Perceived barriers and facilitators to family and community nurses’ care for older adults: a descriptive qualitative study

Background: The aging population is becoming a growing challenge for health care systems, pushing toward the need for systemic adaptations. In Italy, the role of the Family and Community Nurse (FCN) was introduced as a response to these demographic changes, aimed at ensuring personalized and integrated care for the older adults at the national level. Despite national institutional recognition, the implementation of the FCN role varies considerably across regions, resulting in uneven and fragmented service delivery. To better understand this variability, the present study aimed to describe the perceived barriers and facilitators influencing the delivery of community-based care to older adults. Methods: A qualitative descriptive study was conducted, from December 2023 to May 2024, using semi-structured interviews on a purposive sample. Forty-one FCNs from four Italian regions were interviewed. The interviews were transcribed verbatim and analyzed using Qualitative Content Analysis, supported by NVivo software. Results: Under the overarching theme reflecting the barriers and facilitators that influence the delivery of family and community nursing care to older adults, six sub-themes and thirteen categories were identified. The key barriers were the misalignment between strategic leadership level and managerial and operational levels, shortages of instrumental and human resources, heterogeneity and fragmentation of nursing documentation, lack of uniformity of the training pathways and, limited recognition of the FCN role. The most frequent facilitators were current regulations and national policies, the support and collaboration of local organizations and local political institutions, as well as the expansion of interprofessional collaborations. Conclusions: The study emphasizes the need for targeted interventions to strengthen the governance of the FCN role, ensuring greater integration between policy directives, resources, training, and organizational practice. This requires coordinated efforts among health care institutions, universities, and professional organizations to create a system that not only adequately trains FCNs but also ensures their functional and effective placement within community-based care. Clinical trial number: Not applicable.