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Advanced practice nursing interventions promoting capacity-workload balance in adults with multiple chronic

Carole Michalski-Monnerat1, Aurélie Wibin2, Franziska Geese3

  • 1Institute of Higher Education and Research in Healthcare (IUFRS), Faculty of Biology and Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland; Réseau hospitalier neuchâtelois (RHNe), Department of Internal Medicine, Maladière 45, Neuchâtel, Switzerland.

International Journal of Nursing Studies
|March 21, 2026
PubMed
Summary

Advanced practice nurses (APNs) interventions help manage the workload for patients with multiple chronic conditions. These APN-led strategies support patient capacity and workload balance, improving care engagement.

Keywords:
Advanced Practice Role Delineation (APRD) toolAdvanced practice nursingChronic careClinical nurse specialistCumulative complexity modelMultimorbidityNurse practitioner

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Area of Science:

  • Nursing Science
  • Health Services Research
  • Chronic Disease Management

Background:

  • Patients with multiple chronic conditions experience a significant workload that can exceed their management capacity.
  • Existing research acknowledges advanced practice nurses' (APNs) role in chronic disease management.
  • A gap exists in understanding how APN interventions specifically address capacity-workload balance within the Cumulative Complexity Model and align with advanced nursing practice domains.

Purpose of the Study:

  • To map and synthesize APN-led interventions focused on promoting patient capacity-workload balance.
  • To utilize the Cumulative Complexity Model and the Advanced Practice Role Delineation tool for analysis.
  • To understand how these interventions align with internationally recognized domains of advanced nursing practice.

Main Methods:

  • A comprehensive scoping review was conducted using JBI methodology, searching eight databases from inception to 2025.
  • Eligible studies included APN-led interventions for adults with at least two chronic conditions, focusing on capacity, workload, or their balance.
  • Data from quantitative, qualitative, mixed-methods, and review studies were extracted and analyzed descriptively and conceptually.

Main Results:

  • Fifteen articles, predominantly quantitative, were included, with most interventions delivered individually, face-to-face, at home, over 12 months.
  • Common intervention components included care coordination, coaching, clinical follow-up, and individualized care planning.
  • Over half of the interventions aligned with the Cumulative Complexity Model's principles, supporting capacity-workload balance, with direct comprehensive care being the dominant APN domain.

Conclusions:

  • APN-led interventions effectively support patient capacity-workload balance through core components within recognized advanced practice domains.
  • A developed conceptual framework integrates these elements, offering guidance for designing, implementing, and evaluating APN roles and interventions.
  • This framework is crucial for tailoring care to the complex needs of individuals with multiple chronic conditions.