# Primary Nursing in Intensive Care Units

## TL;DR

This study evaluates how well primary nursing was implemented in two intensive care units in a German hospital, finding success in one and room for improvement in the other.

## Contribution

The paper provides empirical evidence on the implementation of primary nursing in two distinct ICU settings using the IzEP(c) tool in Germany.

## Key findings

- Primary nursing was well implemented in the surgical ICU but requires further development in the medical ICU.
- Nursing performance indicators improved in both ICUs, though patient participation in the medical ICU still needs improvement.
- Implementation of primary nursing is feasible but requires continuous managerial support and evaluation.

## Abstract

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.

What is known about this topic?
○Primary nursing (PN) is a nursing organisation model that is practiced internationally in intensive care units (ICUs).○There are first‐quality development projects that address the implementation of PN using the validated tool Instrument zur Erfassung von Pflegesystemen (IzEP(c)) in ICUs in Germany, Austria and Switzerland.
What this paper adds?
○This study focuses on the implementation process of PN in a surgical (ICU 1) and medical (ICU 2) ICU with altogether 48 beds in a German university hospital using IzEP(c).○While PN was practiced in all included patients, results showed a well‐implemented PN in ICU 1 and further necessary development in ICU 2.○Nursing performance indicators of both ICUs reached well results with development potential in, for example, patient participation in ICU 2.

What is known about this topic?
○Primary nursing (PN) is a nursing organisation model that is practiced internationally in intensive care units (ICUs).○There are first‐quality development projects that address the implementation of PN using the validated tool Instrument zur Erfassung von Pflegesystemen (IzEP(c)) in ICUs in Germany, Austria and Switzerland.

Primary nursing (PN) is a nursing organisation model that is practiced internationally in intensive care units (ICUs).

There are first‐quality development projects that address the implementation of PN using the validated tool Instrument zur Erfassung von Pflegesystemen (IzEP(c)) in ICUs in Germany, Austria and Switzerland.

What this paper adds?
○This study focuses on the implementation process of PN in a surgical (ICU 1) and medical (ICU 2) ICU with altogether 48 beds in a German university hospital using IzEP(c).○While PN was practiced in all included patients, results showed a well‐implemented PN in ICU 1 and further necessary development in ICU 2.○Nursing performance indicators of both ICUs reached well results with development potential in, for example, patient participation in ICU 2.

This study focuses on the implementation process of PN in a surgical (ICU 1) and medical (ICU 2) ICU with altogether 48 beds in a German university hospital using IzEP(c).

While PN was practiced in all included patients, results showed a well‐implemented PN in ICU 1 and further necessary development in ICU 2.

Nursing performance indicators of both ICUs reached well results with development potential in, for example, patient participation in ICU 2.