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

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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.