Comments on “Primary nursing: an evaluation of its effects on patient perception of care and staff satisfaction”

Abstract

This paper described a landmark small trial (Intervention group n 1⁄4 28; Control group n 1⁄4 31) which developed and tested earlier research regarding relational continuity of care in the acute hospital setting. Significantly higher levels of both patient and nurse satisfaction were reported where primary nursing was practised. The trial also highlighted the complexity of conducting trials in the natural setting of real acute hospital wards where control of extraneous variables is always a challenge but importantly the trial addressed key ongoing issues in healthcare namely: patient experience and job satisfaction of practitioners. While the authors acknowledged the limitations of their measurement tools, it could be argued that the patient satisfaction instrument was rather naive but reflected the extent of understanding at the time. Patient satisfaction was measured by a specially designed selfreport questionnaire comprising 11 items, 10 of which explored perceptions of nursing care received and one item recorded the recall of the number of nurses having contact during the last 24 h as a proxy for the number of nurses providing care. Patients were asked to rate their perceptions against a 3 point scale which may have encouraged response bias towards the median. Further, the measurement of patient satisfaction has been subject to much criticism over the years principally due to the lack of clarity surrounding the concept (Locker and Dunt, 1978; Fitzpatrick and Hopkins, 1993; Sitzia and Wood, 1997) with the inability of global statements to identify different levels of satisfaction relating to various aspects of care. Thus Question 5: ‘How well do you think the nurses understood you?’ did not permit study participants to consider differential experiences relating to the many aspects of nursing care received. The significant differences between the control and intervention groups must therefore be interpreted with caution. Similarly, the lack of expressed dissatisfaction by the control group was not surprising since the majority of patients consistently report high levels of satisfaction (Locker and Dunt, 1978). This research also highlighted the impact of the method of care delivery upon nurses’ job satisfaction. The nurses’ satisfaction instrument was more sophisticated utilising 7 and 4 point Likert scales and items drawn from previous work. The five items demonstrating significant differences between the control and intervention groups were associated with more autonomous clinical practice namely: ‘accomplishment of something worthwhile’, ‘opportunity to voice opinions’, participation in making decisions, speed of work, and setting own pace of work. These issues have resonance today and are regarded as issues of importance for the job satisfaction of nurses. However, the impact of this research and other similar work is evidenced by the change in nursing care delivery and the rejection of task oriented care delivery. Indeed, no hospital ward in United Kingdom now organises care along task lines rather the named nurse or team nursing are the norm although the reality at the bedside may result in little relational continuity with a single practitioner with the increasing use of health care assistants and temporary/agency nurses to make up the shortfall of permanent qualified nurses. Nonetheless, continuity of care including continuity of caregiver remain important aspirations within nursing provision and are often considered benchmarks of high quality healthcare. The universal reduction in the length of hospital in-patient stays has further highlighted the importance of relational continuity between patients and nurses if meaningful supportive relationships are to be developed between the cared for and professional carers. The current crisis in recruitment and retention of nurses has highlighted the job satisfaction of practitioners as an important policy and employment issue if healthcare delivery targets are to be met; neglect of job ARTICLE IN PRESS