williams, Lillian B., R.N., M.N., "Evaluatlon of Nurslng Care: A Primary Nursing Prolect. Part 1, Report of the Controlled Study." Supervisor Nurse, Volume 6, January 1975. BOOKS: Froebe, Doris J., R.N., Ph.0. and Bdn, R. Joyce, R.N., Ed.D. Ouallty Assumnce Programs and Controls i n Nursing, C.V. Mosby Company; St. Louis, 1976. Hodges, John C. and Whitten, Mary E., Harbrate College Handbook, Harcourt, Bmca B World, Inc.; New York, 1962, Fifth Editlon. Kmn, Thorn, R.N., B.S. Nurslng Team Lendership, W.B. Sounders Company; Philadelphia and London, 1966, Second Editlon. Marram, Gwen D., e l 01, Primary Nurzing:
A Model for Individualized Care, C.V. Morby Company; St. Louis, 1974.
Study Shows Hospital How To Improve Purchasing, Materials Management Practices Opportunities for improving hospital purchasing and materials management practices are identified in a recently published study resulting from a cooperative effort between the AHA and the U.S. General Accounting Office (GAO). The two-part study offers suggestions for achieving sound procurement and materials management practices and provides a checklist on prudent purchasing concepts and materials management principles. Part I of the study provides an assessment of existing practices and recommendations for improvement. Part II presents a checklist and audit guide for self-review and analysis of the effectiveness of materials management functions. The GAO will be sending copies of the report t o U.S. hospitals, according to the AHA. 0
1
NEW TEST
evelopment of a new test to detect carriers of the gene for cystic fibrosis was announced at the joint annual meeting of the American Lung Association, the Christmas Seal organization, and its medical section, the American Thoracic Society. Approximately 3,500 physicians, nurses and volunteer and professional health workers attended the meeting which was the beginning of a year-long observance of the American Lung Association's 75th anniversary. The new test now provides a simple means to detect carriers and provide genetic counseling when a couple contemplating marriage are both found to be carriers. It is simple to perform, inexpensive and suitable for large scale screening. Collaborators in this research with Dr. Jack Lieberman of the Sepulveda Veterans Administration Medical center and professor of medicine at the U.C.L.A. School of medicine, Los Angeles, were W. Kaneshiro, N. Costea, M.D., and the late V. Yakulis. 0 17
