Nursing Delivery Care System

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Journal of Advanced Nursing, 1999, 29(3), 584±591

Integrative literature reviews and meta-analyses

Primary nursing: a mode of care or a philosophy of nursing?
David Pontin PhD RN RSCN RHV
Senior Lecturer ± Health Studies Research, Institute of Health Studies, University of Plymouth, Somerset Centre, Taunton, Somerset TAI 5YD, England. E-mail

Accepted for publication 19 March 1998

Journal of Advanced Nursing 29(3), 584±591 Primary nursing: a mode of care or a philosophy of nursing An examination of the literature surrounding primary nursing has shown that the term `primary nursing' is used to mean different things by different authors. This results in a confusing situation where `primary nursing' is considered by some to mean both a mode of organizing care delivery and a philosophy of nursing. In this paper I argue for a clear separation between the terms which refer to the set of ideas underpinning nursing and descriptions of modes of care. A case is made for using the term `human centred nursing' to refer to nursing beliefs and `primary nursing' to refer to the mode of nursing care delivery. PONTIN D. (1999)

Keywords: primary nursing, mode of care, philosophy of nursing, human-centred nursing structures of primary nursing are themselves a philosophy of nursing and may be transposed to any setting and will be productive in delivering professional nursing practice to patients (Eyres 1992, Watts 1993, Watkins 1993a, 1993b, 1993c, Graham 1993, Castledine 1994, Wright 1995, Neal 1995, Mills 1995, Melville 1995, Booth 1995, Furlong 1996). In this paper I wish to explore these different conceptions of the phrase `primary nursing' and show that the praxis of nursing concepts has been misconceived as a philosophy; this in part is due to the `professionalization project' engaged in by these authors (Davies 1996).

Primary nursing as an organizational concept originated in the United States of America (USA) during the late 1960s and early 1970s, and came to prominence in Britain during the early 1980s (Black 1992). The British proselytes have identi®ed Marie Manthey as the main protagonist behind the development of primary nursing in the USA (Wright 1990, Ersser & Tutton 1991). However, other writers have contributed to the development of the concept and differences have emerged in emphasis and direction. It appears that the main difference between Manthey and a number of US and British authors centres on whether primary nursing is simply a particular mode of care which re¯ects an underlying philosophy of nursing or whether primary nursing is a philosophy of nursing as well as a way to organize the delivery of nursing care. The `mode of care' position emphasizes that primary nursing is a way of organizing nursing care in institutions so that professional nursing practice can be exercized. It maintains that given different environmental circumstances other than a hospital ward, the underlying philosophy might manifest itself in a different form of organization (Athlin et al. 1993). The `philosophy in its own right' position maintains the premise that the forms and

Although Manthey is credited as the originator of the concept of primary nursing, she cites the pioneering work of Lydia Hall at the Loeb Centre in New York during the 1960s as a major in¯uence (Hall 1969, Manthey 1992). The concepts of nursing which in¯uenced Loeb's work ± being patient centred, emphasizing the inter-personal relationships within nursing and humanizing nursing practice ± are taken by Manthey and operationalized via primary nursing. Being patient centred means that nurses and doctors emphasize the comforting, caring aspects of their roles. Ó 1999 Blackwell Science Ltd


Integrative literature reviews and meta-analyses Patients are actively involved in planning their care, and records of care are patient centred rather than being occupationally orientated. The case method allocation...
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