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Object <p>This qualitative study explores how the community nursing center policy reshapes chronic wound care. It captures frontline nurses’ experiences to identify strengths and barriers, providing evidence for optimizing and scaling community nursing center models.</p> Background <p>Global aging and lifestyle changes have intensified the demand for chronic wound care, a service predominantly delivered in primary care settings. To strengthen community capacity, Shanghai has been establishing community nursing centers since 2023. While this policy represents a novel care model, its impact on nurses and real-world effectiveness remains underexplored. This study examines how the policy reshapes wound care practices, evaluates its outcomes, and proposes directions for improvement.</p> Methods <p>This qualitative study combined field visits and in-depth interviews conducted in 10 communities across 6 districts of Shanghai, selected based on healthcare resource data. The sites included central urban (<i>N</i> = 4), suburban (<i>N</i> = 3), and outer suburban (<i>N</i> = 3) areas. Over a month period, semi-structured in-depth interviews were conducted face-to-face with 30 nurses. The study followed the COREQ guidelines for data collection and employed Colaizzi’s 7-step phenomenological analysis to examine patterns across settings.</p> Results <p>Community-based chronic wound care primarily operates through three practice models: home-based care, nursing home care, and community healthcare center care. The standardized development of nursing centers has significantly improved foundational infrastructure and enhanced nurses’ professional motivation. However, three core bottlenecks in the implementation: (1) policy and training gaps: suburban nurses rely on informal networks due to systemic gaps, while urban nurses face service homogenization under functional constraints; (2) digital care lacks institutional support: particularly in home-based care models, nurses’ after-hours social-media guidance though vital for continuity, remains voluntary, unregulated, and unpaid, and (3) financial sustainability pressures: all interviewed centers mainly depend on health insurance reimbursements and government subsidies.</p> Conclusions <p>To enhance the quality of community-based chronic wound care, a regionally differentiated strategy is essential. Suburban areas should establish institutionalized expert consultation systems, university-based generalist and comprehensive training and appropriately broadening the scope of nursing practice, while urban settings ought to prioritize sub-specialized training focused on locally prevalent chronic conditions. Financial sustainability can be improved through public-private partnerships with nursing homes, supported by policy and technological measures that formally recognize nursing labor, including after-hours contributions.</p>

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The impact of Shanghai’s community nursing center policy on chronic wound care practice: a qualitative study

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年3月6日

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  • Shiyu Tang,
  • Jun Li,
  • Tao Wang,
  • Ruiqi Pang,
  • Huahua Dong,
  • Teng Xu,
  • Hong Xu,
  • Ying Ma,
  • Dan Xiao,
  • Qiao Wang,
  • Joanna Nian Chang

摘要

Object

This qualitative study explores how the community nursing center policy reshapes chronic wound care. It captures frontline nurses’ experiences to identify strengths and barriers, providing evidence for optimizing and scaling community nursing center models.

Background

Global aging and lifestyle changes have intensified the demand for chronic wound care, a service predominantly delivered in primary care settings. To strengthen community capacity, Shanghai has been establishing community nursing centers since 2023. While this policy represents a novel care model, its impact on nurses and real-world effectiveness remains underexplored. This study examines how the policy reshapes wound care practices, evaluates its outcomes, and proposes directions for improvement.

Methods

This qualitative study combined field visits and in-depth interviews conducted in 10 communities across 6 districts of Shanghai, selected based on healthcare resource data. The sites included central urban (N = 4), suburban (N = 3), and outer suburban (N = 3) areas. Over a month period, semi-structured in-depth interviews were conducted face-to-face with 30 nurses. The study followed the COREQ guidelines for data collection and employed Colaizzi’s 7-step phenomenological analysis to examine patterns across settings.

Results

Community-based chronic wound care primarily operates through three practice models: home-based care, nursing home care, and community healthcare center care. The standardized development of nursing centers has significantly improved foundational infrastructure and enhanced nurses’ professional motivation. However, three core bottlenecks in the implementation: (1) policy and training gaps: suburban nurses rely on informal networks due to systemic gaps, while urban nurses face service homogenization under functional constraints; (2) digital care lacks institutional support: particularly in home-based care models, nurses’ after-hours social-media guidance though vital for continuity, remains voluntary, unregulated, and unpaid, and (3) financial sustainability pressures: all interviewed centers mainly depend on health insurance reimbursements and government subsidies.

Conclusions

To enhance the quality of community-based chronic wound care, a regionally differentiated strategy is essential. Suburban areas should establish institutionalized expert consultation systems, university-based generalist and comprehensive training and appropriately broadening the scope of nursing practice, while urban settings ought to prioritize sub-specialized training focused on locally prevalent chronic conditions. Financial sustainability can be improved through public-private partnerships with nursing homes, supported by policy and technological measures that formally recognize nursing labor, including after-hours contributions.