Evaluated nurse-led models of care implemented in regional, rural, and remote Australia: A scoping review

Abstract

Background Nurse-led models of care are important for populations residing in regional, rural, and remote settings, who experience barriers to accessing health care. A previous review examining a subset of research undertaken in the Australian context through the Rural Health Multidisciplinary Training program identified a paucity of literature around nurse-led models of care implemented in these settings. Given the maldistribution of the medical workforce in non-metropolitan settings, scoping the broader literature for evidence around nurse-led models of care in these settings is imperative for informing the future directions of the nursing workforce.

Aim To identify available literature for evaluated nurse-led modes of care implemented in regional, rural, and remote geographical settings of Australia.

Methods A scoping review was undertaken using the Joanna Briggs Institutes’ scoping review methodology. A protocol was developed in advance, which documented the objectives, inclusion criteria, and methods. The search involved a comprehensive review of peer-reviewed and grey literature published between 2010 and 2022, to map the evidence examining evaluated nurse-led models of care implemented in regional, rural, and remote settings of Australia. A descriptive approach aligning with the review question and objectives, was used to synthesise findings.

Findings The search retrieved 1807 unique citations, of which 53 were included with an additional 4 studies identified through review of reference lists. In total, 57 studies examining 49 unique nurse-led models of care were included. Studies were heterogenous in the models of care implemented, settings, and research evaluation designs. Most models of care were implemented in the community-health setting. The majority of first authors were affiliated with a university, with the highest proportion based in a metropolitan setting. The benefits of implementing nurse-led models of care included improving hospital indicators, the prevention and management of chronic disease, healthcare access, and health outcomes. Barriers for implementation were widely cited and were attributed to the non-metropolitan setting of implementation and organisational factors. Specific barriers were also cited for the implementation of nurse practitioner (NP) models of care, such as the constraints of the Medicare Benefits Schedule and role ambiguity.

Discussion Nurse-led models of care included in this review were diverse, implemented across the lifespan, mostly led by registered nurses rather than nurses who were also NPs or transitional NPs, and implemented in the community-health setting. The findings expand on the international literature around nurse-led models of care and identify the need for greater support around implementation and evaluation, particularly in non-metropolitan geographical settings.

Conclusion A greater focus on the implementation and evaluation of nurse-led models of care, including NP-led models of care, in regional, rural, and remote settings of Australia, is required. This is important given the maldistribution of the health workforce and inequity experienced by populations residing in these settings when accessing health services. Greater support is required for place-based evaluations of nurse-led models of care, which builds organisational capability and nursing workforce capacity for research.