Primary Nursing in Intensive Care Units

As a patient-centred model of nursing care, primary nursing (PN) ensures continuity of care while promoting systematic involvement of patients and family members in the therapeutic process. To date, comprehensive published research projects that address the implementation of PN on intensive care units (ICUs) are rare.

Primary aim was to evaluate the overall process of development and implementation of PN in two German ICUs of a university hospital. Secondary aims were to identify changes on ICU, as well as nursing performance indicators.

Quantitative design on a surgical (ICU 1) and medical (ICU 2) ICU. We used the validated German Instrument zur Erfassung von Pflegesystemen (IzEP(c)) with separate questionnaires for patients, relatives and medical staff at three data collection points as an as-is analysis before (t₀), after six (t₁) and 12 months (t₂) of implementation of PN in practice. IzEP(c) enables a percentage calculation of the practiced nursing organisation model (overall ICU profile; PN at > 75%), information of the ICU profile (e.g., communication) and nursing performance indicators (e.g., patient participation). For descriptive statistics, a programmed Microsoft Excel spreadsheet with built-in percentage calculations, developed by the IzEP(c) development team, was used.

Data collection took place between September 2023 and March 2025, and 264 questionnaires were analysed. The overall profile on ICU 1 started with individual nursing (44.5%, t₀) up to PN in t₂ (83.0%). ICU 2 reached individual nursing between t₀-t₂ with characteristics toward PN (t₀: 51.0%; t₂: 69.0%). Between t₀-t₂, ICU profile showed good development in communication in ICU 1 (36.0%; 77.0%) and necessary change in ICU 2 (38.5%; 46.5%). Nursing performance indicators reached good development in both ICUs with development potential in, for example, patient participation in ICU 2 (54.0%; 49.5%).

PN was practiced in all included patients in both ICUs, but implementation was not fully achieved in ICU 2. Nevertheless, PN was practiced in included patients on ICU 2. Another evaluation on ICU 2 should be planned.

PN on ICU is feasible and needs continuous support from nursing managers for successful implementation. An accompanying evaluation is mandatory for this purpose.

This study is registered at the German Clinical Trials Register as DRKS00030966.