Nursing care models in primary care and hospital settings: implementation and evaluation

In the last year, the COVID‑19 pandemic has made clear how vulnerabilities in health systems can have profound implications for the health of people. Thus, organizations are taking in place significant changes which are also influencing nursing staff and the nursing care model. This dissertation aims to: 1) explore the effects of primary nursing on patient, -staff,-organizational-related outcomes in hospital settings; 2) identify barriers and facilitators of nursing role implementation in primary care; and 3) assess the effects of the family and community nursing (FCN) practice model on patient-, organizational-related outcomes. Method. To reach aim 1 a multi-centre, prospective before-after study is performed. Primary outcome are healthcare-associated infections. Also, staff-related outcomes are included. To reach aim 2 an integrative literature review was conducted. It combines data from quantitative and qualitative studies from two databases searches (Medline and CINAHL) up to 09 June 2020. Data extraction and identification of emerging themes are performed using the Consolidating Framework for Research Implementation (CFIR). To reach aim 3 a prospective controlled study was designed. The study will recruit older and frail residents in municipalities belonging to Community Health Centres (CHC) of Santhià and Gattinara (Local Health Authority of Vercelli). The Intervention is the FCN and it is allocating in one of the CHC. Primary outcome is hospitalization. Results. In this dissertation, the results of the integrative literature review are listed. 56 papers met the inclusion criteria. The major barriers identified are related to: i) the limited availability of nursing special education, ii) legislations and regulations, iii) organizational setting in which nurse’s role implementation is embedded; and iv) lack of nurse’s role clarity among stakeholders. Major facilitators include: i) prior planning for role introduction and nurses’ involvement in the early stage of role implementation, ii) job satisfaction and nurses’ access to high-quality education, iii) successful doctor-nurse collaboration. Finally, the two study protocols were submitted to the Local Ethics Committee. The before-after study has begun in 2019 with 10 Centres enrolled. Actually, the study has recruited 422 patients and 94 nurses. Discussion. Implementation and evaluation of the nurse’s role in primary care and hospital settings are complex interventions due to several components which interact with each other. In this regard, the Medical Research Council framework has been used to guide the development and evaluation of complex interventions, related to nursing research and practice. Despite using this framework, two different studies have been designed to explore how the nursing care model works and its effects. The studies are still suspended due to restrictions imposed by the ongoing COVID-19 pandemic.