PROCESS, PATTERNS AND PARADOX IN PRIMARY NURSING: A CASE STUDY OF PLANNED CHANGE IN A CHILDREN'S HOSPITAL.
Contributors: Southern Methodist University.
Published: 1986
Number of pages: 207
Subjects: Anthropology, Cultural.; Health Sciences, Nursing.; Health Sciences, Health Care Management.
Description: This research reports on findings from a planned change program in which nurses in a children's hospital endeavored to change their system for delivering nursing care to a newer system--primary nursing.

The primary nursing program on the three study units did not meet with the anticipated success during the fifteen-month field study. Rather, two patterns emerged: rejection by the intensive care nurses; and acceptance of a hybrid pattern in the other two units by "floor" nurses.

A quantitative pretesting and post-testing revealed the emergence of a paradox. Despite the rejection of primary nursing, intensive care nurses perceived their nursing care to be improved. Paradoxically, in the two units where primary nursing appeared to have been accepted, substantial improvements in nursing practice did not follow.

Agreement between parents and nurses about nursing care was tested before and after the initiation of primary nursing. Both groups agreed about the quality of care given and care received before primary nursing was introduced but disagreed after the change. Data from participant observation in the hospital was crucial for placing the findings in context. New nursing leadership and intensive, inservice classes were identified as being instrumental in intensive care nurses' beliefs of improved practice.

Factors impeding the primary nursing program were: daily hospital realities; multiple interpretations of primary nursing practice; proliferation of health care specialists; the nursing department's position in the hospital hierarchy; and significantly, nurses themselves. The "A Factor," a syndrome made up of the distinctive features of amorphousness, ambivalence, ambiguity and the need for anonymity within the profession, was identified as being crucial to nurses' inability to control their practice.
Notes: Source: Dissertation Abstracts International, Volume: 47-05, Section: A, page: 1789.

Thesis (PH.D.)--SOUTHERN METHODIST UNIVERSITY, 1986.

School code: 0210.