Models of care in nursing: a systematic review


  • Ritin Fernandez RN MN (Critical Care) PhD,

    Corresponding author
    1. School of Nursing, Midwifery and Indigenous Health, University of Wollongong, Wollongong
    2. Centre for Research in Nursing and Health, St George Hospital, Kogarah
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  • Maree Johnson RN BAppSci MAppSci PhD,

    1. Centre for Applied Nursing Research, Sydney South West Area Health Service
    2. School of Nursing and Midwifery, University of Western Sydney, Sydney
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  • Duong Thuy Tran BMed (Vietnam) MIPH (USyd),

    1. School of Medicine, University of Western Sydney, Sydney
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  • Charmaine Miranda BPsycholgy

    1. Centre for Positive Psychology and Education, School of Education, University of Western Sydney, Sydney, New South Wales, Australia
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Professor Ritin Fernandez, St George Hospital, Kogarah, NSW 2217, Australia. Email:


Objective  This review investigated the effect of the various models of nursing care delivery using the diverse levels of nurses on patient and nursing outcomes.

Methods  All published studies that investigated patient and nursing outcomes were considered. Studies were included if the nursing delivery models only included nurses with varying skill levels. A literature search was performed using the following databases: Medline (1985–2011), CINAHL (1985–2011), EMBASE (1985 to current) and the Cochrane Controlled Studies Register (Issue 3, 2011 of Cochrane Library). In addition, the reference lists of relevant studies and conference proceedings were also scrutinised. Two reviewers independently assessed the eligibility of the studies for inclusion in the review, the methodological quality and extracted details of eligible studies. Data were analysed using the RevMan software (Nordic Cochrane Centre, Copenhagen, Denmark).

Results  Fourteen studies were included in this review. The results reveal that implementation of the team nursing model of care resulted in significantly decreased incidence of medication errors and adverse intravenous outcomes, as well as lower pain scores among patients; however, there was no effect of this model of care on the incidence of falls. Wards that used a hybrid model demonstrated significant improvement in quality of patient care, but no difference in incidence of pressure areas or infection rates. There were no significant differences in nursing outcomes relating to role clarity, job satisfaction and nurse absenteeism rates between any of the models of care.

Conclusions  Based on the available evidence, a predominance of team nursing within the comparisons is suggestive of its popularity. Patient outcomes, nurse satisfaction, absenteeism and role clarity/confusion did not differ across model comparisons. Little benefit was found within primary nursing comparisons and the cost effectiveness of team nursing over other models remains debatable. Nonetheless, team nursing does present a better model for inexperienced staff to develop, a key aspect in units where skill mix or experience is diverse.