The improvement of the quality of nursing care by introducing of primary nursing

本研究的目的是探讨初级护理是否提高了护理质量，如果是的话，我们如何解决引入初级护理的困难。第一步是对北里大学医院两个病房引入初级护理的效果进行评价。有相当多的证据表明初级护理的好处。例如，初级护士可以根据自己的判断决定护理，因为她是单独和连续地护理每一位病人。但各护士对病人的护理评估、计划护理及评价护理效果的能力参差不齐，只有少数护士具备担任初级护士的资格。目前，两个病房的初级护理部分是在日间值班。从每个病房的组长中挑选一些称职的护士担任初级护士，因为大多数患者都在接受团队护理。对领队意见的调查结果显示，他们认为自己很专业，但并不想提高自己太多。对护理活动的观察研究表明，组长在间接护理上花费的时间比其他护士多，而初级病人的大部分直接护理是由他或她的初级护士或在初级护士下班时监视该病人的相关护士提供的。我们开发了一种问卷来测量患者的满意度，以评估护理质量。因此，应尽快建立具有基层护理能力的护士教育培训计划。

The purpose of this study is to investigate whether or not primary nursing improves the quality of nursing care and, if it does, how we can solve the difficulties of introduction of primary nursing. The first step was to evaluate the result of primary nursing introduced into two wards of Kitasato University Hospital. There were considerable evidences of the benefits of primary nursing care. For instance, the primary nurse could decide on nursing care in her own judgment because she was caring each patient individually and continuously. But each nurse's ability of the nursing assessment of the patient, planning the nursing care to be given and evaluating the outcome of the nursing care given varied, so that only a few nurses were qualified to do as primary nurses. At present, primary nursing care is partially performed on day duty on the two wards. Some competent nurses are chosen as primary nurses from among team leaders on each ward where most of patients are receiving team nursing care. The results of the survey of team leaders' opinions showed that they considered themselves to be professional but did not desire to improve themselves so much. The observation study of nursing activities revealed that the team leader spent more time in indirect care than the other nurses and that the primary patient was given a major part of the direct care by his or her primary nurse or the associated nurse who was monitoring that patient when the primary nurse was off duty. We developed an inventory to measure the patient satisfaction for evaluating the quality of nursing care as well. In conclusion, the education and training program of nurses who are able to perform the primary nursing care should be established as soon as possible.