Understanding the experiences of community nurses implementing integrated care

More needs to be known about nurse involvement in the development of new integrated models of care, says Gemma Prebble, nurse and lecturer in healthcare science at Bangor University’s School of Health Sciences

The complex systemic challenges faced by healthcare systems and organisations have prompted increased interest in innovative collaborative models of care to support delivery of equitable and sustainable services.

The integration of primary and community services is crucial, with community nurses playing a key role in supporting service users at home

As a nurse lecturer at Bangor University, I have combined my passion for community nursing and research with an interest in service development, embarking on a Professional Doctorate in Implementation Sciences to explore innovative integrated models of working in district and community nursing.

As collaborative co-production of health and care models within communities appears to be central to development of integrated care services, it is of particular importance to understand the role of community nursing in supporting these ambitions.

Community context and nursing role

The integration of primary and community services is crucial, with community nurses playing a key role in supporting service users at home, working both autonomously and collaboratively within interprofessional teams.

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The increasing pressures faced by community and primary care services are well documented and have been exacerbated by difficulties in recruitment and retention of skilled nurses.

The complexity of service integration has made implementing innovative collaborative models problematic, particularly within primary and community care settings as models require adaptation to suit contextual requirements. This has led to adoption of a variety of integrated care models, as no one approach will suit all contexts.

Interventions such as Neighbourhood Nursing and Place-Based models demonstrate nurses supporting and leading implementation of collaborative integrated care, offering an interesting solution to the increasing demands through radically revising how services are designed. ​

Translation of innovative models requires working across conventional boundaries and working in unconventional ways. Therefore, integration requires innovation, a cultural shift across organisations.  ​

Although collaborative working underpins integrated care strategies, the role of the community nurse and community nurse leaders as key stakeholders within community service delivery requires exploration.

adopts a systems approach, beginning with a scoping review to identify what is known about the experience of nurses leading implementation and delivery of innovative integrated care models. ​

Is the nursing contribution to delivering integrated care being heard?

As the first stage of this research, a scoping review demonstrated a paucity of evidence giving voice to the experience of nursing and nurse leadership in implementing innovative models of integrated care, and highlighted a disproportionate lack of focus on organisational integration of nursing services within integrated care.

The findings were published in the Journal of Integrated Care: https://doi.org/10.1108/JICA-07-2024-0035

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Thematic analysis emphasised the complexity of the nursing role within implementation of integrated working, identifying both opportunities and challenges, but also drew attention to the tacit attributes that are important in the delivery and maintenance of integrated systems.

Further research is required considering how complex inter-organisational relationships impact on service delivery

The findings suggest further research is required considering how complex inter-organisational relationships impact on service delivery – especially where integration requires delivery that challenges traditional organisational and professional boundaries, while existing within established organisational level structures.

Implementation barriers and facilitators

The next stages of our research will utilise Soft Systems Methodology [SSM], a structured yet flexible method of inquiry, to develop rich pictures which illuminate components of complex issues. Using a combination of data collection strategies drawing on multiple perspectives will allow examination of workforce issues (in particular clinical staff worldviews) and identify barriers and facilitators to implementation of integrated care models.

We hope to inform nursing leadership strategies and develop a deeper understanding of how nurses tacit attributes support collaborative working

Cross case comparison will support examination of system requirements, in particular how services have been adapted or need to be adapted to deliver integrated care models. Through developing an understanding of how contextual factors influence implementation of integrated care models we aim to map how stakeholders can work together effectively to deliver system change in different organisations and clinical settings.

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Giving voice to nurses delivering integrated services through exploring organisational integration, we hope to inform nursing leadership strategies and develop a deeper understanding of how nurses tacit attributes support collaborative working.

Gemma Prebble is a lecturer in healthcare science at Bangor University’s School of Health Sciences