Impact of Primary Nursing on Nursing-sensitive Outcomes in Inpatients Units: a Multicentre Pre-Post Study

Primary Nursing: Uno Studio Pre e Post - Studio PRIMARY

The aim of this quasi-experimental before-after study is to evaluate whether the implementation of the Primary Nursing (PN) pattern of care improves nursing-sensitive outcomes in adult inpatients and nurse-related outcomes across hospital wards in Northern Italy.

The main questions it aims to answer are:

1. What is the impact of the PN on inpatients' nursing-sensitive outcomes, including healthcare-associated infections, falls, pressure injuries, functional status, and patient satisfaction?
2. What is the impact of the PN on nurse-related outcomes, including burnout, missed nursing care, job satisfaction, and intention to leave?

This study follows a multicentre, uncontrolled before-after design: in the pre-intervention phase, wards operated according to their existing nursing care models (functional or team nursing); this was followed by the implementation of the PN across all participating wards.

The PN assigns each patient to a single reference nurse who is responsible for planning, delivering, and evaluating nursing care throughout the entire hospital stay. In the primary nurse's absence, an associate nurse ensures continuity by following the individualised care plan.

Inclusion Criteria (patients):

• Hospital stay of at least 48 hours in the study ward
• Capacity to provide written informed consent
• Clinical conditions permitting completion of self-reported outcome measures

Inclusion Criteria (nurses):

- Nursing staff employed in the study ward for at least 6 months

Exclusion Criteria (nurses):

• Nursing staff joining the ward after the implementation phase of the PN model