THE EFFECTIVENESS OF NURSING BEDS - A REVIEW OF THE LITERATURE

A literature search was conducted to identify 'nursing led in-patient units' where the nurse is the designated leader of the clinical team. The review concentrates on studies which have attempted to measure the impact of nursing-led in-patient units and reviews both the methodolo gy and outcomes. Three major bodies of work were identified. Lydia Hal l's evaluation of the Loeb Center for Nursing and Rehabilitation (USA) is reviewed in some detail. This work was the model for 'nursing beds ' at the two Oxfordshire Nursing Development Units (UK) in the 1980s. Studies evaluating these centres are reviewed and reports of similar U K units discussed. A third body of work evaluates a nurse-managed crit ical care environment. Common features include a case mix based on nur sing need with nurses having authority to admit and discharge patients . While results are generally favourable, with improved patient indepe ndence, fewer readmissions, lower mortality and cost, savings reported in some or all of the studies, all studies reviewed demonstrate the d ifficulties of applying an experimental model to real life clinical se rvices. Methodological limitations render firm conclusions difficult. Techniques adopted. from studies in field settings, the so-called 'qua si-experiment', are advocated as a remedy, as is further study of the process of care in investigating this model of care delivery.