Daily practices of advanced practice nurses within a multi-professional primary care practice in Switzerland: a qualitative analysis.

BACKGROUND: The rising global population of older persons with chronic conditions demands new primary care models. Advanced practice nurses (APNs) can help meet that need. In Switzerland, APNs have only recently been introduced in primary care and little is known about their daily practice. This study aims to describe APNs' activities and general roles at four sites with multi-professional primary care practices in the Swiss cantons of Bern and Solothurn. METHODS: To study the practices of APNs at the study sites, we adopted a social constructivist perspective, lending methods from ethnographic field research. We interviewed, observed and accompanied participants over five months, generating rich data on their daily practices. The analysis followed Braun and Clarke's six-step thematic analysis process. RESULTS: The APNs' daily practices cover three main themes. Their core activities are working with expanded clinical skills and being on-site specialists for patients and their relatives. These practices are surrounded by net activities, i.e., taking care of patients in tandem with the physicians and regular visits in residential long-term care facilities. The outer activity layer consists of cohesive activities, with which APNs anchor and facilitate their role and catalyze further development of the care model. APNs tailor their expanded medical knowledge and nursing practice to maximize the value they provide in patient care. CONCLUSIONS: This study extends our knowledge of APNs' daily practice within a Swiss multi-professional primary care practice. Our results indicate competencies that need to be integrated in APN education and point out the high potential of APN integration in such primary care practices.

Integration of an advanced practice nurse into a primary care practice: a qualitative analysis of experiences with changes in general practitioner professional roles in a Swiss multiprofessional primary care practice.

BACKGROUND: The complex care needs of people with chronic illnesses and multimorbidity pose a significant challenge to the Swiss primary care system. Ensuring efficient, high-quality care will require new care models. Internationally, the integration of advanced practice nurses (APNs) into primary care models has shown promising results. The current study investigates how general practitioners (GPs) in Switzerland experience the integration of APNs into their primary care teams with respect to their own professional roles. METHODS: We used a qualitative, social-constructivist approach, focusing on six individual interviews with general practitioners within the frame of a larger study including GPs and APNs in a Swiss multiprofessional primary care practice. Data were analysed following Braun and Clarke's approach for reflexive thematic analysis. SETTING AND PARTICIPANTS: The study took place between August 2019 and February 2020 in a Swiss multiprofessional primary care practice that had been working with APNs for nine years. Participants included six general practitioners. RESULTS: We identified three main themes characterising Swiss GPs' experiences with the integration of APNs into their primary care team: (1) trust as foundation for collaboration with APNs; (2) build-up of the APN role by delegation, teaching, and supervision, investing time particularly at the beginning of their collaboration with the APN - a time investment that declined significantly as the APNs' competencies grew - and (3) synergies of partnership-based collaboration with APNs. Physicians who were experienced teachers and supervisors, and who delegated tasks based on who would be able to fulfil them most efficiently and effectively, experienced not only a broad range of synergies, but also possibilities to further develop the range of their own activities. Comprehensive, high-quality patient care was perceived as a particular added value. CONCLUSION: Our analysis revealed that GPs experienced interprofessional synergies when working collaboratively with APNs. These were rooted in trust and relied on abilities in teaching, supervision and delegation to achieve maximum impact. Capitalising on the integration of APNs into primary care, this new care model can be adapted to diverse individual settings. We conclude this article by highlighting the potential of working collaboratively with APNs, who play increasingly important roles in the primary care of polymorbid patients with complex needs.

Flyer to improve self-management of symptoms for patients with cancer ­ Evaluation of feasibility and comprehensibility of the Symptom Navi / Flyer Symptom Navi zur Unterstützung des Selbstmanagements von Symptomen bei Krebs ­ Evaluation von Anwendbarkeit und Verständlichkeit.

Background: Short informations with graphic elements may support self management of symptoms. Enhancing self-management is a key element of cancer care. Since 2011 different organisations have been developing patient education handouts, the so called symptom navi with three different graphical variants and slightly different text. Aim: To lay ground for a Swiss-wide standard of the symptom navi, we evaluated (a) the utility of the sheets and (b) the preference for the graphical layout and c) complexity of provided text with patients, their relatives, and health professionals. Methods: We conducted three focus groups with 14 patients and one relative, and an online-survey with 16 health professionals. Descriptive data analysis were combined with thematic analysis of qualitative data. Results: Overall, the symptom navi were well received by patients and health professionals. All participants welcomed the conciseness of information and requested information was easy to find. The structure of the symptom navi supported the readability and facilitated the self-assessment of a patients' condition. Smileys to support the evaluation of symptom burden was the most favoured graphic layout. For patients, the graduation of the severity of symptoms with different colours supported their feelings of safety. However, symptom navi do not substitute personal contact and counselling. Conclusions: The most favoured graphical layout will now be further developed and refined. A future evaluation will investigate the content validity of the symptom navi.

"Don't let the world become too small" ­ How patients with advanced cancer and their significant others cope with transitions during the last year of life. A qualitative study / «Die Welt nicht zu klein werden lassen¼. Wie Menschen mit einer Krebserkrankung und Angehörige Übergänge in den letzten Monaten bewältigen. Eine qualitative Studie

Background: In the last year of life, persons with advanced cancer and their significant others are affected by several transitions. They perform psychological adjustment processes during transformation. This requires strategies for patients and their significant others. Research in German about this theme is missing. Aim: We explored the experiences with illness management during transitions in the last year of life of patients with advanced cancer and their significant others. Method: In this qualitative study, we conducted structured interviews with five dyads, consisting of persons with Karnofsky Index ≥ 60 % and life expectancy of six to twelve months as well as their significant others. To interpret the interviews, we used qualitative content analysis according to Mayring. Results: The main theme "Don't let the world become too small" expresses that limitations diminished the lifeworld and the participants struggled against this process. This is revealed in three categories: "Being shocked by diagnosis ­ realigning again", "Bearing limitations and loss ­ finding new ways in daily life", "Living in uncertainty ­ holding out together". Conclusions: Patients and significant others live in changing lifeworlds caused by transitions. Health care professionals should be attentive and may gain deeper knowledge about transitions. Further research in German-speaking contexts will help to improve nursing care and psychooncological interventions.