The development of a primary nursing model based on Swanson’s caring theory at an emergency department in a private hospital

Abstract

           This descriptive study aimed to: (1) analyze problems of a nursing care model in an emergency department (ED), (2) develop a primary nursing care model based on Swanson’s Caring Theory, and 3) evaluate an appropriateness of the developed primary nursing model. The key informants comprised 16 nurses working at an emergency department in a private hospital. They were consisted of eight professional nurses, one nurse manager, one supervisor, and six in-charge nurses. Data collection were conducted using focus group discussion with open-ended questionnaires, and an appraisal form of model appropriateness. Data were analyzed by content analysis and calculated the suitability score.

            The results of this study were as follows. 1) The problems of ED were divided into three categories. (1) the structure dimension demonstrated, inappropriate ratio between nurse and patient from time to time, unsystematic assignment unless nurses’ competencies consideration, nurses’ roles did not facilitate continuity of care along with nursing process and lack of systematic and proper communication system and patient bed placement. (2)The system of care illustrated lack of continuity of care irrelevant to nursing process and incomplete holistic care. (3) The outcome showed dissatisfaction of both patients and nurses, and incidences of care errors. 2) The developed primary nursing model constructed from resolving emerging problems and integrating with three concepts of primary nursing system, Swanson’s caring model, and Donabedian’s quality of care evaluation model. The model’s structure and process dimensions emphasized on continuity and holistic approach from admission until discharge with systematic communication, while the outcome measured both patient and nurses’ satisfaction along with incidence reports. Finally, 3) the developed primary nursing model was appropriate for adoption with 92.84%.

            This study suggests that this model of care should be applied in an emergency department to improve the process of continuing nursing care and to evaluate the quality and effectiveness of care