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

本研究目的在探讨基础护理是否能提升护理品质，以及如何解决基础护理导入的困难。第一步是评估北里大学医院两个病房实施基础护理的效果。有相当多的证据表明初级护理的好处。例如，主诊护士可以根据自己的判断来决定护理，因为她是在单独和连续地照顾每一个病人。但每位护士对病人的护理评估、护理计划和护理效果的评价能力参差不齐，只有少数护士能胜任责任护士的工作。目前，这两间病房的部分初级护理工作是在日间当值时进行的。在大部分病人接受团队护理的病房，从团队领导中挑选一些有能力的护士作为主要护士。对组长意见的调查结果显示，他们认为自己是专业的，但不希望提高自己这么多。护理活动的观察研究表明，组长花更多的时间在间接护理比其他护士，主要病人的直接护理的主要部分由他或她的主要护士或相关的护士谁是监测病人时，主要护士下班。本研究设计病人满意度量表，以评估护理服务品质。因此，应尽快建立基层护理人员的教育和培训计划。

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.