Changing to primary nursing in a nursing home in Finland: experiences of residents, their family members and nurses.
OBJECTIVE
The aim of the study was to find out how nursing home residents, their families and nurses experienced the change to primary nursing in the nursing home.


BACKGROUND
This study was carried out in a nursing home in Finland. Following years of functional nursing, the change to primary nursing had started 18 months prior to data collection. The transition was preceded by staff training, planning for the change to primary nursing and discussions with staff members. Meetings were also arranged with family members to inform them of what was happening and why. Staff implemented the changeover independently with the support of the institution's management.


METHODS
The data were gathered in focused interviews. There were five interview themes: change in the nursing home, the position of the resident in the nursing home, the relationship between the resident and nurse, the relationship between family member and nurse, and the role of the nurse as provider of nursing care.


RESULTS
Residents reported no major changes in nursing care or in their relationship with nurses. However, family members had noticed changes in the behaviour of the nursing staff. Staff members had become friendlier, spent more time with the residents and showed a strong job motivation. Cooperation between nurses and family members had changed very little. Some nurses in the early stages of the change tended to show signs of resistance. Others said that there had been many changes during the past year, that they acted more independently and could use their own decision-making authority more freely than before. They treated residents as individuals and gave them a greater say in decision-making. They felt responsible for the development of the workplace as a collectivity.


CONCLUSIONS
Primary nursing is one way in which nurses and family members can work more closely in the best interests of older residents. The findings of this study speak in favour of making the change from functional to primary nursing and at the same time highlight certain problems and possibilities in this process.
Laakso
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Clinical Research Associate, Hormos Medical Oy Ltd, Tykistökatu, Turku, Finland.
Routasalo
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D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001291:Attitude of Health Personnel; D001294:Attitude to Health; D003659:Decision Making, Organizational; D005190:Family / Q000523:psychology*; D005260:Female; D005387:Finland; D006801:Humans; D007297:Inpatients / Q000523:psychology*; D007587:Job Description; D008297:Male; D008875:Middle Aged; D016294:Models, Nursing; D009042:Motivation; D009723:Nurse-Patient Relations; D009735:Nursing Homes / Q000458:organization & administration*; D015404:Nursing Methodology Research; D009740:Nursing Staff / Q000458:organization & administration* / Q000523:psychology*; D009936:Organizational Innovation; D011321:Primary Nursing / Q000458:organization & administration*; D017009:Professional Autonomy; D011368:Professional-Family Relations; D011795:Surveys and Questionnaires