Primary nursing vs. Team nursing – Literature review

Search and Selection Criteria

To answer the PICO question, I searched online databases such as CINAHL, OVID, Cochrane database and ScienceDirect for articles related to the topic. Using Boolean operators, I refined my search with different combinations of keywords such as “primary nursing”, “team nursing”, “models of care”, “nursing models”, “quality of care”, “satisfaction” and “cost.” Although initial searches were limited to publications from the year 2005 to 2011, subsequent searches were expanded beyond this range due to limited results of articles that had carried out a primary evaluation within the range. For instance, no study on the cost associated with different models of nursing was found within the initial range chosen. Following expanded search, various studies that carried out a primary evaluation and others based on literature reviews evaluating primary and team nursing in terms of quality of care, patient and staff satisfaction and cost were identified, the discussion of which follows in subsequent sections.

Quality of Care

Various studies have evaluated the impact of nursing model on the quality of care. Sjetne et al. (2009) for instance evaluated how different models of nursing organisation affects nurses perception of quality of care through a cross-section survey of a sample drawn from Norwegian hospitals. The study compared wards with three types of nursing models: primary, team and a hybrid of primary and team nursing. Although the quality ratings did not differ significantly among the models, consideration of local ward conditions indicated that primary nursing to reduce the variance of care at ward level by as much as 32 per cent, a reduction not noted in other models (Sjetne et al. 2009, p. 330). Other studies have also found out that primary nursing improves the quality of care when compared with team nursing for instance with regard to decreasing omissions during care provision (Daeffler, 1975, as cited in Tiedeman & Lookinland, 2004, p. 295).

In other studies, the benefits of primary nursing over team nursing with respect to quality of care are not evident. This was for instance the case in one study where Nissen, Boumans and Landerweerd (1997) compared quality-of-care scores between primary-nursing and control groups in an 850-bed Dutch hospital. The study evaluated such scores at three different times; one before a structured primary nursing intervention was  introduced and the remaining two evaluations following the intervention. The study assessed both process and outcome measures of quality of care provided. Process evaluations related to the effect of introducing primary nursing on the “co-ordination of care, instrumental aspects of care and expressive aspects of care” (Nissen, Boumans & Landerweerd, 1997, P. 93). Outcome evaluations were related to patient variables such as stress, satisfaction, and initiative that resulted from the introduction of the primary nursing model. The results of the study did not find introduction of primary nursing to have significant beneficial effects on the quality of care except with respect to instrumental aspects of care where primary nursing intervention was associated with significantly higher scores (Nissen, Boumans & Landerweerd, 1997, P. 98). In support of such findings are studies (e.g. Wilson & Dawson, 1989, as cited in Tiedeman & Lookinland, 2004, p. 295) whose findings indicate that primary nursing and team nursing do not differ significantly in terms of quality. Further the findings in other studies (e.g. O’Connor, 1994, as cited in Tiedeman & Lookinland, 2004, p. 295) that assignment to a fixed team improves the quality of care significantly, may imply that team nursing may be implemented in a manner to meet equivalent levels of care as those associated with primary nursing. Continue to patient satisfaction.

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