Evaluating and improving a model of nursing care delivery: A process of partnership



      Evaluating and improving a model of nursing care is a fundamental part of clinical practice improvement. While Australian nurses are showing increasing interest in improving models of care delivery, more research is needed that addresses and articulates the processes attendant upon evaluating, re-designing and implementing improvements to the provision of nursing care. Providing nurses with an open opportunity to plan, act, observe and reflect on their practice promotes successful partnerships between academics and clinicians.


      The aim of this study was to evaluate and improve the model of nursing care delivery to patients in a general surgical ward using participatory action research.


      Researchers conducted non-participant observations (n = 9) of two hours duration across the 24 h period. Focus groups (n = 3) were used to share non-participant observation data with staff, providing them with an opportunity to reflect on their practice and explore possible solutions. Data was collected in 2008–2009.


      Two main problem areas were identified as impeding the nurses’ ability to provide care to patients: (i) practices and behaviours of nurses and (ii) infrastructure and physical layout of the ward. An overview of issues within each problem area is presented.


      Shifting the focus of task-centred care towards a more patient-centred care approach, results directly in improvements in resource utilisation, improved cost-effectiveness and job satisfaction for nursing staff. New ways of thinking about nursing processes and systems, workflow design and skill allocation will guide hospital administrators and managers in the effective and efficient allocation of nursing work in similar settings.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Collegian
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Ballé M.
        • Régnier A.
        Lean as a learning system in a hospital ward.
        Leadership in Health Services. 2007; 20: 33-41
        • Ben-Tovim D.I.
        • Bassham J.E.
        • Bolch D.
        • Martin M.A.
        • Dougherty M.
        • Szwarcbord M.
        Lean thinking across a hospital: Redesigning care at the Flinders Medical Centre.
        Australian Health Review. 2007; 31: 10-15
        • Bowling A.
        Research methods in health: Investigating health and health services.
        2nd edition. Open University Press, Buckingham2002
        • Creswell J.W.
        • Plano-Clark V.L.
        Designing and conducting mixed methods research.
        Sage Publications, California2007
        • Curry J.
        • McGregor C.
        The current state of patient journey redesign in Australia.
        in: Wise M. Grain H. Chu S. HIC 2005 and HINZ 2005: Proceedings. Health Informatics Society of Australia, Brunswick East, Vic2005: 323-331
        • Davidson J.U.
        • Davidson J.C.
        Fundamentals of restructuring: How to accomplish transformational change via transformational leadership.
        Kansas Nurse. 2000; 75: 1-3
        • Davidson P.
        • Halcomb E.
        • Hickman L.
        • Phillips J.
        • Graham B.
        Beyond the rhetoric: What do we mean by a ‘model of care’?.
        Australian Journal of Advanced Nursing. 2006; 23: 47-55
        • Davidson P.M.
        • Elliott D.
        Managing approaches to nursing care delivery.
        in: Daly J. Preparing for professional nursing practice. Maclennan & Petty, Sydney2001
        • Degerhammar M.
        • Wade B.
        The introduction of a new system of care delivery into a surgical ward in Sweden.
        International Journal of Nursing Studies. 1991; 28: 325-336
        • Fowler J.
        • Hardy J.
        • Howarth T.
        Trialling collaborative nursing models of care: The impact of change.
        Australian Journal of Advanced Nursing. 2006; 23: 40-46
        • Gerrish K.
        • Lacey A.
        The research process in nursing.
        Blackwell Publishing, Oxford2006
        • Glasson J.B.
        • Chang E.
        • Bidwell J.W.
        The value of participatory action research in clinical nursing practice.
        International Journal of Nursing Practice. 2008; 14: 34-39
        • Hayman B.
        • Cioffi J.
        • Wilkes L.
        Redesign of the model of nursing practice in an acute care ward: Nurses’ experiences.
        Collegian. 2006; 13: 31-36
        • Heron J.
        Co-operative inquiry – Research into the human condition.
        SAGE Publications, London1996
        • Jimmerson C.
        • Weber D.
        • Sobek II., D.K.
        Reducing waste and errors: Piloting lean principles at IHC.
        Joint Commission Journal on Quality and Safety. 2005; 31: 249-257
        • Kemmis S.
        • McTaggart R.
        The action research reader.
        3rd edition. Deakin University Press, Waurn Ponds, Australia1986
        • Liamputtong P.
        • Ezzy D.
        Qualitative research methods: A health focus, South Melbourne.
        Oxford University Press, 2005
        • Lindeman M.A.
        • Black K.
        • Smith R.
        • Gough J.
        • Bryce A.
        • Gilsenan B.
        • et al.
        Changing practice in residential aged care using participatory methods.
        Education for Health. 2003; 16: 22-31
        • Lundgren S.M.
        • Segesten K.
        Nurses’ altered conceptions of work in a ward with all-RN staffing.
        Journal of Clinical Nursing. 2002; 11: 197-204
        • Marshall C.
        • Rossman G.B.
        Designing qualitative research.
        2nd edition. SAGE Publications, California1995
        • Maxwell J.A.
        Qualitative research design: An interactive approach.
        2nd edition. SAGE Publications, Thousand Oaks, California2005
        • Meyer J.
        Using qualitative methods in health-related action research.
        in: Pope C. Mays N. Qualitative research in health care. BMJ Books, London1999
        • NSW Health
        Easy guide to clinical practice improvement.
        NSW Health Department, Sydney2002
        • O’Connell B.
        • Duke M.
        • Bennett P.
        • Crawford S.
        • Korfiatis V.
        The trials and tribulations of team nursing.
        Collegian. 2006; 13: 11-17
        • Reason P.
        Three approaches to participative inquiry.
        in: Denzin N.K. Lincoln Y.S. Handbook of Qualitative Research. Sage Publications, Inc., Thousand Oaks, CA, US1994: 324-339
        • Spencer L.
        • Ritchie J.
        • O’Connor W.
        Carrying out qualitative analysis.
        in: Ritchie J. Lewis J. Qualitative research practice – A guide for social science students and researchers. SAGE Publications, London2003
        • Stringer E.T.
        Action research: A handbook for practitioners.
        SAGE Publications, London1999
        • Tran D.T.
        • Johnson M.
        • Fernandez R.
        • Jones S.
        A shared care model vs. a patient allocation model of nursing care delivery: Comparing nursing staff satisfaction and stress outcomes.
        International Journal of Nursing Practice. 2010; 16: 148-158
        • Wallace J.C.
        • Savitz L.
        Estimating waste in frontline health care worker activities.
        Journal of Evaluation in Clinical Practice. 2008; 14: 178-180
        • Waterman H.
        • Tillen D.
        • Dickson R.
        • de Koning K.
        Action research: A systematic review and guidance for assessment’.
        Health Technology Assessment. 2001; 5