Transformation of Nursing Practice Following Health Service Decentralisation in Thai Subdistrict Health Promoting Hospitals: A Qualitative Study

Health service decentralisation has transformed the delivery of primary healthcare in Thailand. Since transferring health promoting hospitals to local government, the role of nurses and day-to-day practices have altered; however, limited research has explored the ways in which nurses are navigating these changes. To investigate registered nurses’ experiences of practice transformation following health service decentralisation in Thailand.

This was a qualitative descriptive study undertaken with 14 registered nurses in Subdistrict Health Promoting Hospitals (SHPH). Data were generated from semi-structured interviews and analyzed using thematic analysis.

Fourteen community nurses from six Subdistrict Health Promoting Hospitals participated in the study. Participants had varying levels of experience in community nursing and had worked within both pre- and post-decentralisation contexts. Five themes were derived from the data. (1) expanded scope of nursing practice, (2) complexity of navigating decentralised healthcare systems, (3) ongoing professional development and learning, (4) resilience and compassionate care, and (5) enhanced relationships and community engagement. Nurses expressed an expanding array of work, including health care planning, administration and community work, along with increasing administrative workload and pressures. Nevertheless, nurses described sustained commitment and efforts to deliver high-quality care.

The findings indicate that health service decentralisation has reshaped community nursing practice by expanding professional roles and increasing organisational complexity. The study highlights the need for workforce support, continuing professional development, and organisational strategies that enable nurses to respond effectively to evolving responsibilities while sustaining person-centred community care.

Health service decentralisation has contributed to an expansion of nursing work and an increase in the complexity of nursing practice within the Thai context. A focus on appropriate training, professional support and organisational support are likely to assist in ensuring quality primary healthcare services by supporting nurses through this ongoing process.