Defining and Practicing Nursing Care Management in Internal Medicine and ICU: A Mixed-Methods Perspective

Background: Nurses play a central role in coordinating care and ensuring continuity in care settings. However, the meaning, scope, and enactment of nursing care management remain insufficiently defined, particularly in internal medicine wards and intensive care units (ICUs). Aim: To explore how nurses define and experience nursing care management and to examine perceived responsibility and task allocation for core care-management activities across internal medicine and ICU settings. Design: Exploratory sequential mixed-methods study. Methods: The study comprised two sequential phases. First, qualitative data were collected through three focus groups with internal medicine and ICU nurses (n = 15) to explore nurses’ conceptualizations and experiences of care management. Findings from this phase informed the development of a structured questionnaire, which was subsequently administered in a cross-sectional survey to nurses in the participating units (n = 119). Quantitative data assessed perceived responsibility for key care-management activities and task allocation patterns. Results: Qualitative findings indicated that nurses conceptualize nursing care management as a dynamic, integrative process encompassing coordination, advocacy, and continuity of care across disciplines and shifts. Quantitative survey results showed broad agreement that care management falls within the nursing role; however, substantial ambiguity persisted regarding responsibility for specific activities—particularly physical assessment, communication with families, and interdisciplinary coordination. Integration of findings demonstrated that qualitative themes contextualized these quantitative patterns by highlighting tensions between professional preparation, institutional norms, workload constraints, and enacted practice. Conclusions: By integrating qualitative and quantitative findings, this study shows that nurses act as key care coordinators in internal wards settings yet operate within unclear role boundaries. Clarifying nursing care-management roles through empowerment-oriented organizational and educational strategies may strengthen professional identity, interdisciplinary collaboration, and care quality.