1998 Volume 2 Issue 1 Pages 28-39
In April 1994, the Ministry of Health and Welfare abolished the patient attendant system in hospitals in order to decrease patients' expenditure and improve the quality of nursing services. The purpose of this study is to investigate the actual nursing services in three hospitals which have abolished the patient attendant system and to examine the administrative policy of hospital directors and nursing directors for managing patient care.
Method: We nursed as participant observers in wards and conducted semi-structured interviews with hospital directors, nursing directors, nurses, assistant nurses and nurse-aides.
Result and discussion: Assistant nurses accounted for more than 50 % of nursing staff. Almost all nursing staff had been working from the time before the abolishment of the patient attendant system. The characteristic of nursing services in these hospitals is summarized in five points: 1) lack of information exchange on patient care, 2) hard working conditions, 3) lack of planned nursing care, 4) lack of autonomy in decision making and, 5) poor teamwork among nursing staff.
Conclusion: Nursing services were not improved following the abolishment of patient attendant system in the three hospitals. Hospital directors and nursing directors did not recognize hard working conditions of nursing staff. Additionally, they were expecting nursing staff to raise the level of nursing services, but they neither prepared better working environment, nor exhibited their leadership to train nursing staff in accordance with their careers. Nursing staff mentioned that hospital directors and nursing directors did not listen to nurses' opinions. The attitude of hospital administrators seemed to strongly influence actual nursing service quality.
