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Global nurse navigation models in chronic disease care: A scoping review and conceptual framework development
Amy-Louise Byrne1, Intima Alrimawi2, Roxanne Mirabal-Beltran2
1School of Nursing, Midwifery and Social Sciences, CQUniversity, Sydney, Australia.
Background:
Nurse Navigator (NN) models have expanded globally to address rising chronic disease burdens and patients' unmet psychosocial and sociocultural needs. Variations in health system structures have produced diverse NN models across countries.
Purpose:
This scoping review examined how NN models are implemented in chronic disease care and identified shared and divergent features.
Methods:
Using JBI methodology and PRISMA-ScR reporting, a systematic search of five databases was conducted in March 2025. Guided by Vanasse's multidimensional care-trajectory model (Vanasse et al., 2018), 35 studies from Australia, Canada, Korea, Singapore, and the United States were included.
Discussion:
NNs deliver direct and indirect care across varied settings, grounded in person-centered practice, care coordination, system improvement, and healthcare equity. Findings are limited to NN models in chronic and complex care, with exclusion of acute care settings, non-nurse-led navigation models, and services described using alternative terminology. Additionally, only one study each from Singapore and Korea was identified, limiting the transferability of country-specific findings. NNs may enhance coordination, reduce hospital utilization, and improve trust, self-efficacy, and access. Models differ in autonomy, referral timing, and system integration.
Conclusion:
We present the Global Chronic and Complex NN Model of Care to guide service design, policy, and research.
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Nursing Clinical Information System
A Nursing Clinical Information System (NCIS) is a specialized type of healthcare information system tailored to meet the unique needs of nursing practice. It incorporates the principles of nursing informatics to streamline information management and improve the quality of care delivery.
Critical attributes of NCIS include: