Abstract
The healthcare system of Ukraine is under unprecedented strain due to war, population displacement, infrastructure destruction, and workforce shortages. International experience demonstrates the effectiveness of hospital-substituting technologies as a strategy for the deinstitutionalization of medical care, but this potential remains underutilized in Ukraine. This article aims to substantiate the need for systemic transformation of healthcare delivery through the creation of specialized nursing units and to develop management solutions for different levels of the healthcare system. Based on a systematic literature review and analysis of international experience (Hospital at Home programs, Community Diagnostic Centres, Buurtzorg, Esther Project, Gesundes Kinzigtal, PEN-Plus), key models of nursing care organization were identified: functional, individualized, primary care, team-based, and virtual models. For Ukraine, the most promising is the team-based model, adapted to resource-constrained settings and integrated with telemedicine technologies. The current state of nursing in Ukraine was analyzed, revealing systemic problems: hierarchical structures limiting collaboration, a lack of continuing education systems, and insufficient training for complex cases. A concept for creating nursing units at three levels is proposed: primary care (mobile teams for chronic and palliative patients), multidisciplinary hospitals (continuing care departments and nurse coordinators), and diagnostic centers (expanding nurses’functions in the diagnostic process). A phased implementation plan (2026-2030) was developed, and specific management solutions were formulated for the Ministry of Health, regional administrations, district military administrations, local self-government bodies, and healthcare facility managers. In conclusion, the transformation of Ukraine’s healthcare system based on the development of hospital-substituting technologies and strengthening the role of nurses with higher education is a strategic priority capable of increasing the accessibility and quality of medical care, optimizing resource use, and ensuring the system’s resilience during war and post-war recovery.
References
1. NHS England Midlands. (2025, August 20). Community Diagnostic Centres helping thousands more patients access tests in the Midlands without visiting hospital. https://www.england.nhs.uk/midlands/2025/08/20/community-diagnostic-centres-helping-thousands-more-patients-access-tests-in-the-midlands-without-visiting-hospital/
2. North East and North Cumbria NHS Provider Collaborative. (2025, December 17). Region’s community NHS teams keeping people safe at home this winter. https://nenc-providers.nhs.uk/latest-news-and-events/latest-news/regions-community-nhs-teams-keeping-people-safe-home-winter
3. Denecke, K., May, R., Ribaud, E., Borycki, E. M., & Kushniruk, A. W. (2024). Preparing for Hospital at Home: A review of the current landscape of training practices. Studies in Health Technology and Informatics, (321), 48–52. https://doi.org/10.3233/SHTI241060
4. Westbrooke, L. A. (2024). Hospital in the Home: Nurse-led models of care and pathways. Studies in Health Technology and Informatics, (315), 432–436. https://doi.org/10.3233/SHTI240185
5. Bransgrove, N. J., Porter, J. E., Peck, B., & Bishop, J. (2024). Mapping Hospital in the Home models of care: A systematic review. Journal of Advanced Nursing. Advance online publication. https://doi.org/10.1111/jan.16639
6. Paul, M. M., Matthews, M. R., Greaney, G. B., Wallenstein, D. W., Greenwood, J. D., Spaulding, T., et al. (2024). Advancing family medicine in a model unit: A living lab for health care design and innovation. medRxiv. https://doi.org/10.1101/2024.10.14.24315467
7. Peninsula Diagnostics Network. (2026, February 15). Community Diagnostic Centres. https://peninsuladiagnostics.nhs.uk/cdc-pathology
8. Table 2. Integration models in selected countries. (2025). In Comparative analysis of health and social care integration. PMC. https://pmc.ncbi.nlm.nih.gov/articles/PMC12194770/table/jmahp-13-00028-t002/
9. World Health Organization Regional Office for Africa. (2025, August 27). African health leaders, partners call for greater investment in integrated NCD services. https://www.afro.who.int/news/african-health-leaders-partners-call-greater-investment-integrated-ncd-services
10. Razom. (2025, April 17). United for Better Care: Razom, Face the Future, Still Strong, and Patients of Ukraine shape the future of nursing in Ukraine. https://www.razomforukraine.org/united-for-better-care-razom-face-the-future-still-strong-and-patients-of-ukraine-shape-the-future-of-nursing-in-ukraine/
11. Nursa. (2025, May 29). What are the 4 essential nursing care models? https://nursa.com/blog/nursing-care-models-primary-individual-and-team-nursing-models
12. IntelyCare. (2025, November 17). Nursing care delivery models: Overview. https://www.intelycare.com/facilities/resources/nursing-care-delivery-models-overview/
13. Grytsko, R., Furtak, I. I., & Parobetska, I. M. (2014). Experience and problems of the primary health care centers’ specialists in the implementation of the integrated health system based on family medicine in Ukraine. Wiadomości Lekarskie, 67(2 Pt 2), 298–301.
14. Clipper, B. (2025). Evolving virtual nursing care models. Nurse Leader, 23(6), Article 102536. https://doi.org/10.1016/j.mnl.2025.102536
15. International Rescue Committee. (2024). Community Nurse, Odesa, Ukraine. https://unjobs.org/vacancies/1714422801866
16. Furtak, I. I., Hrytsko, R. Yu., Holunov, A. I., & Parobetska, I. M. (2015). Intehrovana model okhorony zdorov’ia na zasadakh simeinoi medytsyny dlia Ukrainy [Integrated health care model based on family medicine for Ukraine]. Skhidnoievropeiskyi zhurnal hromadskoho zdorov’ia, (2), 193–194 (in Ukrainian)
17. Mezha. (2025, October 27). Yagotyn Hospital to open long-term care unit for displaced persons in November 2025. https://mezha.net/eng/bukvy/yagotyn-hospital-to-open-long-term-care-unit-for-displaced-persons-in-november-2025/
18. American Hospital Association. (2025, July 15). 5 innovative nurse-led models of care to explore. https://www.aha.org/2025-07-15-5-innovative-nurse-led-models-care-explore
19. Becker’s Hospital Review. (2025, July 14). 5 innovative nurse-led care models. https://www.beckershospitalreview.com/quality/nursing/5-innovative-nurse-led-care-models/
20. Rivne24. (2025, November 11). Free nursing care for IDPs in Rivne region. https://rivne24.com/en/free-nursing-care-for-idps/
21. Interfax-Ukraine. (2025, October 8). Natscluzhba zdorov’ia pochynaie pryiom zaiavok na uchast u proekti z nadannia posluh z dovhotryvaloho medsetrynskoho dohliadu dlia VPO [The National Health Service begins accepting applications for participation in a project to provide long-term nursing care services for IDPs]. https://ru.interfax.com.ua/news/general/1110749-amp.html (in Ukrainian)
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Copyright (c) 2026 Roman Grytsko, Orysia Grytsko, Solomiia Pekanets