Primary nursing: autonomy or autocracy?

There has been an almost exponential increase in the number of clinical areas using primary nursing as a mode for delivering nursing care. Concurrently, the amount of written material pertaining to primary nursing has grown. In this paper, a small sample of this literature is reviewed. Most of the literature can be seen as either descriptive or as evaluative research. Many of the papers reviewed have methodological weaknesses; also the findings are equivocal about the advantages and the nature of primary nursing. A major problem appears to be that the basic tenets, beliefs and values of primary nursing have not been systematically investigated; thus attempts to evaluate primary nursing without such a philosophical analysis may be misdirected. This paper argues that such an analysis: (a) is now necessary; (b) requires a qualitative research approach to generate theory; and (c) that a grounded theory methodology is the most appropriate way to do this. A preliminary field study is briefly described and the generated data discussed.