Promoting family-centred care through primary nursing practice in Nigeria : an action research project
The context of the family in developing countries, especially in Nigeria, is very wide and embraces the immediate as well as the extended family members. The involvement of the family in health care can not be over-emphasised in the Nigerian society where every family member assumes the role of his/her brother's keeper. The expectations of and the role of the Nigerian extended family system in the health care of its members, the problem of incompatibility of the nursing process with the Nigerian nursing organisational pattern, which is predominantly functional nursing, and the increased call for the improvement of the quality of nursing care in Nigeria informed this study. The 'outsider' model of action research project using an 'insider' was undertaken to promote family-centred care through the introduction of primary nursing in Nigeria. The project involved introduction and evaluation of change in a model ward in a Nigerian hospital. The change was implemented in phases. A 37-bed medical-surgical ward in a 400-bed tertiary health institution formed the nucleus site for the change. Twenty-eight nursing staff (25 trained and 3 untrained), all patients and their families in the model ward and others took part in the change. In the pre-change evaluation study, 10 patients and 8 family members were assessed, while 8 patients and 6 family members were involved in the post-change evaluation. Data collection was carried out before and after the introduction of the change through observation, review of records, interview and self-report questionnaire. Measures used in the study included: QUALPACS, nurse-patient and nurse-family interaction sheets, modified Riser satisfaction questionnaire for patient and family satisfaction, questionnaire to determine the focus of nursing care and questionnaire to assess the practice of primary nursing in the model ward. Families and patients were supportive of the change, nurses were receptive of the change, hospital administration was helpful and other health care practitioners were neutral about the change. Other wards in the hospital and other hospitals expressed willingness to join in the change. After the introduction of primary nursing into the model ward, there appeared to be (1) marked improvement in the quality of nursing care received by the patients, (2) higher levels of family and patient satisfaction with nursing care, (3) an increase in the frequency of nurse-patient and nurse-family interactions, (4) improvement in the level of patient and family involvement in interactions and (5) an increase in the number of nurse-patient and nurse-family interactions in which supportive nursing activities were involved. Despite the study limitations, further research and replication studies are suggested to enable the spread of family-centred nursing care into other hospitals. Possibilities for continuity measures, outcomes for nursing staff and other health care practitioners have been raised as necessary variables for future evaluative studies. The need for more long term studies on primary nursing, and an in-depth study to ascertain the association between presence of family at patient's beside while the patient is under care and the level of patient satisfaction with nursing care have been implicated from this study.