Development and implementation of primary nursing in the intensive care unit: evaluation in mixed-methods design

Background: In a university hospital, the development and implementation of Primary Nursing (Prozessverantwortliche Pflege, PP) in a pilot intensive care unit was initiated. To develop the roles of nurses with and without process responsibility a working group PP was founded while taking into account the skill-grade mix. Aim: The working group aimed to develop the roles of process-responsible nurses (PP) and nurses (P), as well as to plan and implement the implementation process. Methods: Development and piloting steps were taken based on the recommendations of the Medical Research Council. At three measurement points, the instrument for recording nursing systems (IzEP (c)) was used quantitatively and a focus group interview, as well as a ward process analysis, were used qualitatively in t(0) (as-is analysis before development and piloting), t(1) (6 months after implementation) and t(2) (12 months after implementation). Results: PP mainly take over the care process's design and control. The IzEP (c) analysis showed that room care was practiced in t(0) with 50.0 %. The values increased towards PP from 74.0 % in t(1) to 83.5 % in t(2). Qualitatively obtained data supported these results and showed further optimization potential for practice. Conclusions: The results prove the successful implementation of PP in practice. For the development and implementation of new nursing roles, the involvement of the affected nurses is mandatory.