Ethnography: primary nursing, an investigation into the nature of one type of patient care modality

Yamashita, Mineko (1986) Ethnography: primary nursing, an investigation into the nature of one type of patient care modality. Masters thesis, Memorial University of Newfoundland.

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Abstract

The purpose of this study was to describe the nature of primary nursing by using five core elements under which nurses' activities were described by observing nurses on a unit and interviewing them over a period of three months. -- The study was based on the ethnographical approach. Through the method of participant observation, the interactions taking place between the nurses and their patipnts, the family, members, peers and other health care personnel were examined. The main focus was placed on the nurse-patient interaction as occurred on the unit. Documents, such as Progress Notes (Nurses' Notes), kardex and communication books, which were related to patient-care delivery, were also examined. From the literature review, the following five core elements were identified. These core elements were: Responsibility, accountability, autonomy, caring and decentralized communication. The data were analyzed on an ongoing basis to identify, sort and categorize the nurses' activities under appropriate core elements. -- Each participant practised her primary nursing care delivery mode with definite, identified constructs which formed a conceptual framework to guide her practice. While the constructs identified and the outcome of care delivered by the participants were similar, the mode of patient care delivery was found to be unique to each individual nurse. -- Despite each participant's diverse approach to patient care, a similar pattern of activities and behavior occurred consistently among all participants under the identified constructs and the pattern was examined as a group behavior to derive a definition of primary nursing. Based on the data obtained from this study using these constructs to describe the nature of primary nursing, the following definition of primary nursing emerged. -- Primary nursing is a nursing care delivery system whereby each primary nurse is assigned to a group of four to six patients. The primary nurse is responsible and accountable for her patients' individualized total care. She carries out a comprehensive patient care in an autonomous and caring manner by coordinating and collaborating with the family and other health care members through direct and open communication. As a multidisciplinary member of the health care system, the primary nurse acts as the patient advocate. She is empowered to delegate responsibility, in her absence, to her peers by the nursing care plan. In this way, continuity of care on a 24-hour basis is ensured throughout the patient's hospitalization.

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