Nursing Model and Health Outcomes of Elderly People with Multimorbidity: a Quasi-experimental Study

Effect of the Primary Nursing Model on Health Outcomes of Elderly Person with Multimorbidity: a Quasi-experimental Study

The goal of this quasi-experimental study is to analyze the effect of organizing nursing care according to the primary nursing model on therapeutic self-care and satisfaction with nursing care for elderly people with multimorbidity in hospital. Participants were patients of both sexes aged over 65 years with at least two chronic diseases admitted to an acute hospital ward. The main questions it aims to answer are:

• Does the use of the primary nursing model increase participants' perceived ability for therapeutic self-care?
• Does the use of the primary care model increase participants' satisfaction with nursing care? The researchers are comparing whether implementing the primary nursing model with the usual care model increases patients' capacity for therapeutic self-care.

Participants:

• Complete a self-care skills questionnaire on admission to the inpatient unit;
• Complete the same self-care questionnaire on discharge from hospital;
• Complete the same self-care questionnaire by telephone one month after discharge from hospital
• Complete a nursing care satisfaction questionnaire on discharge from hospital;

Study Overview

• Status: Completed
• Conditions: Aged; Patient Outcome Assessment; Multimorbidity
• Intervention / Treatment: Behavioral: Changing the nursing care model to the primary nursing model

Detailed Description

The self-care skills questionnaire used was the Therapeutic Self-care Scale (TSC), translated and validated for the Portuguese population.

The questionnaire used to assess satisfaction with care was the Scale of Citizen Satisfaction with Care (ESCCE), validated for the Portuguese population.

• Study Type: Interventional
• Enrollment (Actual): 206
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Portugal
  • Lisboa, Portugal, 2745-849
    • Hospital da Luz

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Have at least two chronic diseases
• Have at least one disease classified in the International Classification of Diseases, Ninth Revision (ICD9) and belonging to one of the following groups: cardiovascular disease, cancer, chronic obstructive pulmonary disease and diabetes;
• Expect to be hospitalised for more than 48 hours;
• Have the cognitive ability to read, write and understand the information provided;
• Speak, read and write Portuguese.

Exclusion Criteria:

• Transfer to other levels of care within the organisation
• Discharged to other care units outside the organisation
• Episodes of readmission within 30 days of leaving hospital, as this made the last moment of data collection impossible.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Health Services Research
• Allocation: Non-Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Changing the nursing care model to the primary nursing model; Inpatient unit where the primary nursing model has been implemented.	Behavioral: Changing the nursing care model to the primary nursing model; The nurses received training in primary nursing care before the start of the intervention. The model was tested and implemented in early April 2022. Since then, all patients admitted to the unit have been assigned to a primary nurse within the first 48 hours. This nurse is responsible for developing and monitoring the patient's care plan, assessing care needs, implementing the care plan and evaluating the outcomes. This nurse is also responsible for coordinating care needs and discharge planning with other healthcare professionals. When the primary nurse is not working, another nurse from his or her team continues the care plan that he or she has defined. All patients admitted to the unit who met the selection criteria were informed about the study and, if they agreed to take part, completed a self-care competence questionnaire at admission (baseline), at discharge and one month after discharge. They also completed a questionnaire on satisfaction with nursing care at discharge.
No Intervention: Standard of care; In this unit there was no change in the model of nursing care; the model used was the individualized care model. In this model, each nurse is responsible for the whole care of a group of patients on one working day and may or may not be given responsibility for the same patients on subsequent days. The patients who agreed to participate in the study completed the same questionnaires and at the same frequency as the patients in the intervention unit.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Average global self-care score at discharge from inpatient unit	Evaluated by the difference in response to the Therapeutic Self-Care Scale on admission and discharge from the unit. It is a 12-question Likert scale with a minimum score of zero (0) and a maximum score of five (5), with higher scores corresponding to better results. Average response scores are used.	On the day of discharge from the inpatient unit, assessment up to 24 hours later.
Average global self-care score at follow-up	Evaluated by the difference between the response to the Therapeutic Self-Care Scale at discharge and at follow-up. Also assessed by the difference between the response to the Therapeutic Self-Care Scale at admission and at follow-up. Therapeutic Self-Care Scale is a 12-question Likert scale with a minimum score of zero (0) and a maximum score of five (5), with higher scores corresponding to better results. Average response scores are used.	At the follow-up 30 days after hospital discharge

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Average score for satisfaction with nursing care at discharge from inpatient unit	Assessed by answering the Citizen Satisfaction with Nursing Care Scale at discharge from the unit. This is a 47-question Likert scale with a minimum score of one (1) and a maximum of seven (7), with higher scores corresponding to better results. Average and total response scores are used.	On the day of discharge from the inpatient unit, assessment up to 24 hours later.

Collaborators and Investigators

• Sponsor: Hospital da Luz, Portugal
• Collaborators: Universidade Católica Portuguesa
• Investigators: Study Director: Elvio Jesus, Professor, Universidade Católica Portuguesa; Study Chair: Elisabete Nunes, Professor, Nursing School of Lisbon

Study record dates

Study Major Dates

• Study Start (Actual): April 18, 2022
• Primary Completion (Actual): August 31, 2023
• Study Completion (Actual): August 31, 2023

Study Registration Dates

• First Submitted: November 12, 2024
• First Submitted That Met QC Criteria: November 20, 2024
• First Posted (Estimated): November 22, 2024

Study Record Updates

• Last Update Posted (Estimated): November 22, 2024
• Last Update Submitted That Met QC Criteria: November 20, 2024
• Last Verified: November 1, 2024

More Information

Terms related to this study

• Other Study ID Numbers: CES/01/2022/ME

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES
• IPD Plan Description: Only IPD used in the results publication
• IPD Sharing Supporting Information Type: SAP

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: No