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

Patients with multiple chronic conditions often face a cumulative workload that exceeds their capacity to manage daily life and healthcare. Although there is evidence of the contribution of advanced practice nurses in chronic disease management, no prior synthesis has examined how their interventions specifically address capacity-workload balance as conceptualised in the Cumulative Complexity Model-a framework that explains how the interaction between patients' capacity and treatment workload shapes engagement in care-or how these interventions align with internationally recognised domains of advanced nursing practice.

To map and synthesise advanced practice nurse-led interventions that promote patient capacity-workload balance, using the Cumulative Complexity Model and the Advanced Practice Role Delineation tool.

Eight databases were searched from inception to 2025.

A scoping review was conducted following the JBI methodology. Eligible articles included interventions or activities led by clinical nurse specialists, nurse practitioners, or generically titled advanced practice nurses for adults living with at least two chronic conditions. Interventions had to relate to patient capacity, workload, or their balance. Included study designs were quantitative, qualitative, mixed-methods, and review studies. Data were extracted by using a structured framework and analysed descriptively and conceptually.

Fifteen articles, most quantitative, were included. Most interventions were delivered at home, individually, face-to-face, and over 12 months. Common components included care coordination, coaching, regular clinical follow-up, and individualised care planning. Although none of the articles explicitly referenced the Cumulative Complexity Model, over half of the interventions aligned with its principles by aiming to support capacity-workload balance. The dominant advanced nursing practice domain for interventions was direct comprehensive care. Interventions encompassing all five domains were described in one article that involved a clinical nurse specialist. Outcomes focused on patient- and system-level indicators such as health improvement, quality of life, healthcare utilisation, and costs. A conceptual framework was developed, providing a retrospective lens on how advanced practice nurses address capacity-workload balance for adults with multiple chronic conditions through key interventions embedded within core domains of advanced practice.

This review highlights how interventions led by advanced practice nurses can support patient capacity-workload balance through core components embedded in recognised domains of advanced practice. A conceptual framework integrating these elements offers insights to guide the development, implementation, and evaluation of advanced nursing roles and interventions tailored to the complex needs of individuals with multiple chronic conditions.

The protocol was registered in the Open Science Framework on April 22, 2025.

Advanced practice nurses help balance the care workload and capacity for patients with multimorbidity - mapped in a framework.