The introduction of a new system of care delivery into a surgical ward in Sweden.

Action research is used to implement a change in the system of care delivery on a surgical ward in Sweden. Couched within a Lewinian framework the stages of change, the problems faced by staff and their solutions are described. The effects of the change to a system of care more closely resembling the Loeb model of primary nursing, in which accountability is for the duration of the shift, were closely monitored. Observation of registered nurses showed a three-fold increase in the time spent giving direct patient care. A significant increase in scores on a measure of "Intrinsic Job Satisfaction" was also found (P less than 0.01) together with increased scores on a measure of "Patient Focus" (P less than 0.001). These findings were sustained over time. The problems of evaluating a system of care which is based on a different philosophy are addressed.