Strengthening the structural conditions that support nursing autonomy, including clear role recognition and aligned policy mechanisms, is essential for ensuring timely access to care and the long-term viability of community-based models.
Abstract
Nurses are central to palliative care, yet their community contributions remain undervalued. This study aimed to clarify how political and professional documents conceptualize nursing autonomy in community palliative care. Using the READ (Reading materials, Extracting data, Analyzing data, Distilling findings) methodology, a comparative documentary analysis was conducted in the Netherlands, Portugal, Spain, and the United Kingdom. Sixty-eight strategic documents, identified through systematic searches and expert consultation, underwent targeted qualitative content analysis, combining deductive coding with inductive theme generation. Results reveal a multilevel framework of professional representation: (1) micro-level interventions; (2) meso-level contextual determinants; and (3) macro-level systemic dimensions. A critical tension exists between technical visibility and formal authority. In Portugal and Spain, robust taxonomic infrastructures provide high clinical visibility, yet legal frameworks prioritize "system breadth" over specialized nursing roles. The UK and the Netherlands emphasize "vertical career trajectories," where specialty recognition and advanced education act as levers for clinical agency and nurse-led care. While all country policies prioritize home-based care, differences in how they improve autonomy may influence workforce sustainability and professional migration. These findings suggest that failing to formalize-specialized roles creates "gray zones" of responsibility. Strengthening the structural conditions that support nursing autonomy, including clear role recognition and aligned policy mechanisms, is essential for ensuring timely access to care and the long-term viability of community-based models. This study provides a roadmap for policymakers to reconcile professional agency with the universal right to high-quality care at the end-of-life.
Introduction. The publication in the Italian Official Gazette (12 May 2026) of the decree activating second-cycle clinical Master’s tracks (primary care; intensive and emergency care; pediatric) has reopened a long-standing question about how specialist practice and advanced practice can be combined in concrete professional exercise. Nursing scientific societies have a stake in this transition as cultural infrastructures that connect education, regulation, the labor market, and health-service implementation. Objective. To develop a shared, policy-oriented position on how nursing scientific societies can contribute to the architecture of professional identity in Italy, using the roundtable discussion held at The Nursing Forum 2026 as the primary deliberative material. Methods. Documentary qualitative analysis of the full roundtable transcript (eight societies plus the chair) combined with reflexive thematic analysis and exploratory lexicometric analysis (word and n-gram frequencies, keyword-in-context, term co-occurrence). The position-development process was iterative, with checkpoint-based validation by the writing group. Findings and position statements. Seven themes were identified, from which nine numbered position statements were derived, addressing professional identity as social mandate; the distinction and connection between specialist and advanced practice; competency frameworks as shared language; validation of specialist education; alignment of the new Master’s degrees with workforce planning, accreditation and contracts; explicit workforce numbers; safe attribution and visibility in information systems; outcomes as the ultimate criterion; and scientific societies as cultural infrastructure. Conclusions. Professional identity should be anchored in nursing’s social mandate and made visible, accountable, and measurable. Scientific societies can connect education, competencies, accreditation, and policy, provided that workforce numbers and contractual recognition are addressed in parallel. This document is a position paper informed by a roundtable discussion; formal multi-society consensus would require the documented endorsement process described herein.
Rosario Caruso, Francesca Angelelli, Paola Arcadi et al.· International Journal of Hea...· 1 citation
BACKGROUND
Despite increasing recognition of their central role, General Practice (GP) and Primary Health Care and Community Medicine (PCCM) remain structurally and academically fragmented in Italy, limiting the development of a coherent scientific and professional identity.
AIM
To explore clinicians' and trainees' perspectives on barriers and facilitators to developing a unified postgraduate specialty curriculum in GP, PCCM, and to identify conditions for change.
METHODS
We conducted a participatory action research study, integrating a structured workshop with constructivist grounded theory analysis. Forty-four primary care professionals generated 176 qualitative data units, which were iteratively coded and organised into themes.
RESULTS
Five interrelated themes emerged: (1) lack of interprofessional literacy; (2) power dynamics and professional tribalism; (3) recognition of a shared cultural matrix; (4) need for academic and professional identity; and (5) importance of building collaborative projects. Barriers extended beyond knowledge gaps to institutional fragmentation and status asymmetries. Participants identified a shared person-centred care model as a basis for integration, while the absence of a recognised scientific disciplinary sector was seen as a major barrier to legitimacy, research capacity and workforce attractiveness.
CONCLUSIONS
Developing a unified specialty in GP, PCCM is not merely a medical education reform but a strategic institutional priority for the National Health Service. Establishing a dedicated scientific disciplinary sector and a pre-postgraduate curriculum is essential to address workforce shortages, enhance professional attractiveness and reorient medical education and doctors identity towards community-based care. To be truly transformative, this innovation requires institutional and policy changes grounded in the recognition that medical education policy is also healthcare policy.
Viviana Forte, G. Sessa, Vincenzo Lavecchia et al.· Recenti progressi in medicin...· 1 citation
AIM
To explore healthcare professionals' perspectives and experiences of patients with aborted cancer surgery.
DESIGN
A multicentre study with a qualitative research design with focus group interviews according to Krueger and Casey. The study was guided by the Consolidated criteria for reporting qualitative research (COREQ) checklist.
METHODS
Four focus groups were conducted, consisting of a diverse group of twelve healthcare professionals from three accredited comprehensive cancer centers and university hospitals. Data were collected in April-May 2025. A semi-structured interview guide was used to support the interviews. Data analysis was deductively analysed using directed content analysis guided by the Fundamentals of Care framework.
RESULTS
The care context, its organization, culture and policies, makes it difficult to maintain safe person-centered care for patients undergoing aborted cancer surgery. The contact nurse plays an important role in upholding safe person-centered care despite these contextual barriers. Surprisingly, our findings showed that physical needs were entirely absent from the professionals' accounts. It was evident that nursing competence was underutilized in the care chain, particularly among the registered nurses on the ward. The need for supervision was clearly emphasized by all professional groups except the surgeons.
CONCLUSIONS
Maintaining safe, person-centered care for patients undergoing aborted cancer surgery is hindered by organizational, cultural, and policy-related barriers within the care context. Despite these challenges, the contact nurse remains a key facilitator of person-centered care.
IMPACT
What problem did the study address? The study addressed how organizational, cultural, and policy-related conditions within the care context make it difficult to maintain safe, person-centred care for patients undergoing aborted cancer surgery. What were the main findings? The contact nurse plays a crucial role in sustaining safety and person-centered care despite these contextual barriers. Where and on whom will the research have an impact? The research will impact healthcare organizations and multidisciplinary cancer teams by informing policy and practice aimed at strengthening person-centred and safe cancer care.
PATIENT OR PUBLIC CONTRIBUTION
No patient or public involvement was required because the study focused on professional experiences, without involving patient data or issues affecting patients or the public.
Carina Wennerholm, Anna Persdotter, Tina Gustavell et al.· Journal of Advanced Nursing· 0 citations
PurposeTo develop a professional nursing professional practice model (PPM) to guide performance at a university hospital.DesignSequential multimethod design for theory development.MethodThe study was executed in four sequential phases: (1) identification of the need for a PPM; (2) preliminary model design; (3) internal and peer validation; and (4) evaluation against international standards.FindingsThis PPM prioritizes holistic care for patients and their families to ensure clinical excellence and safety in nursing services. It integrates synergistic management, organizational structures, and continuous quality improvement to address contemporary healthcare challenges within a holistic care philosophy.ConclusionsThe "Bonds that Transform, Care that transcends" model provides a new framework for holistic hospital nursing practice. Grounded in humanistic perspectives, the model posits that therapeutic relationships transcend clinical procedures through high-quality interactions among staff, patients, and families. By fostering mutual growth, this care extends beyond the hospital to transform individuals, strengthen autonomy, and dignify the human condition. Broadly, this framework bridges theoretical holism with clinical pragmatism, promoting nursing leadership, facilitating education, advancing research, and offering a scalable roadmap for humanizing high-complexity healthcare institutions.
Alejandra Parisotto, Maria Marta Palermo, Alicia Valentina García et al.· Journal of Holistic Nursing· 0 citations
AIM
To examine the dimensions and meanings of the work environment of Primary Health Care nurses in relation to organizational conditions and professional practice.
DESIGN
Sequential explanatory mixed-methods study.
METHODS
This study was conducted with Primary Health Care nurses in Manaus, Brazil. The quantitative phase included 243 participants using a validated work environment scale, analysed descriptively and compared across health districts. The qualitative phase involved 16 interviews analysed through thematic analysis. The phases were integrated using joint displays and meta-inferences to connect, compare and interpret the findings.
RESULTS
Work motivation was classified as healthy, particularly regarding meaning, recognition and autonomy, whereas safety and strategic management fell within the attention range, without differences across the districts. The qualitative findings confirmed and expanded these results and, for motivation, reframed them: motivation rested on the meaning nurses attribute to care rather than on favourable conditions, compensating for weaknesses in safety and management, the most fragile dimension.
CONCLUSION
The work environment is sustained from within, through professional commitment, whereas the structures that should protect and organize the work remain fragile, especially in a territorially complex, resource-constrained Amazonian setting.
IMPLICATIONS FOR THE PROFESSION
The findings support continuous, institutionalized strategies for worker protection, violence prevention, psychological support and participatory management.
IMPACT
This study shows that professional engagement coexists with organizational challenges, informing policy and workforce interventions.
REPORTING METHOD
STROBE and COREQ guidelines.
NO PATIENT OR PUBLIC INVOLVEMENT
No patient or public involvement.
L. L. C. de Andrade, Laura Cavalcanti de Farias Brehmer, Elisiane Lorenzini et al.· Journal of Advanced Nursing· 0 citations
OBJECTIVE(S)
To explore how healthcare workers, managers, and policymakers understand, perceive, and operate preconception care (PCC).
DESIGN
An interpretive descriptive qualitative study was conducted (April-September 2025) in two government hospitals. Data from interviews, focus groups, document review, and observations were analyzed using constant-comparative methods to generate an explanatory account of PCC practice.
SAMPLE
Thirty-six participants were purposively recruited, including healthcare workers, hospital managers, policymakers, health bureau staff, and NGO stakeholders. Data were collected in Amharic, transcribed, translated, and analyzed inductively, focusing on patterns, tensions, and system-level influences.
RESULTS
Preconception care emerged as structurally unsupported yet sustained through individual effort, shaped differently across system levels. Frontline providers delivered it through moral commitment and improvisation within routine services, rendering it invisible and inconsistent. Fragmented knowledge, shaped by a biomedical focus, limited training, and confusion with antenatal care, further undermined consistent delivery. Managers described the absence of training, supervision, and performance indicators, limiting accountability and integration into service delivery. Policymakers emphasized it as a strategic priority but highlighted gaps in operationalization, coordination, and resource allocation. Across levels, gendered norms and reliance on community trust networks shaped access and reinforced inequities, revealing a persistent misalignment between policy intent and practice.
CONCLUSIONS
PCC functions as an informal practice sustained by individual agency within weakly institutionalized systems. Strengthening implementation requires bridging policy and practice through system integration, managerial accountability, and gender-responsive, community-engaged care models.
Y. Aynalem, Pauline Paul, Z. Lassi et al.· Public Health Nursing· 0 citations
