Total patient care versus team nursing : do they make a difference in the quality of care?

An ex post facto exploratory and descriptive study was conducted to determine if there were differences in the quality of patient care delivered under two forms of nursing care delivery systems. The two systems of nursing care delivery studied were team nursing and total patient care nursing. Both systems were evaluated over successive eight month periods in the setting of a rural 72-bed hospital. Quality of patient care was assessed by use of four instruments. The four instruments were: a) nosocomial infection rates, b) patient incident reports, c) patient satisfaction questionnaires, and d) patient care quality assurance audits. The data were analyzed using descriptive and inferential statistical techniques. Significant differences were not apparent between the two systems of nursing care delivery in the areas of nosocomial infection rates and patent satisfaction indices. Total patient care demonstrated statistically significant improvement in the areas of number of patient incidents (p = .05), and patient quality assurance audits (p = .008). Patient falls and medication errors were significantly reduced. Patient care was improved significantly in all areas measured, with the greatest change demonstrated in the areas of: a) the nurse's knowledge of patients' diagnoses, and conditions, b) the patients' treatments and the effects of therapy, c) patient and family teaching with associated charting, and d) increased interdisciplinary communication between health team members. Implications for nursing are vast. As health care costs and patient expectations continue to soar, the most efficient and effective nursing care delivery system is essential.