(1) Background: The nursing profession has undergone a significant transformation not only in a formal context but also in terms of the increased educational competencies required of nurses and their preparedness to adapt to evolving roles and statuses. The aim of our study was to examine the experience of advanced practice nurses who conduct independent consultations on patients and to identify the main challenges they face in their practice. (2) Methods: We carried out 22 semi-structured interviews with nurses responsible for conducting independent consultations across three urban polyclinics located in Aktobe, Almaty, and Astana. All interviews were audio-recorded, transcribed verbatim, and subjected to qualitative content analysis. (3) Results: The content analysis revealed three main themes: “People awareness of the role of an independent nursing appointment”, “Adaptation of the work environment”, and “Confidence of nurses to provide independent services”. (4) Conclusions: Limited competency among nurses and the absence of quality metrics for autonomous nursing consultations present substantial obstacles to assessing and enhancing the quality of care delivered by nurses in their independent roles. Developing and implementing quality indicators for independent nursing appointment, as well as additional training within the framework of interprofessional continuous education for nurses, are important steps toward enhancing the effectiveness, safety, and accessibility of nursing care.

Background: Primary probing of the nasolacrimal duct remains the first-line surgical intervention for congenital nasolacrimal duct obstruction (CNLDO) in infants and young children. However, age-dependent success rates have been less thoroughly investigated. This systematic review and meta-analysis aims to evaluate the age-related success rates of primary probing in children with CNLDO. Methods: Systematic literature searches were performed in PubMed, Web of Science, Scopus, ScienceDirect, and Google Scholar in May 2025. A random-effects model was applied to estimate the overall success rate, while sensitivity analyses and publication bias assessments were performed to explore sources of variability. All statistical analyses were carried out using the “meta” and “metafor” packages in RStudio. Results: This meta-analysis reveals age-stratified success rates of primary probing for CNLDO: the highest pooled success rate occurred in infants aged 0–6 months (90.67%, I² = 81%, p < 0.01), with procedures under general anesthesia achieving 95.42% (I² = 50%; p = 0.11) efficacy. Success rates remained favorable in the 6–12 month group (85.18%, I² = 86%, p < 0.01 overall; 89.60% with general anesthesia) but declined progressively thereafter (82.34%, I² = 78%, p < 0.01 at 12–24 months). While a modest rebound occurred in the 24–48 month group (85.33%, I² = 69%, p < 0.01), the oldest cohort (48+ months) demonstrated markedly reduced efficacy (63.47%, I² = 66%, p = 0.05), despite exclusive use of general anesthesia. Conclusion: Primary probing yields the most favorable outcomes when conducted before 12 months of age, particularly under general anesthesia. Nonetheless, the overall certainty of evidence is low—mainly due to variability across studies—which should be taken into account in clinical decision-making.

Background/Objectives: The implementation of advanced practice nursing in Kazakhstan is aimed at improving the accessibility and quality of primary healthcare. One of the key indicators of the effectiveness of this model is patient satisfaction, which reflects the perceived quality of care and directly influences treatment adherence. The aim of the study was to assess patient satisfaction with nurse-led consultations in primary healthcare institutions in Kazakhstan. Methods: A cross-sectional study was conducted using a questionnaire developed on the basis of Karin Bergman’s instrument and adapted to the Kazakhstani context. A total of 621 patients who attended independent nursing consultations in polyclinics in Aktobe, Almaty, Astana, and the village of Merke participated in the survey. Descriptive statistics and Pearson’s χ² test were applied, with statistical significance set at p < 0.05. Results: The majority of respondents were women, with a median age of 61 years. Awareness of independent consultations was higher among patients who regularly visited nurses (97.1% vs. 86.9%; p < 0.006). High satisfaction levels were associated with service accessibility, quality of examination, and clarity of recommendations. Among regular visitors, 99.2% reported satisfaction with the nurse’s work, and 76.6% rated the service as “excellent”. In contrast, patients with irregular visits more often reported dissatisfaction due to insufficient attention and limited knowledge of nurses. Conclusions: The findings confirm a high level of patient satisfaction with advanced practice nursing services and highlight the importance of this model in strengthening primary healthcare in Kazakhstan.

Maternal and child health is a global priority, particularly concerning maternal and child mortality and the protection of socially disadvantaged populations. At the primary health care level, patronage services involve additional active visits based on an individualized plan for children identified as having medical or social risks threatening their life, health, development, or safety. This study explores the organization of patronage control for newborns and young children, based on a universal progressive model aimed at identifying and mitigating risks, as well as reducing the number of mandatory visits for families without identified risks. Purpose. The study explores the features of patronage services for young children in primary health care both in Kazakhstan and internationally. Methods. This review included observational studies, randomized controlled trials, reviews, and articles related to nursing patronage work. A comprehensive search was conducted across state, English, and Russian language databases such as PubMed/ Medline and Google Scholar. Keywords used included patronage, nursing, early childhood, active visitation, and care. The search strategy involved combining terms with logical operators and conducting manual searches for additional references in the reference lists of relevant articles. Results. Out of 112 articles initially identified, 38 were included after abstract and full text evaluation. The review highlights patronage activities provided to young children in Kazakhstan and other countries. Despite some differences in patronage services, commonalities were observed in the areas of service provided. Conclusion. While there are specific features of children’s patronage services in Kazakhstan, patronage nurses play a crucial role in monitoring the children's condition and living environment, conducting necessary examinations, and providing psychological support to both the child and family. Keywords: patronage, visiting nurses, children, active visits, care

Introduction. Population ageing has led to a growing prevalence of multimorbidity among older adults, making it a dominant challenge for primary health care systems. The coexistence of multiple chronic conditions in older patients is associated with increased clinical complexity, functional decline, polypharmacy, and higher healthcare utilization, highlighting the limitations of disease-oriented models of care. Objective. To analyze and summarize current scientific evidence on multimorbidity among older adults, with a particular focus on organizational aspects of care and patient-centered approaches in primary health care. Methods. A literature review was conducted using PubMed, Web of Science, Scopus, ScienceDirect, and Google Scholar between January and February 2026. Peer-reviewed studies addressing multimorbidity in older adults, organizational models of care, patient-centered approaches, and management in primary health care settings were included. The findings were synthesized using a qualitative thematic approach. Results. The reviewed literature demonstrates a high and increasing prevalence of multimorbidity among older adults receiving primary health care. Multimorbidity is consistently associated with reduced quality of life, functional limitations, increased healthcare utilization, and polypharmacy. Primary health care faces significant organizational challenges, including fragmented care, limited coordination, and guideline-driven polypharmacy. Interventions targeting multimorbidity show limited and heterogeneous effectiveness, while patient-centered approaches improve patient experience and engagement, though their impact on clinical outcomes remains inconsistent. Conclusions. Multimorbidity among older adults represents a major and growing challenge for primary health care. The findings underscore the need to transition from disease-centered models toward integrated, patient-centered approaches that address clinical complexity, polypharmacy, and social determinants of health. Strengthening primary care–based, coordinated models of care is essential to improving outcomes for older patients with multimorbidity. Введение. Старение населения приводит к росту распространённости мультиморбидности среди пожилых людей, что делает данное состояние одной из ведущих проблем для системы первичной медико-санитарной помощи. Сочетание нескольких хронических заболеваний у пожилых пациентов ассоциируется с повышенной клинической сложностью, функциональным снижением, полипрагмазией и увеличением потребления медицинских услуг, что подчёркивает ограничения заболевательно-ориентированных моделей оказания медицинской помощи. Цель. Анализ и обобщение современных научных данных, посвящённых мультиморбидности у пожилых пациентов, с акцентом на организационные аспекты медицинской помощи и пациент-ориентированные подходы в условиях первичной медико-санитарной помощи. Материалы и методы исследования. Обзор литературы был проведён с использованием баз данных PubMed, Web of Science, Scopus, ScienceDirect и Google Scholar в период с января по февраль 2026 года. В обзор были включены рецензируемые научные исследования, посвящённые мультиморбидности у пожилых людей, моделям организации медицинской помощи, пациент-ориентированным подходам и вопросам ведения пациентов в условиях первичной медико-санитарной помощи. Полученные данные были синтезированы с применением качественного тематического анализа. Результаты. Анализ литературы показал высокую и продолжающую расти распространённость мультиморбидности среди пожилых пациентов, получающих первичную медико-санитарную помощь. Мультиморбидность устойчиво ассоциируется со снижением качества жизни, функциональными ограничениями, увеличением потребления медицинских услуг и полипрагмазией. В системе первичной медико-санитарной помощи выявлены значительные организационные трудности, включая фрагментацию медицинской помощи, недостаточную координацию и полипрагмазию, обусловленную следованием клиническим рекомендациям по отдельным заболеваниям. Эффективность вмешательств, направленных на ведение мультиморбидности, остаётся ограниченной и неоднородной, тогда как пациент-ориентированные подходы способствуют улучшению опыта пациентов и их...

This study outlines the progression of nursing reform and the establishment of the Center for Nursing Improvement in Kazakhstan. Through this initiative, the healthcare sector aims to align with international standards. The project "Enhancing Higher Education Potential in Nursing through Healthcare Reform" was conceived to support ongoing transformations in nursing. It focuses on advancing nursing expertise in Kazakhstani healthcare, enhancing the role of medical universities in nursing research, fostering leadership and management systems in nursing, and refining nursing education at the master's and PhD levels. Keywords: nursing, nursing reform, regulatory frameworks, nursing education, Center for Nursing Improvement