Training Needs Analysis of Primary Care Nurses in Care Coordination: Protocol for a Mixed-Methods Study

Main Article Content

Marlène Karam
https://orcid.org/0000-0001-5277-2000
Dimitri Létourneau-Aspirot
https://orcid.org/0000-0001-5174-4024
Pegah Torabi
https://orcid.org/0009-0007-3101-5001
Benoit-Pierre Stock
https://orcid.org/0009-0006-6885-3896
Isabelle Brault
https://orcid.org/0000-0002-7041-1820

Abstract

Introduction: The coordination of care and services aims to improve the coherence and continuity of care. Primary care nurses play a central role in this process, but are often insufficiently equipped to fully assume this responsibility.


Objective: This research project aims to analyze the continuing education needs of nurse care coordinators to design training that responds to these needs and thereby optimizes their professional practice.


Methods: A sequential explanatory mixed-methods design, quantitative followed by qualitative, will be used. The “Model of Nursing Care coordination activities for patients with complex needs” and the framework of the Quebec National Institute of Public Health will guide the study. The quantitative phase will involve a survey (self-administered questionnaire) of 150 nurse care coordinators from 2 healthcare institutions in Quebec (Canada) to document their characteristics and continuing education needs. Descriptive and bivariate analyses (ANOVA) will be conducted. The qualitative phase will then complement and explain how the practice environment characteristics contribute to these needs using 4 focus groups with a total of 20 care coordinators and will be analyzed thematically. Data integration will use convergent triangulation comparing quantitative and qualitative findings.


Discussion and Research Spin-offs: The results of this study will help identify the continuing education needs of the target population and guide the development of tailored training, thereby strengthening competencies and contributing to high-quality service delivery.

Article Details

How to Cite
Karam, M., Létourneau-Aspirot, D., Torabi, P., Stock, B.-P., & Brault, I. (2026). Training Needs Analysis of Primary Care Nurses in Care Coordination: Protocol for a Mixed-Methods Study. Science of Nursing and Health Practices. https://doi.org/10.62212/snahp.188
Section
Research protocol articles

References

Agarwal, R., Jain, P., Ghosh, M. S. et Parihar, K. S. (2017). Importance of primary health care in the society. International Journal of Health Sciences, 1(1), 6–11. https://doi.org/10.21744/ijhs.v1i1.17

Alan, Ü. et Atalay Kabasakal, K. (2020). Effect of number of response options on the psychometric properties of Likert-type scales used with children. Studies in Educational Evaluation, 66, 100895. https://doi.org/10.1016/j.stueduc.2020.100895

Anderson, A. et Hewner, S. (2021). Care Coordination: A Concept Analysis. The American journal of nursing, 121(12), 30–38. https://doi.org/10.1097/01.NAJ.0000803188.10432.e1

Association canadienne des infirmières et infirmiers en médecine de famille. (2019). Compétences nationales des infirmières et infirmiers autorisés en soins primaires. https://www.cfpna.ca/fr/_files/ugd/99bd1f_c1ff9ee41e984ef09e4ff4b0b2360461.pdf

Carroll, J. C., Talbot, Y., Permaul, J., Tobin, A., Moineddin, R., Blaine, S., Bloom, J., Butt, D., Kay, K. et Telner, D. (2016). Academic family health teams: Part 1: Patient perceptions of core primary care domains. Canadian family physician Medecin de famille canadien, 62(1), e23–e30.

Centre intégré universitaire de santé et de services sociaux de l’Est-de-l’Île-de-Montréal. (2022). Nos fondements organisationnels. https://ciusss-estmtl.gouv.qc.ca/propos/connaitre-votre-ciusss/nos-fondements-organisationnels

Chao, Y. H., Huang, W. Y., Tang, C. H., Pan, Y. A., Chiou, J. Y., Ku, L. E. et Wei, J. C. (2022). Effects of continuity of care on hospitalizations and healthcare costs in older adults with dementia. BMC geriatrics, 22(1), 724. https://doi.org/10.1186/s12877-022-03407-7

Cheraghi, R., Ebrahimi, H., Kheibar, N. et Sahebihagh, M. H. (2023). Reasons for resistance to change in nursing: An integrative review. BMC Nursing, 22(1), 310. https://doi.org/10.1186/s12912-023-01460-0

Coffey, A., Mulcahy, H., Savage, E., Fitzgerald, S., Bradley, C., Benefield, L. et Leahy-Warren, P. (2017). Transitional care interventions: Relevance for nursing in the community. Public health nursing, 34(5), 454–460. https://doi.org/10.1111/phn.12324

Colbert, C. Y., French, J. C., Arroliga, A. C. et Bierer, S. B. (2019). Best practice versus actual practice: An audit of survey pretesting practices reported in a sample of medical education journals. Medical education online, 24(1). https://doi.org/10.1080/10872981.2019.1673596

Cowie, J., Nicoll, A., Dimova, E. D., Campbell, P. et Duncan, E. A. (2020). The barriers and facilitators influencing the sustainability of hospital-based interventions: A systematic review. BMC Health Services Research, 20(1), 588. https://doi.org/10.1186/s12913-020-05434-9

Creswell, J. W. et Plano Clark, V. L. (2018). Designing and conducting mixed methods research (3e éd.). SAGE Publications, Inc.

Cyr, J. (2019). An integrative approach to measurement: Focus groups as a survey pretest. Quality & Quantity, 53(2), 897–913. https://doi.org/10.1007/s11135-018-0795-5

de Rezende, N. A. et de Medeiros, D. D. (2022). How rating scales influence responses’ reliability, extreme points, middle point and respondent’s preferences. Journal of Business Research, 138, 266–274. https://doi.org/10.1016/j.jbusres.2021.09.031

Déry, J., d’Amour, D. et Roy, C. (2017). L’étendue optimale de la pratique infirmière. Perspective infirmiere : revue officielle de l’Ordre des infirmières et infirmiers du Quebec, 14(1), 51–55.

Déry, J., Paquet, M., Boyer, L., Dubois, S., Lavigne, G. et Lavoie-Tremblay, M. (2022). Optimizing nurses’ enacted scope of practice to its full potential as an integrated strategy for the continuous improvement of clinical performance: A multicentre descriptive analysis. Journal of Nursing Management, 30(1), 205–213. https://doi.org/10.1111/jonm.13473

Direction de santé publique du Centre intégré de santé et de services sociaux de Laval. (2022). Portrait sur la situation des personnes aînées à Laval. https://www.lavalensante.com/fileadmin/internet/cisss_laval/Documentation/Sante_publique/Profils_et_portraits/Portraits/Portrait_sur_les_aines_a_Laval_2022.pdf

Doss, S. M., Bergum, B., Hopkins, L., Solis, R. et Lyon, M. (2025). Transforming Transitional Care: Early Hospital Discharge through the Care at Home Program. Journal of the American Medical Directors Association, 26(7), 105681. https://doi.org/10.1016/j.jamda.2025.105681

Du, Y. L., Ma, C. H., Liao, Y. F., Wang, L., Zhang, Y. et Niu, G. (2021). Is Clinical Scenario Simulation Teaching Effective in Cultivating the Competency of Nursing Students to Recognize and Assess the Risk of Pressure Ulcers?. Risk management and healthcare policy, 14, 2887–2896. https://doi.org/10.2147/RMHP.S315138

Easley, J., Wassersug, R., Matthias, S., Tompson, M., Schneider, N. D., O’Brien, M. A., Vick, B. et Fitch, M. (2023). Patient Engagement in Health Research: Perspectives from Patient Participants. Current oncology (Toronto, Ont.), 30(3), 2770–2780. https://doi.org/10.3390/curroncol30030210

Ferreira, R., da Silva Abbad, G. et Mourão, L. (2014). Training Needs Analysis at Work. Dans K. Kraiger, J. Passmore, N. Santos et S. Malvezzi (dir.), The Wiley Blackwell handbook of the psychology of training, development, and performance improvement (p. 32-49). John Wiley & Sons, Ltd. https://doi.org/10.1002/9781118736982.ch3

Fortin, M.-F. et Gagnon, J. (2022). Fondements et étapes du processus de recherche : méthodes quantitatives et qualitatives (4e éd.). Chenelière éducation.

Gagné, D. (2004). Définition du rôle de l’intervenant pivot dans le cadre de l’implantation d’un projet de réseau de services intégrés au Saguenay-Lac-Saint-Jean [Mémoire de maîtrise, Université du Québec à Chicoutimi]. Constellation. https://constellation.uqac.ca/id/eprint/653/1/18317978.pdf

Gibbs, G. R. (2018). Analyzing Qualitative Data. (2e éd.). SAGE Publications Ltd. https://doi.org/10.4135/9781526441867

Gonçalves, L. B. B., Cruz, R. S. B. L. C., Quirino, G. D. S. et Pinto, A. G. A. (2022). Nurse training for care management: Integrative literature review. Revista brasileira de enfermagem, 75(3), e20201186. https://doi.org/10.1590/0034-7167-2020-1186

Grant J. (2002). Learning needs assessment: Assessing the need. BMJ (Clinical research ed.), 324(7330), 156–159. https://doi.org/10.1136/bmj.324.7330.156

Griscti, O. et Jacono, J. (2006). Effectiveness of continuing education programmes in nursing: Literature review. Journal of Advanced Nursing, 55(4), 449–456. https://doi.org/10.1111/j.1365-2648.2006.03940.x

Harkness, T. (2020). Effective care coordination and transition management for older adults. Nursing Made Incredibly Easy!, 18(5), 26–32. https://doi.org/10.1097/01.NME.0000694184.27758.b9

Harteis, C., Billett, S., Goller, M., Rausch, A. et Seifried, J. (2015). Effects of age, gender and occupation on perceived workplace learning support. International Journal of Training Research, 13(1), 64–81. https://doi.org/10.1080/14480220.2015.1051349

Hempel, S., Ganz, D., Saluja, S., Bolshakova, M., Kim, T., Turvey, C., Cordasco, K., Basu, A., Page, T., Mahmood, R., Motala, A., Barnard, J., Wong, M., Fu, N. et Miake-Lye, I. M. (2023). Care coordination across healthcare systems: Development of a research agenda, implications for practice, and recommendations for policy based on a modified Delphi panel. BMJ Open, 13(5), e060232. https://doi.org/10.1136/bmjopen-2021-060232

Hennink, M. et Kaiser, B. N. (2022). Sample sizes for saturation in qualitative research: A systematic review of empirical tests. Social Science & Medicine, 292, 114523. https://doi.org/10.1016/j.socscimed.2021.114523

Hong, Q. N., Gonzalez-Reyes, A. et Pluye, P. (2018). Improving the usefulness of a tool for appraising the quality of qualitative, quantitative and mixed methods studies, the Mixed Methods Appraisal Tool (MMAT). Journal of Evaluation in Clinical Practice, 24(3), 459–467. https://doi.org/10.1111/jep.12884

Howse, D., Delahunty-Pike, A., Dumont-Samson, O., Bisson, M., Lambert, M., Doucet, S., Chouinard, M.-C., Hudon, C., Scott, C., Burge, F., Wilhelm, L., Warren, M., Porter, J., Schwarz, C., Rubenstein, D. et Gaudreau, A. (2022). Patient engagement works: Patient and researcher experiences of patient partnership in primary healthcare research. The Annals of Family Medicine, 20(Suppl 1), 2908. https://doi.org/10.1370/afm.20.s1.2908

Hudon, C., Chouinard, M. C., Dubois, M. F., Roberge, P., Loignon, C., Tchouaket, É., Lambert, M., Hudon, É., Diadiou, F. et Bouliane, D. (2018). Case Management in Primary Care for Frequent Users of Health Care Services: A Mixed Methods Study. Annals of family medicine, 16(3), 232–239. https://doi.org/10.1370/afm.2233

Hughes, A. M., Zajac, S., Woods, A. L. et Salas, E. (2019). The role of work environment in training sustainment: A meta-analysis. Human Factors, 62(1), 166–183. https://doi.org/10.1177/0018720819845988

Izumi, S., Barfield, P. A., Basin, B., Mood, L., Neunzert, C., Tadesse, R., Bradley, K. J. et Tanner, C. A. (2018). Care coordination: Identifying and connecting the most appropriate care to the patients. Research in nursing & health, 41(1), 49–56. https://doi.org/10.1002/nur.21843

Jesus, T. S., Stern, B. Z., Lee, D., Zhang, M., Struhar, J., Heinemann, A. W., Jordan, N. et Deutsch, A. (2024). Systematic review of contemporary interventions for improving discharge support and transitions of care from the patient experience perspective. PLoS One, 19(5), e0299176. https://doi.org/10.1371/journal.pone.0299176

Karam, M., Chouinard, M. C., Poitras, M. E., Couturier, Y., Vedel, I., Grgurevic, N. et Hudon, C. (2021). Nursing Care Coordination for Patients with Complex Needs in Primary Healthcare: A Scoping Review. International journal of integrated care, 21(1), 16. https://doi.org/10.5334/ijic.5518

Karam, M., Chouinard, M.-C., Couturier, Y., Vedel, I. et Hudon, C. (2023). Nursing care coordination in primary healthcare for patients with complex needs: A comparative case study. International Journal of Integrated Care, 23(1), 1–22. https://doi.org/10.5334/ijic.6729

Karam, M., Chouinard, M. C., Kevork, M., Fleming, R. et Arnaud, D. (2026). Nurses’ and Patients’ Perspectives on Care Coordination Across Health Care and Social Services Sectors: A Qualitative Study. The Canadian journal of nursing research = Revue canadienne de recherche en sciences infirmieres, 58(1), 48–57. https://doi.org/10.1177/08445621251395347

Karam, M., Hudon, C., Chouinard, M. C., Vermeulen, L. et Duhoux, A. (2025). Transitions of older adults between emergency departments and community care in Quebec: A case study. Geriatric nursing (New York, N.Y.), 66(Pt B). https://doi.org/10.1016/j.gerinurse.2025.103611

Karpen S. C. (2018). The Social Psychology of Biased Self-Assessment. American journal of pharmaceutical education, 82(5), 6299. https://doi.org/10.5688/ajpe6299

Khatri, R., Endalamaw, A., Erku, D., Wolka, E., Nigatu, F., Zewdie, A. et Assefa, Y. (2023). Continuity and care coordination of primary health care: A scoping review. BMC health services research, 23(1), 750. https://doi.org/10.1186/s12913-023-09718-8

Kodwani, A. D. et Prashar, S. (2021). Influence of individual characteristics, training design and environmental factors on training transfer: A study using hierarchical regression. Evidence-based HRM: a Global Forum for Empirical Scholarship, 9(4), 354–373. https://doi.org/10.1108/EBHRM-09-2019-0085

Koo, M. et Yang, S.-W. (2025). Likert-Type Scale. Encyclopedia, 5(1), 18. https://doi.org/10.3390/encyclopedia5010018

Kowalski, C. P., Nevedal, A. L., Finley, E. P., Young, J. P., Lewinski, A. A., Midboe, A. M. et Hamilton, A. B. (2024). Planning for and assessing rigor in rapid qualitative analysis (PARRQA): A consensus-based framework for designing, conducting, and reporting. Implementation Science, 19(1), 71. https://doi.org/10.1186/s13012-024-01397-1

Kuluski, K., Ho, J. W., Hans, P. K. et Nelson, M. (2017). Community Care for People with Complex Care Needs: Bridging the Gap between Health and Social Care. International journal of integrated care, 17(4), 2. https://doi.org/10.5334/ijic.2944

Labesse, M. E. (2008). Cadre de référence sur l’analyse de besoins de formation - volet formation continue. Institut national de santé publique du Québec. https://www.inspq.qc.ca/sites/default/files/publications/800_cadre_de_reference.pdf

Lamb G. (2015). Overview and Summary: Care Coordination: Benefits of Interprofessional Collaboration. Online journal of issues in nursing, 20(3), 1. https://doi.org/10.3912/OJIN.Vol20No03ManOS

Lee, J. J. et Bae, S. G. (2019). Implementation of a care coordination system for chronic diseases. Yeungnam University journal of medicine, 36(1), 1–7. https://doi.org/10.12701/yujm.2019.00073

Lin, W., Huang, I. C., Wang, S. L., Yang, M. C. et Yaung, C. L. (2010). Continuity of diabetes care is associated with avoidable hospitalizations: Evidence from Taiwan’s National Health Insurance scheme. International journal for quality in health care, 22(1), 3–8. https://doi.org/10.1093/intqhc/mzp059

Ljungholm, L., Klinga, C., Edin-Liljegren, A. et Ekstedt, M. (2022). What matters in care continuity on the chronic care trajectory for patients and family carers? A conceptual model. Journal of Clinical Nursing, 31(9-10), 1327–1338. https://doi.org/10.1111/jocn.15989

Loiselle, C. G. et Profetto McGrath, J.(2007). Méthodes de recherche en sciences infirmières: approches quantitatives et qualitatives. Éditions du renouveau pédagogiques Inc.

Lukewich, J., Taylor, S., Poitras, M. E. et Martin-Misener, R. (2018). Advancing family practice nursing in canada: An environmental scan of international literature and national efforts towards competency development. Nursing leadership (Toronto, Ont.), 31(2), 66–78. https://doi.org/10.12927/cjnl.2018.25602

Lumsden, K. (2025). Focus Group - Introduction. National Centre for Research Methods. https://www.ncrm.ac.uk/resources/online/all/?id=20852&utm_source

Morgan, D. L. et Hoffman, K. (2018). A System for Coding the Interaction in Focus Groups and Dyadic Interviews. The Qualitative Report, 23(3), 519–531. https://doi.org/10.46743/2160-3715/2018.2733

Mukurunge, E., Reid, M., Fichardt, A. et Nel, M. (2021). Interactive workshops as a learning and teaching method for primary healthcare nurses. Health SA Gesondheid, 26, 1643. https://doi.org/10.4102/hsag.v26i0.1643

Noble, H. et Heale, R. (2019). Triangulation in research, with examples. Evidence Based Nursing, 22(3), 67–68. https://doi.org/10.1136/ebnurs-2019-103145

Nowell, L. S., Norris, J. M., White, D. E. et Moules, N. J. (2017). Thematic Analysis: Striving to Meet the Trustworthiness Criteria. International Journal of Qualitative Methods, 16(1). https://doi.org/10.1177/1609406917733847

Ocakoğlu, G. et Macunluoğlu, A. C. (2023). Comparison of the performances of non-parametric k-sample test procedures as an alternative to one-way analysis of variance. The European Research Journal, 9(4), 687–696. https://doi.org/10.18621/eurj.1037546

Oliveira, C. A., Weber, B., Dos Santos, J. L. F., Zucoloto, M. L., de Camargo, L. L., Zanetti, A. C. G., Rzewuska, M. et de Azevedo-Marques, J. M. (2022). Health complexity assessment in primary care: A validity and feasibility study of the INTERMED tool. PLoS One, 17(2), e0263702. https://doi.org/10.1371/journal.pone.0263702

Parker, S. et Fuller, J. (2016). Are nurses well placed as care co-ordinators in primary care and what is needed to develop their role: A rapid review? Health & Social Care in the Community, 24(2), 113–122. https://doi.org/10.1111/hsc.12194

Pilcher, J. (2016). Learning needs assessment: Not only for continuing education. Journal for Nurses in Professional Development, 32(4), 122–129. https://doi.org/10.1097/nnd.0000000000000245

Pluye, P., Bengoechea, E. G., Granikov, V., Kaur, N. et Tang, D. L. (2018). Tout un monde de possibilités en méthodes mixtes: revue des combinaisons des stratégies utilisées pour intégrer les phases, résultats et données qualitatifs et quantitatifs en méthodes mixtes. Dans M. Bujold, Q. N. Hong, V. Ridde, C. J. Bourque, M. J. Dogba, I. Vedel et P. Pluye (dir.), Oser les défis des méthodes mixtes en sciences sociales et sciences de la santé (p. 28-48). Cahiers scientifiques de l’Acfas. https://numerique.banq.qc.ca/patrimoine/details/52327/3738061

Poitras, M. E., Ferguson, F., Bergeron, A., Rodrigue, M-E. et Paré, L.. (2019). Guide pratique à l’intention des infirmières cliniciennes qui travaillent dans un groupe de médecine de famille ou un groupe de médecine de famille universitaire dans une perspective de collaboration interprofessionnelle (Publication no : 19-924-11W). Ministère de la Santé et des Services Sociaux, Gouvernement du Québec. https://publications.msss.gouv.qc.ca/msss/fichiers/2019/19-924-11W.pdf

Saucier, A. et Biron, A. (2018). Développement d’un consensus professionnel face aux interventions de l’infirmière pivot en oncologie en vue de soutenir la planification des effectifs au Québec. Canadian oncology nursing journal = Revue canadienne de nursing oncologique, 28(4), 301–307. https://doi.org/10.5737/23688076284301307

Stalmeijer, R. E., Brown, M. E. L. et O’Brien, B. C. (2024). How to discuss transferability of qualitative research in health professions education. The clinical teacher, 21(6), e13762. https://doi.org/10.1111/tct.13762

Thielmann, I., Heck, D. W. et Hilbig, B. E. (2016). Anonymity and incentives: An investigation of techniques to reduce socially desirable responding in the Trust Game. Judgment and Decision Making, 11(5), 527–536. https://doi.org/10.1017/S1930297500004605

Toulany, A., Gorter, J. W. et Harrison, M. (2022). A call for action: Recommendations to improve transition to adult care for youth with complex health care needs. Paediatrics & child health, 27(5), 297–309. https://doi.org/10.1093/pch/pxac047

Tu, Y.-K., Blance, A., Clerehugh, V. et Gilthorpe, M. S. (2005). Statistical Power for Analyses of Changes in Randomized Controlled Trials. Journal of Dental Research, 84(3), 283–287. https://doi.org/10.1177/154405910508400315

van Grootel, J. W. M., Collet, R. J., van Dongen, J. M., van der Leeden, M., Geleijn, E., Ostelo, R., van der Schaaf, M., Wiertsema, S. et Major, M. E. (2025). Experiences with hospital-to-home transitions: Perspectives from patients, family members and healthcare professionals. A systematic review and meta-synthesis of qualitative studies. Disability and rehabilitation, 47(7), 1644–1658. https://doi.org/10.1080/09638288.2024.2384624

WHO European Centre for Primary Health Care. (2023). Understanding primary health care. World Health Organization. https://www.who.int/europe/news-room/questions-and-answers/item/questions-and-answers-understanding-primary-health-care

Willis, G. B. (2015). Analysis of the cognitive interview in questionnaire design. Oxford University Press.

Wutich, A., Beresford, M. et Bernard, H. R. (2024). Sample Sizes for 10 Types of Qualitative Data Analysis: An Integrative Review, Empirical Guidance, and Next Steps. International Journal of Qualitative Methods, 23. https://doi.org/10.1177/16094069241296206

Zhao, Y., Xu, Y., Ma, D., Fang, S., Zhi, S., He, M., Zhu, X., Dong, Y., Song, D., Yiming, A. et Sun, J. (2024). The impact of education/training on nurses caring for patients with stroke: a scoping review. BMC nursing, 23(1), 90. https://doi.org/10.1186/s12912-024-01754-x

Zhenjing, G., Chupradit, S., Ku, K. Y., Nassani, A. A. et Haffar, M. (2022). Impact of Employees’ workplace environment on employees’ performance: A multi-mediation model. Frontiers in public health, 10, 890400. https://doi.org/10.3389/fpubh.2022.890400