Designing a rheumatology and immunology nursing training model for resource-limited settings: application of the...

Inadequate training has intensified the shortage of specialized rheumatology and immunology nurses, particularly in resource-limited settings. To address this gap, a theory-driven and evidence-based training model was developed to strengthen nurses' core competencies and professional capacity.

The model was developed in two sequential phases following the updated Medical Research Council (MRC) framework for complex interventions. Phase 1 focused on evidence identification through five activities: evidence synthesis, stakeholder engagement, program theory development, contextual analysis, and economic evaluation. Phase 2 involved a two-stage modeling process, including the construction of a hierarchical case library and the design of a tiered Case-Based Learning (CBL) model incorporating progressive levels of complexity (basic, intermediate, and advanced).

Evidence synthesis identified CBL as the most effective educational strategy for enhancing nursing competencies, with progressive implementation showing particular promise. Stakeholder engagement revealed low trainee confidence and dissatisfaction with current unsystematic programs, while trainers emphasized the need for structured CBL, laboratory test interpretation, medication management, and communication skills. The program theory, grounded in the Zone of Proximal Development, supported a staged learning pathway from foundational to advanced levels. Contextual analysis outlined key barriers and six design elements to address them, and the economic evaluation confirmed the feasibility and cost-effectiveness of a localized training model. The final product was a hierarchical case library constructed from authentic clinical records and a three-tiered CBL model ensuring continuity through a spiral progression of knowledge and skills.

This study developed a theory-driven, evidence-based nursing training model using the MRC framework and tailored to local needs in resource-limited hospitals. The model offers a structured and scalable approach to strengthening competencies in rheumatology and immunology nursing and provides a methodological reference for developing complex educational interventions in similar settings. A pilot cluster-randomized controlled trial has been conducted to further evaluate its feasibility and effectiveness.