The effectiveness of a team nursing model compared with a total patient care model on staff wellbeing when organizing nursing work in acute care wards

Abstract

Background The organization of the work of nurses, according to recognized models of care, can have a significant impact on the wellbeing and performance of nurses and nursing teams. This thesis focuses on two models of nursing care delivery, namely, team and total patient care, and their effect on nurses’ wellbeing. Objectives To examine the effectiveness of a team nursing model compared with a total patient care model on staff wellbeing when organizing nursing work in acute care wards. Inclusion criteria Types of participants Participants were nurses working on wards in acute care hospitals. Types of intervention The intervention was the use of a team nursing model when organizing nursing work. The comparator was the use of a total patient care model. Types of studies This review considered quantitative study designs for inclusion in the review. Types of outcomes The outcome of interest was staff wellbeing which was measured by staff outcomes in relation to job satisfaction, turnover, absenteeism, stress levels and burnout. Search strategy The search strategy aimed to find both published and unpublished studies from 1995 to April 21, 2014. Methodological quality Quantitative papers selected for retrieval were assessed by two independent reviewers for methodological validity prior to inclusion in the review using standardized critical appraisal instruments from the Joanna Briggs Institute. Data collection Data was extracted from papers included in the review using the standardized data extraction tool from the Joanna Briggs Institute. The data extracted included specific details about the interventions, populations, study methods and outcomes of significance to the review question and its specific objectives. Data synthesis Due to the heterogeneity of the included quantitative studies, meta-analysis was not possible thus results have been presented in a narrative form. Results The database search returned 10,067 records. Forty-three full text titles were assessed, and of these 40 were excluded, resulting in three studies being included in the review. Two of the studies were quasi experimental designs and the other was considered an uncontrolled before and after experimental study. There were no statistically significant differences observed in any study in the overall job satisfaction of nurses using a team nursing model compared with a total patient care model. Some differences in job satisfaction were however observed within different subgroups of nurses. There were no statistically significant differences in either stress or job tension. Within the selected studies, the specific outcomes of absenteeism and burnout were not addressed. Conclusions Due to the limited number of quantitative studies identified for inclusion it was not possible to determine whether organizing nursing work in a team nursing model or a total patient care model is more effective in terms of staff wellbeing. Neither a team nursing model or a total patient care model had a significant influence on nurses’ overall job satisfaction, stress levels or staff turnover. There is an inability to ascertain if the type of model of care affects absenteeism or burnout as these outcomes were not addressed in any of the identified studies. Implications for practice Caution should be taken when evaluating which model of care is appropriate and the decision needs to incorporate staff experience levels and staff skill mix. There needs to be clear definition of nursing roles. Implications for research There is a need for further quantitative studies that are well designed with sufficient sample sizes to allow for attrition of participants, and that explore the impact each model has on nurse’s wellbeing, in particular, studies that address burnout and absenteeism. Consistent terminology is required to enable future comparison and research to occur at an international level. Future studies on models of care should include economic analysis to fully inform policy and practice.