Page 453 - Encyclopedia of Nursing Research

420 n PRIMARY NURSING

Chasen, 2009, Goldenberg, 2002; Maloni,
2010; Muglia & Katz, 2010; Sprague, O’Brien, Primary nursing
P Newburn-Cook, Heaman, & Nimrod, 2008).
It is unclear whether preterm birth is
preventable (Ashton et al., 2009; Institute of Primary nursing is a delivery system for
Medicine, 2007; Muglia & Katz, 2010). Both nursing care. A delivery system is a set of
the Institute of Medicine and the Surgeon organizing principles that is used to deliver
General call for increased multidisciplinary a product or service. It generally consists of
research efforts into biomedical and epidemi- four elements: decision making, work allo-
ological factors and psychosocial and behav- cation, communication, and management.
ioral issues (Ashton et al., 2009; Fry-Johnson There are four prototypical delivery systems
& Rowley, 2010; Honest et al., 2009; Institute used in hospital nursing: functional nursing,
of Medicine, 2007; Muglia & Katz, 2010). team nursing, total patient care, and primary
Increased understanding of the process of nursing. each of these systems defines the
parturition, the multiple causes of preterm four organizing elements differently.
birth ,predictive biomarkers, risk factors, Primary nursing clearly allocates deci-
and the factors influencing the rise in pre- sion-making responsibility for care delivery
term births is needed before effective inter- and care management to a specific RN. This
ventions can be created (Ashton et al., 2009; individual establishes the responsibility
Institute of Medicine, 2007). Future efforts relationship by explaining it to the patient
to prevent preterm birth include implemen- and his or her family. Commensurate with
tation of evidence-based practice assisted by this responsibility, the RN has the author-
professional education and training, and a ity to decide, in partnership with the patient
return to doing what works, such as regional- whenever possible, how nursing care will
ization of perinatal care rather than interho- be given to this patient. This plan of care
spital competition driven by reimbursement is to be followed by others caring for the
(Braillon & Bewley, 2010; Goldenberg, 2002; patient when the primary nurse is not there,
Institute of Medicine, 2007). Further, recon- unless the patient’s condition changes. The
ceptualization of prenatal care is needed as primary nurse role includes giving direct
the current model does not meet the needs of care as well as comprehensive patient care
women at risk for preterm birth, particularly planning and coordination. Full implemen-
when intensive monitoring occurs during the tation of the primary nursing system has a
last weeks of pregnancy and not when early major impact on all roles and relationships
signs of complications emerge (Goldenberg, among the staff and among other health
2002; lu, Tache, Alexander, Kotelchuck, & professionals.
Halfon, 2003; Maloni, 2010). Prenatal care for Primary nursing is the only nursing care
high-risk pregnancies also needs to include delivery system that clearly establishes the
intrapregnancy care for continued follow-up role autonomy characteristic of a true pro-
between pregnancies to improve maternal fession. Successful implementation requires
preconception health (Ashton et al., 2009). a transformational change process. On the
Ultimately, increased access to insurance basis of the theory of decentralized deci-
and provision of quality woman’s health care sion making, the system requires the staff to
across the life span, beginning at birth, may become empowered, which in turn mandates
be most effective in promoting both maternal a workplace culture that includes good team-
and fetal/neonatal health (Ashton et al., 2009; work and effective leadership.
Maloni, 2010). Primary nursing was developed by
a staff of nurses on a 23-bed medical unit
Judith A. Maloni at the University of Minnesota Hospitals