Paper
Wednesday, July 11, 2007
This presentation is part of : Acute Care Initiatives
Acute Care Nurse's Perceptions of Changing Health Care Delivery Models: Total Patient Care to Primary Nursing
Margie Crandall, PhD, RN, Center for Advancing Nursing Research & Clinical Practice, UC Davis Health Systems, Sacramento, CA, USA and Barbara Rickabaugh, RN, MS, Center for Advancing Nursing Research & Clinical Practice, University of California Davis Medical Center, Sacramento, CA, USA.
Learning Objective #1: 1. Participants will identify at least two barriers and strategies that either hinder or promote a system-wide nursing practice change in an acute care setting.
Learning Objective #2: 2. Participants will identify at least 2 patient or nurse outcomes subsequent to the implementation of a practice model change to primary nursing.
Purpose:
 
To explore what acute care nurses perceived influenced their process of implementation from total patient care to primary nursing, at initial implementation and 6 months post implementation.
 
Method:
 
A qualitative study was conducted using thematic analysis.  Unit based nurse practice councils, responsible for planning and implementing change, were interviewed. Twenty-six semi-structured group interviews (15 in phase 1, 11 in phase 2) were audio-recorded and transcribed.  Using constant comparative analysis, transcripts were read line-by-line and significant words and phrases were categorized and coded.  An audit trail was maintained to document all aspects of the study, data analysis and description of the findings.  Participants verified 4 themes.
 
Results:
 
Initial implementation data analysis identified 2 themes that emerged as barriers to practice change:
 
Theme 1 – The need for preparation, resources, and administrative support.

Nurses required knowledge about primary nursing and practice council structure and responsibilities, knowledgeable guidance from leadership, and adequate staffing to support the change. 

Theme 2 – Staff resistance to change.

Staff resistance included both behavioral and emotional reactions to practice change.  Fear, anxiety, anger, being overwhelmed, sabotage and hostility were reported. 

Six months post implementation data analysis identified 2 themes: 

Theme 3 – Confronting barriers with creative practice strategies.

Nurses identified several strategies that included assignment modification, tools, orientation program, and revision of the existing job description to include key components of primary nursing. 

Theme 4 – Improved outcomes through patient knowing.

Subsequent to the implementation of the strategies, nurses perceived improved nurse-patient relationships and improved patient and nurse satisfaction and outcomes. 

Conclusion: 

Prior to implementation of a system-wide nursing practice change, nurses require preparational education regarding the model, committee process and communication strategies in order to plan and implement system changes.  On-going leadership involvement and support is critical.  Nurses perceived the primary nursing model improved patient and nurse outcomes.

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