The global landscape of the evolving nurses' roles and core competency in primary healthcare: An expanding umbrella review

IF 7.1 1区医学 Q1 NURSING

International Journal of Nursing Studies Pub Date : 2025-08-06 DOI:10.1016/j.ijnurstu.2025.105177

Doris Sau Fung Yu , Feng Chen , An-Ran Li , Cathy Wai Ying Wong , Jinghe Chen , Shiyin Zhan , Sally Wai Chi Chan , Eleanor Holroyd , Sek Ying Chair , Chan Yuk Sim , William Chi Wai Wong

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引用次数: 0

Abstract

Background

A transformative primary healthcare system that delivers effective, efficient and equitable care services is imperative to tackle the ever-emerging challenges to population health such as the surging major lifestyle risks, mental health issues, the burden of chronic care and novel infectious diseases. Nurses, as one of the major service stakeholders in this global agenda, needs to proactively seek role advancement and competency development in primary healthcare. This process can be facilitated by seeking a comprehensive understanding of the global landscape of nurses' roles and competencies in primary healthcare.

Objective

To identify nurses' roles and competencies in PHC from a global perspective, and to explore how different nurses' roles evolve in different healthcare systems over time.

Design

Umbrella review.

Methods

A comprehensive search was conducted in nine databases from 1980 to April 2, 2025. We included all types of review papers published in English or Chinese, with the aim of exploring the changing roles of nurses in PHC. Two reviewers independently screened search records, conducted quality appraisals, and extracted data from the included reviews. An integrative framework of core competencies for primary care nurses was developed, based on the prescriptions of different health authorities from around the world, to guide the synthesis of data on nurses' roles in PHC. Data extraction and integration from the original studies in each review were performed to identify role differentiation among nurses of different ranks. Stacked area charts were created to visualize the evolvement of nurses' role in PHC over time.

Results

A total of 54 reviews published over two decades were identified. The nurses' roles covered eight domains: professional practice, case management, communication and collaboration, health promotion and education, legal, ethical and safety, professional development and research, leadership, and administrative actions. Over the decades, nurses' roles have expanded from conducting primary care practice to engaging in research, interdisciplinary communication, and quality assurance, with landmark years for such changes identified. Role differentiation across nursing ranks was noted, with advanced practice nurses (APN) more engaged in professional development, research, and leadership functions. A dearth of research conducted in low- and middle-income countries was observed.

Conclusions

This expanding umbrella review delineates the scope and evolvement of nurses' roles in primary healthcare from a global perspective. The findings provided important insights to inform the advancement of nurses' competency frameworks, advanced role specialization, pre-registration nursing education in primary healthcare.

Systematic review registration

This review has been registered in PROSPERO (identification number: CRD42024544197).

查看原文本刊更多论文

演变护士的角色和核心竞争力的全球格局在初级卫生保健：扩大伞审查

要应对不断出现的人口健康挑战，如激增的主要生活方式风险、精神健康问题、慢性护理负担和新型传染病，必须建立一个能够提供有效、高效和公平的医疗服务的变革性初级卫生保健系统。护士作为这一全球议程中的主要服务利益相关者之一，需要在初级卫生保健中积极寻求角色提升和能力发展。通过全面了解护士在初级卫生保健中的作用和能力的全球格局，可以促进这一进程。目的从全球视角确定护士在初级保健中的角色和能力，并探讨护士角色在不同医疗体系中的演变。DesignUmbrella审查。方法对1980年至2025年4月2日9个数据库进行综合检索。我们纳入了所有类型的以英文或中文发表的综述论文，目的是探讨护士在初级保健中的角色变化。两位审稿人独立筛选检索记录，进行质量评估，并从纳入的综述中提取数据。根据世界各地不同卫生当局的处方，制定了初级保健护士核心能力的综合框架，以指导关于护士在初级保健中的作用的数据综合。从每个综述的原始研究中提取和整合数据，以确定不同级别护士的角色分化。创建了堆叠面积图来可视化护士在初级保健中的角色随时间的演变。结果共收录了20多年来发表的54篇综述。护士的角色涵盖八个领域：专业实践、病例管理、沟通与协作、健康促进与教育、法律、道德与安全、专业发展与研究、领导和行政行为。在过去的几十年里，护士的角色已经从进行初级保健实践扩展到从事研究，跨学科交流和质量保证，并确定了这些变化的里程碑年份。注意到护士职级之间的角色分化，高级执业护士（APN）更多地参与专业发展、研究和领导职能。观察到在低收入和中等收入国家进行的研究缺乏。结论：本综述从全球视角概述了护士在初级卫生保健中的作用范围和演变。本研究结果为促进初级卫生保健护士胜任力框架、高级角色专业化和注册前护理教育提供了重要见解。系统综述注册本综述已在PROSPERO注册（识别号：CRD42024544197）。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

International Journal of Nursing Studies 医学-护理

CiteScore

15.00

自引率

2.50%

发文量

181

审稿时长

21 days

期刊介绍： The International Journal of Nursing Studies (IJNS) is a highly respected journal that has been publishing original peer-reviewed articles since 1963. It provides a forum for original research and scholarship about health care delivery, organisation, management, workforce, policy, and research methods relevant to nursing, midwifery, and other health related professions. The journal aims to support evidence informed policy and practice by publishing research, systematic and other scholarly reviews, critical discussion, and commentary of the highest standard. The IJNS is indexed in major databases including PubMed, Medline, Thomson Reuters - Science Citation Index, Scopus, Thomson Reuters - Social Science Citation Index, CINAHL, and the BNI (British Nursing Index).