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Transforming Healthcare Delivery: Advances in Organizational Models of Nursing Care

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

Deadline for manuscript submissions: 31 December 2026 | Viewed by 7946

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Dr. Alessio Conti

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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
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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

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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 (7 papers)

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Research

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23 pages, 855 KB

Open AccessArticle

Dual Workload Related to Agriculture/Fishing and Family Involvement in the Household Among Rural and Small-Scale Fishing Workers in Southern Brazil: Implications for Nursing Care Organization in Primary Health Care

by Marta Regina Cezar-Vaz, Clarice Alves Bonow, Shester Cardoso Damaceno, Rudson Amaral da Silva, Geoffrey Obumneme Okoroigwe and Gabriela Laudares Albuquerque de Oliveira

Nurs. Rep. 2026, 16(7), 247; https://doi.org/10.3390/nursrep16070247 - 15 Jul 2026

Viewed by 220

Abstract

Background/Objectives: In rural settings, work, family, and environmental conditions are closely intertwined, requiring Primary Health Care to recognize care needs arising from productive work and everyday family responsibilities. This study aimed to analyze overall and domain-specific levels of perceived workload related to agriculture/fishing and family involvement in the household among rural and small-scale fishing workers, examine associated factors, and discuss analytical implications for nursing care organization in Primary Health Care. Methods: This cross-sectional study was conducted in three island territories in Rio Grande, southern Brazil, following the STROBE guidelines. Data were collected using a structured questionnaire on sociodemographic, family, and occupational characteristics and the NASA Task Load Index (NASA-TLX), applied separately to assess workload related to agriculture/fishing and family involvement in the household. Results: The sample included 146 rural and small-scale fishing workers. Perceived workload could suggest high in both dimensions, with higher levels in agriculture/fishing (mean 84.0 ± 16.5; 89.7% high/very high) than in family involvement in the household (mean 76.1 ± 24.5; 75.4% high/very high). Agriculture/fishing workload perceived could suggest highest scores for overall effort level, temporal demand, and physical demand, whereas family involvement could suggest highest scores for performance-related workload and overall effort level. In the adjusted model, agriculture/fishing perceived workload may be associated with longer daily working time (b = 1.69; 95% CI: 0.82 to 2.56; p < 0.001) and shorter rest time during work (b = −0.05; 95% CI: −0.08 to −0.01; p = 0.011). Perceived workload related to family involvement in the household may be associated with monthly income up to two minimum wages (b = 19.90; 95% CI: 7.78 to 32.10; p = 0.001). The adjusted R² values were 17.3% and 6.7%, respectively. Conclusions: Perceived workload appears to be related to high levels in both productive and family household contexts. The findings might contribute to providing analytical support for future discussions on nursing care organization in Primary Health Care, potentially by considering working conditions, family responsibilities, and territorial context when discussing care needs among rural and small-scale fishing workers. Full article

(This article belongs to the Special Issue Transforming Healthcare Delivery: Advances in Organizational Models of Nursing Care)

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25 pages, 648 KB

Open AccessArticle

Legal Literacy in Clinical Nursing Practice: A Walker and Avant Concept Analysis

by Yufei Xing, Xiaolong Wang, Enming Zhang, Jiajia Yu and Qiong Fang

Nurs. Rep. 2026, 16(6), 200; https://doi.org/10.3390/nursrep16060200 - 12 Jun 2026

Viewed by 545

Abstract

Background: The legal dimensions of nursing practice have become increasingly complex, yet the concept of legal literacy in clinical nurses remains insufficiently defined. Existing studies use terms such as legal knowledge, legal awareness, legal cognition, and law-based practice capacity inconsistently, which hinders conceptual clarity, valid measurement, and targeted educational intervention. This study aimed to clarify the conceptual boundaries, defining attributes, antecedents, consequences, empirical referents, and operational definition of legal literacy in clinical nurses. Methods: A concept analysis was conducted using Walker and Avant’s eight-step method. A systematic literature search was performed across six databases and supplemented by searches in JSTOR and HeinOnline for non-clinical uses of the concept. The search covered database inception to December 2024. Screening and reporting followed PRISMA 2020 guidelines. Fifty-six papers were included. Data extraction and analysis were conducted using content analysis with independent dual-reviewer coding. Results: Legal literacy in clinical nurses was distinguished from four related concepts: legal knowledge, legal awareness, legal cognition, and medical ethics. Three defining attributes were identified: normative understanding, value internalization oriented toward rights and responsibilities, and law-based situational practice. Antecedents were identified at macro, meso, and micro levels, while consequences were observed for individual nurses, healthcare organizations, and patient rights. Analysis of empirical referents revealed a persistent gap between conceptualization and measurement, particularly in assessing law-based situational practice. An operational definition was developed accordingly. Conclusions: Legal literacy in clinical nurses is a multidimensional professional competency integrating legal understanding, rights- and responsibility-oriented value internalization, and the ability to translate these into lawful clinical action. The findings provide a conceptual basis for future instrument development and targeted educational and management interventions. Full article

(This article belongs to the Special Issue Transforming Healthcare Delivery: Advances in Organizational Models of Nursing Care)

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16 pages, 687 KB

Open AccessArticle

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 940

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 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

Open AccessArticle

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 1763

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 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)

Review

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30 pages, 5537 KB

Open AccessReview

Conceptual Plurality in Transition Programmes for Newly Hired Nurses: An Umbrella Review

by Marcello Torre, Cristina Arrigoni, Rosario Caruso, Antonio Maria Giuseppe Staffa, Desiree Lucà and Arianna Magon

Nurs. Rep. 2026, 16(5), 163; https://doi.org/10.3390/nursrep16050163 - 13 May 2026

Viewed by 910

Abstract

Background/Objectives: Nurse transition programmes are widely implemented to support newly hired nurses and promote workforce retention. Despite the growing number of published reviews, conceptual inconsistency and methodological heterogeneity limit the interpretability and cumulative value of the evidence. This umbrella review aimed to synthesise and critically examine review-level evidence on nurse transition programmes, clarifying programme typologies, contexts, methodological approaches, reported outcomes, and thematic patterns. Methods: An umbrella review was conducted in accordance with PRISMA 2020 guidance. Systematic searches were performed in CINAHL, PubMed, Scopus, Web of Science, and Google Scholar, supplemented by citation tracking. Results: Fourteen reviews published between 2010 and 2025 were included: 12 reviews of primary studies and two reviews of secondary evidence (one umbrella review and one meta-review). Programme models and outcome measures were highly heterogeneous, and primary study overlap was slight (CCA = 2.55), indicating that reviews in the corpus drew on largely non-overlapping sets of primary studies. Transition programmes for new nurses commonly use one-on-one preceptorships with supernumerary practice, simulation-based learning, and active methods like case studies and reflective journaling to build competence and confidence. Their duration varies from a few days to 12 months, aligning with the progressive learning curve of new graduates. Professional outcomes, particularly competence and confidence, were consistently reported, whereas organisational outcomes, such as retention, showed mixed, methodologically constrained evidence. Patient-level outcomes were rarely examined. Thematic analysis revealed a shift over time from individual professional readiness towards implementation and organisational considerations. Conclusions: Given this conceptual plurality, there is an urgent need to standardise key indicators for evaluating the effectiveness of nurse transition programmes across healthcare settings globally. Full article

(This article belongs to the Special Issue Transforming Healthcare Delivery: Advances in Organizational Models of Nursing Care)

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Other

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18 pages, 931 KB

Open AccessSystematic 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 1314

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 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

Open AccessOpinion

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 1291

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 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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