Table 4 Recommendations for education, clinical practice, and future research, based on the study findings

- This study emphasizes the pressing need for all nurses working with people with CDs to be offered basic CD training—even the experienced nurses, who may benefit from continuing education opportunities to expand their scope of practice.

- Both mental health/psychiatric and addiction issues must be covered in undergraduate nursing programs [48].

- Continuing professional education in CDs should be standardized within the clinical settings.

- ECHO is an online collaborative model of continuing education that relies on active participation for content.

- Limited and fragmented participation should be addressed in future ECHO programmes—or in other types of online collaborative learning models—by developing mechanisms for engaging non-contributing participants with active knowledge sharers.

- Despite its many benefits, group learning can negatively influence participation.

- Nurses may not feel comfortable sharing with the group or interacting with other participants, especially with those in a senior position or with more expertise.

- Ensuring that educational programmes have a positive, encouraging environment can help to build a culture of trust between participants.

- Carefully selecting facilitators who are both knowledgeable in the specialist area and team builders in their approach to sharing knowledge.

- The key task of the facilitator is to create a safe learning environment in which participants can share both their successes and their challenges.

- ECHO—and other types of videoconference-based educational programmes—depends on a reliable Internet connection and the use of visual connectivity to improve communication and relationship building between participants.

- Access to a dedicated technological support service during the sessions is a prerequisite to ensure the successful conduct of the learning activities.

- Providing optimal care for individuals with CDs is challenging for nurses, and it has been associated with a higher vulnerability to burnout syndrome, and low job satisfaction and work engagement among nurses [72, 73].

- Mentoring programmes and clinical supervision should be further incorporated into nursing practice and clinical settings.

- A team-based approach to continuing professional development should be prioritized to enhance collaboration and communication between colleagues, and to align care practices around shared values and goals.

- Emotional support is essential to enrich the continuing education programmes already in place.

- Future continuing education programmes should integrate self-confidence enhancing strategies to support nurses in caring for individuals with complex healthcare needs.

- The factors influencing nursing competency development are multi-faceted.

- A tailored approach to continuing professional education, in which the structure and clinical content of interventions are personalized to the needs of participants is essential to facilitating and sustaining changes in clinical practice.

- Researchers, educators, and clinical leaders should develop mechanisms to reinforce nurses’ participation in and motivation towards continuing professional education, and should do so by engaging them in all design and maintenance procedures, from planning their initiatives to evaluating and improving them.

- Protected time periods during working hours should be established for nurses so that they may benefit from continuing professional development opportunities.

- Working environments should provide nurses with the minimum requirements of technical equipment (e.g., desktop or laptop computer, Internet connection, webcam or HD cam, and speakers and microphones), so that participants can fully benefit from online educational programmes.

- Supportive leadership from local stakeholders (e.g., care coordinator, health administrators, organizational leaders) is crucial to fostering best care practices and promoting a culture of change.