Adaption, benefit and quality of care associated with primary nursing in an acute inpatient setting: A cross‐sectional descriptive study

Aims: The aim of this study was to investigate the adoption of primary nursing and to determine the quality of primary nurse-led care in an acute inpatient setting. Design: Descriptive cross-sectional study. Methods: Participants included inpatients (N = 369) and nurses (N = 381). To assess adoption of primary nursing, patient records were analysed and an online survey of nurses was conducted from May–June 2017. To measure quality of nursing care, a structured questionnaire was administered to inpatients. Results: Patients reported high quality of individualized, responsive and proficient care, but lower levels of coordinated care. Most nurses agreed that primary nursing is beneficial for person-centred caring. However, only two-thirds found that it was practiced on their unit and only half of care planning activities were attributable to primary nurses. Conclusion: While perceived as beneficial, adoption of primary nursing in clinical practice remains partial. Hence, primary nursing may not be enough to ensure continuity and coordination of acute care

The Importance of Time in Ethical Decision Making

Departing from a contemporary novel about a boy who is going to die from leukaemia, this article shows how the dimension of time can be seen as a morally relevant category that bridges both 'dramatic' issues, which constitute the dominant focus of bioethical decision making, and 'undramatic' issues, which characterize the lived experience of patients, relatives and health care workers. The moral task of comparing the various time dimensions of a given situation is explained as an act of 'synchronizing' the clocks. Ethical sensitivity and competence are presented as core skills that allow a continuity of care in situations where dramatic issues seem to be resolved, but undramatic ones are still not addressed. A nine-step model of shared decision making is proposed as an approach to identifying critical junctures within an illness trajectory and synchronizing the clocks of the involved actors