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Nursing Reports
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Transforming Healthcare Delivery: Advances in Organizational Models of Nursing Care
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Transforming Healthcare Delivery: Advances in Organizational Models of Nursing Care

A special issue of Nursing Reports (ISSN 2039-4403).

Deadline for manuscript submissions: 30 April 2026 | Viewed by 3926

Special Issue Editor

Dr. Alessio Conti

E-Mail Website
Guest Editor
Department of Clinical and Biological Sciences, University of Torino, 10126 Turin, Italy
Interests: clinical nursing; nursing education; nursing assessment; advanced practice nursing; nursing; nursing diagnosis
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

The organization of nursing care is a cornerstone of healthcare systems, influencing access, equity, and the overall quality of patient outcomes. In recent years, a convergence of demographic, epidemiological, and environmental changes, combined with the acceleration of digital innovation, has pushed traditional care delivery models to their limits. In this context, the emergence of innovative organizational models of nursing care is not only timely, but essential. Such models are reshaping healthcare by integrating technological advancements and sustainable principles into everyday practice. Digital transformation, including the use of artificial intelligence, telehealth, remote monitoring, and data-driven decision-making, has the potential to enhance care continuity, personalize interventions, and reduce administrative burdens on nursing professionals. Simultaneously, the pressing demands of the climate crisis are prompting health systems to adopt greener care pathways, resource-efficient workflows, and ecologically responsible infrastructure, all of which require rethinking traditional organizational paradigms. Innovative care models, such as nurse-led services, integrated community-based care, and digitally enabled multidisciplinary teams, are showing promise in aligning quality care with environmental sustainability and digital efficiency. However, despite growing interest and early successes, further research is needed to critically assess their implementation, scalability, and impact across diverse healthcare settings, from the hospital setting to community care. This Special Issue invites contributions that explore how organizational innovation in nursing can support a digital, sustainable, and human-centered transformation of care. We particularly encourage submissions that examine the connection between technological advancement, environmental responsibility, and nursing leadership in shaping the future of healthcare delivery. We are pleased to invite you to contribute to this Special Issue entitled “Transforming Healthcare Delivery: Advances in Organizational Models of Nursing Care”, which aims to collect original research, reviews, theoretical contributions, and case studies addressing the development, implementation, and evaluation of novel care models in nursing practice. The aim of this Special Issue is to investigate how innovative organizational models in nursing can respond to current and future healthcare challenges by promoting not only environmental sustainability, but also the sustainability of care systems themselves. Faced with growing resource constraints, aging populations, workforce shortages, and rising patient complexity, healthcare organizations must adopt models that ensure long-term viability, operational efficiency, and human-centeredness. These innovations should support nurses in delivering high-quality, safe, and person-centered care, while fostering resilient and adaptive organizational environments. This collection will also emphasize how the integration of digital tools such as telehealth, decision support systems, and remote monitoring can be leveraged to strengthen continuity, personalization, and equity in care delivery. At the same time, sustainable care requires structures that optimize workforce well-being, reduce unnecessary duplication, and align with value-based principles. From nurse-led models to decentralized community-based interventions, the Special Issue will explore practices that promote ecological, organizational, and clinical sustainability. This topic aligns closely with the scope of Nursing Reports, which welcomes interdisciplinary and international contributions that advance knowledge in nursing science, education, practice, and system innovation. We look forward to receiving your contributions.

Dr. Alessio Conti
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 250 words) can be sent to the Editorial Office for assessment.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Nursing Reports is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 1800 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • models
  • organizational
  • nursing care
  • patient-centered care
  • telemedicine
  • advanced practice nursing
  • health services sustainability
  • green healthcare
  • digital health innovation
  • nurse-led models of care
  • interprofessional collaboration

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Published Papers (4 papers)

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Research

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16 pages, 687 KB  
Article
Turbulence in Nursing—A Conceptual and Contextual Exploration
by Helene Åvik Persson, Anders Palm and Karin Samuelson
Nurs. Rep. 2026, 16(4), 119; https://doi.org/10.3390/nursrep16040119 - 2 Apr 2026
Viewed by 365
Abstract
Background/Objectives: Contemporary healthcare systems are characterised by rapid change, high workload, and staff shortages, creating conditions that may compromise care quality and generate turbulence in nursing. Turbulence has been discussed in nursing research. However, greater conceptual clarity is needed regarding its underlying [...] Read more.
Background/Objectives: Contemporary healthcare systems are characterised by rapid change, high workload, and staff shortages, creating conditions that may compromise care quality and generate turbulence in nursing. Turbulence has been discussed in nursing research. However, greater conceptual clarity is needed regarding its underlying factors and implications for nursing work. The aim of this study was to explore and analyse the concept of turbulence in nursing and its related factors. Methods: The study was conducted using the Simultaneous Concept Analysis Method involving a consensus group and a nursing care, expert group and included content validity index ratings as a validation technique. Results: Eight factors related to turbulence in nursing were identified. A conceptual model was developed to illustrate the interrelationships among these factors and their role within the turbulence concept. Based on this model and the demonstrated contextual interconnections, a comprehensive definition of turbulence in nursing was formulated. Conclusions: The study has achieved a deeper understanding of the concept “turbulence in nursing” through the identification of eight different, generally valid turbulence-related factors and their presumed impact on nursing care. A conceptual model of interacting forces in turbulence in nursing has been presented as both a detector and a compass for mapping and counteracting future tendencies toward turbulence in the work environment. The study enables healthcare professionals and leaders to detect and address emerging turbulence in nursing practice and education. By clarifying its underlying major related sources, the model serves as a practical guide for improving the work environment, strengthening team resilience, and ultimately enhancing patient safety and quality of care. Full article
(This article belongs to the Special Issue Transforming Healthcare Delivery: Advances in Organizational Models of Nursing Care)
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15 pages, 260 KB  
Article
Staying Despite the Intention to Leave: Insights from Frontline Nurses and Nurse Managers from a Qualitative Descriptive Study
by Martina Falomo, Stefania Chiappinotto, Giovanni Napoli, Anna Inserra, Maura Mesaglio and Alvisa Palese
Nurs. Rep. 2026, 16(2), 58; https://doi.org/10.3390/nursrep16020058 - 10 Feb 2026
Viewed by 1010
Abstract
Background/Objectives: The global nursing workforce shortage has heightened concerns about burnout, workload, and nurse retention, with an increasing intention to leave the profession and the unit, especially in the post-pandemic context. Although intention to leave has been widely studied, limited attention has [...] Read more.
Background/Objectives: The global nursing workforce shortage has heightened concerns about burnout, workload, and nurse retention, with an increasing intention to leave the profession and the unit, especially in the post-pandemic context. Although intention to leave has been widely studied, limited attention has been paid to nurses who continue to provide high-quality care and persist despite expressing a desire to leave. This study aimed to explore the reasons for persistence among nurses who intend to leave the organization and the profession. Methods: A descriptive qualitative study was conducted involving frontline nurses and nurse managers working in a large university healthcare trust in Northern Italy. Data were collected through three focus groups, using a semi-structured interview, until data saturation was achieved. Data were analyzed using inductive content analysis. Findings were reported in accordance with COnsolidated criteria for REporting Qualitative research guidelines. Results: Thirty-two participants were included. Overall, two main themes emerged: ‘Reasons that are inside of me’ and ‘Reasons that are outside of me but influence my decisions to stay’, with eight and six subthemes respectively. Internal reasons included professional passion, commitment, autonomy, perceived usefulness, and supportive collegial relationships. External reasons included organizational flexibility, opportunities for internal mobility and professional development, responsiveness to nurses’ expectations, and, in some cases, limited external employment alternatives. Conclusions: Persistence represents a distinct and underexplored dimension within the intention-to-leave continuum. While internal reasons reflect deeply rooted professional identity, external organizational reasons are modifiable and play a critical role in promoting retention. Organizational strategies aligned with nurses’ values, expectations, and professional development needs may enhance workforce stability and inform more targeted retention interventions. Full article
(This article belongs to the Special Issue Transforming Healthcare Delivery: Advances in Organizational Models of Nursing Care)

Other

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18 pages, 931 KB  
Systematic Review
Lessons Learned from Governance and Management of Virtual Hospital Initiatives: A Systematic Review
by Afrooz Purarjomandlangrudi, Amir Hossein Ghapanchi, Josephine Stevens, Navid Ahmadi Eftekhari and Kirsty Barnes
Nurs. Rep. 2025, 15(12), 451; https://doi.org/10.3390/nursrep15120451 - 17 Dec 2025
Cited by 1 | Viewed by 951
Abstract
Background: Hospital In The Home (HITH), also called Hospital at Home or Virtual Hospital, delivers hospital-level care in patients’ homes to enhance outcomes and reduce hospital bed occupancy. Despite widespread implementation, strategic guidance for managing HITH initiatives remains limited. Methods: Following PRISMA 2020 [...] Read more.
Background: Hospital In The Home (HITH), also called Hospital at Home or Virtual Hospital, delivers hospital-level care in patients’ homes to enhance outcomes and reduce hospital bed occupancy. Despite widespread implementation, strategic guidance for managing HITH initiatives remains limited. Methods: Following PRISMA 2020 guidelines, we conducted a systematic review (protocol not registered) searching ScienceDirect and Scopus (inception to December 2023) using the terms “hospital in the home,” “HITH,” “hospital at home,” “virtual care” AND “lesson,” “management,” “governance.” Peer-reviewed studies reporting lessons learned, best practices, or governance strategies for HITH programs with sufficient implementation detail were included; we excluded studies focusing solely on clinical effectiveness without organizational aspects, conference abstracts, and editorials. Two researchers independently screened records, extracted data, and conducted thematic analysis. Quality assessment used the Mixed Methods Appraisal Tool (MMAT). Sixteen studies (12 high-quality, 3 moderate, 1 low) were included. The studies were moderate overall, based on predominantly observational program evaluations and case studies. Results: Forty-two lessons were identified and classified into nine categories: combining care modalities, technology integration, impact on patient outcomes, training and specialized knowledge, care coordination, governance structures, financial sustainability, cross-sector collaboration, and patient selection. These categories fall under four themes: care delivery models; staffing and team dynamics; governance and financial sustainability; and patient selection and safety. Conclusions: This framework provides healthcare executives and program managers with evidence-based guidance for implementing and enhancing HITH programs, addressing a critical gap in governance and management literature. Full article
(This article belongs to the Special Issue Transforming Healthcare Delivery: Advances in Organizational Models of Nursing Care)
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9 pages, 215 KB  
Opinion
Nursing Assistant in Italy: The Principle of Delegation of Health Activities and Liability Profiles
by Livio Pietro TRonconi, Vittorio Bolcato, Luca Bianco Prevot and Giuseppe Basile
Nurs. Rep. 2025, 15(12), 443; https://doi.org/10.3390/nursrep15120443 - 11 Dec 2025
Viewed by 921
Abstract
Background/Objectives: The institution of the nursing assistant (NA) profile in Italy, established by the Decree 28 February 2025 responds to the chronic shortage of healthcare personnel, especially in nursing. This figure, non-healthcare but trained to perform basic healthcare tasks, aims to support nurses [...] Read more.
Background/Objectives: The institution of the nursing assistant (NA) profile in Italy, established by the Decree 28 February 2025 responds to the chronic shortage of healthcare personnel, especially in nursing. This figure, non-healthcare but trained to perform basic healthcare tasks, aims to support nurses and ensure continuity of care, especially in community and long-term care settings, through further nursing activities delegation. The model aligns with international practices, emphasizing delegation within multiprofessional teams, based on formalized protocols and continuous on-site training, within standardized, low-discretion contexts. The delegation of health activities, however, presents legal and medico-legal challenges regarding scope of practice and supervision. Methods: The aim of this paper is critically discussing delegation of health activities to non-healthcare providers and the related issues of liability in team-based delivery of care, considering the specific regulatory setting of health providers in Italy. Results: Critical activities such as nutrition and hydration, in particular artificially, and drug administration highlight the limits of delegation and the ongoing need for professional nurse oversight. In pre-hospital emergency care, standardized, protocol-based systems and simulation-based training successfully integrate non-healthcare personnel within the health team. Conversely, chronic and long-term care remain fragmented, lacking organizational maturity, regular supervision, and uniform regulation. Conclusions: The decree represents a step toward structured team-based care, but its success depends on robust governance, protocol clarity, organizational guidelines, and sustained practice-based education to prevent unsafe delegation and unauthorized practice. Full article
(This article belongs to the Special Issue Transforming Healthcare Delivery: Advances in Organizational Models of Nursing Care)
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