An exploration of the nature of nursing practice in patient -focused care

Mary Beth Esposito, University of Rhode Island


Patient-focused care (PFC) is the latest care delivery model to emerge in the hospital setting. Despite wide-spread model adoption, little empirical investigation has occurred. Participant observation, in-depth interview, and document review were the methods used in this study to describe the nature of nursing practice and the knowledge used by nurses in PFC; to describe the way nurses design care in PFC as compared to the former primary nursing model; and to understand the impact of PFC on nurses and patients as perceived by nurses. Three experienced nurses practicing on an adolescent unit at a teaching hospital in the northeast United States were observed on 21 shifts and were each interviewed on three occasions.^ It was found that the nature of individual nursing practice maintained the patient-orientation of primary nursing but overlaid a task-orientation associated with delegation to assistive personnel. Nursing practice emerged as a process involving four phases: assessment, definition of the situation, establishing goals, and taking action. This extends Kim's (1994) framework, which proposed that nursing practice involves a deliberation and an enactment phase, by suggesting that deliberation includes the phases of assessment, definition of the situation, and establishing goals. A philosophy of care and a philosophy of therapy were also used in nursing practice, supporting Kim's (1994) conception.^ Knowledge of the individual patient was used to tailor nursing care. Tailoring was observed in patients cared for by a nurse over a hospitalization and more significantly in patients cared for over multiple hospitalizations. Tailoring was not seen in patients cared for over a single shift during a brief, episodic hospitalization. Knowing the patient occurred over time, through physical contact and time spent talking while performing routine activities. Delegation limited the nurse's ability to know the patient and thus, to tailor care. Delegation also added risk and complexity to nursing practice.^ Patient outcomes included prompt response by associate staff to basic care needs and that patients 'slipped through the cracks'. Nursing outcomes included developing delegating and communicating skills and feeling 'behind the eight ball'. These outcomes should be interpreted in the context of this organization's operational characteristics. ^

Subject Area

Health Sciences, Nursing|Health Sciences, Health Care Management

Recommended Citation

Mary Beth Esposito, "An exploration of the nature of nursing practice in patient -focused care" (1998). Dissertations and Master's Theses (Campus Access). Paper AAI9902560.