PASSiON Patient care in family practices - The potential of APN
The increase in chronic illnesses, multimorbidity and a shortage of specialists make it essential to adapt primary care. There is potential for the use of APNs in Swiss family practices.
Factsheet
- Schools involved School of Health Professions
- Institute(s) Nursing
- Research unit(s) Innovation in the Field of Health Care and Human Resources Development
- Funding organisation Others
- Duration 15.10.2020 - 31.03.2025
- Head of project Dr. Margarithe Ch. Feuz-Schlunegger
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Project staff
Dr. Margarithe Ch. Feuz-Schlunegger
Prof. Dr. Maya Zumstein-Shaha -
Partner
Vontobel-Stiftung
Stiftung Pflegewissenschaft Schweiz - Keywords Advanced Practice Nurses, family practice, chronically ill people
Situation
Switzerland faces the challenge of continuing to provide primary health care for an increasing number of elderly, chronically ill, and multimorbid individuals. Advanced Practice Nurses (APNs) have the potential to fill gaps in primary health care. The PhD project provides the first insights into the competencies of APNs in family practices and their contributions within the framework of cross-institutional employment compared to family practices without APNs in Switzerland. The aim of this study was to de-scribe the health care provided to chronically ill individuals in family practices with and without APNs, and to identify similarities and differences. The following re-search questions were the focus: 1) What are the competencies of APNs in adult care in family practices? 2) What is the contribution of APNs to older, chronically ill patients in an interprofessional context in two Swiss family practices? 3) What are the similarities and differences between family practices with and without APNs in the primary care of chronically ill patients? 4) How are methods and data analysis triangulation described in case studies on APNs in primary care?
Course of action
Research questions 1) and 4) were answered with scoping reviews. Re-search questions 2) and 3) were investigated using a multiple case study design with interviews, observations, analysis of patient records, and questionnaires. Five family practices in rural areas and mountain regions in German-speaking Switzerland were included. In two of these practices, an Advanced Practice Nurse (APN) was employed. First, a within-case analysis was conducted for the five family practices. The qualitative data from interviews, observations, and patient records were inductively combined into case vignettes using thematic analysis according to Braun and Clarke. The quantitative data from the questionnaires were descriptively analyzed and formed the case contexts. Second, a cross-case analysis was applied using a deductive thematic analysis according to Braun and Clarke. This analysis was based on Wagner's Chronic Care Model.
Result
The first scoping review showed that competencies in direct clinical practice, particularly nursing or medical activities, were most frequently mentioned for APNs. The within-case analyses showed that APNs contributed to the areas of promoting self-management, prevention, and health promotion in complex, stable, and un-stable patient situations, which had previously been insufficiently covered by other health care professions in family practices. APNs strengthened interface management through cross-institutional employment and flexible, addressee-oriented communication. The cross-case analysis identified the following commonalities in patient care in the five family practices: Chronically ill patients wanted to be perceived as holistic individuals. Guidelines for multimorbidity were lacking, and relevant services, such as coordination, were only partially refunded. The family practices with APNs differed in that the roles within the team were less clear, and criteria for referring patients to the APNs were missing. Additionally, these teams were in a longer process of change. The second scoping review showed that descriptions of the various procedures for triangulating methodology and data analysis in case studies were insufficient. Therefore, case studies were poorly methodologically standardized, which negatively affected the traceability of the research process.
Looking ahead
APNs provide additional patient centered care in family practices that was not possible in this setting without APNs. However, there are uncertainties in the process of referring patients to APNs. Adjustments to existing practice structures to accommodate new models should be investigated. Further, the creation of post-master continuing education programs for APNs, the establishment of interprofessional exchange forums, such as case discussions in family practices, and the use of job descriptions, are recommended.
