Patients' experiences with the advanced practice nurse role in Swiss family practices: a qualitative study.

BACKGROUND: Considering shortages of general practitioners (GP) and strategies for improving the quality of health care provision, many countries have implemented interprofessional care models with advanced practice nurses (APN). International evidence suggests that APN care results in high patient satisfaction. In Switzerland, the role is still new, and the patient perspective has not yet been researched. Our aim was therefore to explore patients' experiences with the APN role in Swiss family practices. METHODS: We conducted 22 semi-structured interviews in four different family practices with patients aged 18 to 97 suffering from minor acute to multiple chronic diseases, and who had at least one consultation with an APN. All interviews were audiotaped, transcribed verbatim, and analysed using qualitative content analysis. RESULTS: The analysis resulted in five themes: Despite the unfamiliarity, all patients were willing to be consulted by an APN because it was recommended by their GP (1); after several encounters, most participants perceived differences between the APN and the GP consultation in terms of the length and style of the consultations as well as the complexity of their tasks (2); the interviewees emphasised coaching, guidance, care coordination, and GP-assisting tasks as APN core competencies and attributed the characteristics empathetic, trustworthy, and competent to the APN role (3); most patients especially valued home visits and the holistic approach of the APNs, but they also noticed that in certain cases GP supervision was required (4); and due to the close collaboration between the APN and the GP, patients felt safe, well cared for and experienced improvements in physical and psychological well-being as well as in daily activities (5). CONCLUSION: Our results suggested that patients value the APNs' competencies, despite their initial lack of role knowledge. Trust in the GP seemed to be the most important factor for patients' receptiveness toward the APN role. Overall, patients perceived an added value due to the enlargement of the scope of practice offered by APNs. The patient perspective might provide valuable insights for further APN role implementation in Swiss family practices.

Advanced practice nurses' and general practitioners' first experiences with introducing the advanced practice nurse role to Swiss primary care: a qualitative study.

BACKGROUND: Primary care is facing a multimorbid, ageing population and a lack of general practitioners (GPs), especially in rural areas. In many countries, advanced practice nurses (APNs) may be a potential solution for these challenges. Switzerland, however, is in the early stages of APN role development with a handful of pilot projects that are unresearched. Our aim was to explore the experiences of APNs and GPs involved in introducing the APN role to Swiss primary care. METHODS: We organised two focus group discussions with APNs (n = 9) engaged in primary care across German-speaking Switzerland and individual interviews with APNs (n = 2) and GPs (n = 4) from two pilot projects in remote areas. Data analysis followed an exploratory hybrid approach of thematic analysis and was guided by the PEPPA Plus framework. RESULTS: The analysis resulted in five main themes: The participants considered themselves pioneers developing a new model in primary care, seeking to shape and improve future health care ((1) pioneering spirit). Both nurses and doctors agreed on the additional value of the APN role, a role seen as having more time for and a different approach to patient care, bringing higher quality of care and flexibility to the practice ((2) added value from the APN role). Participants also emphasized the importance of asking for advice when unsure about diagnostic steps or appropriate treatment ((3) awareness of limited knowledge and skills). The main barriers identified included the impression that Swiss doctors have little knowledge about nurses in advanced roles ((4) GP's lack of knowledge regarding the APN role), and that further regulations will be important to foster role clarity and accountability ((5) political and legal obstacles in introducing the APN role). CONCLUSIONS: The early phase of introducing APNs to Swiss primary care is characterised by heterogeneous, small-scale projects of pioneering GPs and APNs recognising the added value and limits of APNs despite a lack of governance and knowledge regarding the APN role among GPs. Experiences gained from ongoing projects provide elements of good practice for political discussions and regulations.

[Burdens and coping strategies of informal caregivers. The perspective of informal caregivers]. / Belastungserleben und Coping-Strategien pflegender Angehöriger. Perspektive der Angehörigen.

BACKGROUND AND AIM: Taking care of a person at the end of life at home is difficult and challenging. In a qualitative study, the burdens experienced by informal caregivers as well as their coping strategies to face these burdens were investigated. MATERIAL AND METHODS: Narrative interviews with 25 informal caregivers were conducted. Interviews were transcribed verbatim and analyzed using a constant comparative approach. RESULTS: Informal caregivers feel tired and overburdened, alone and abandoned, experience grief and fear, feel helpless and experience a feeling of having lost control over their own life. To cope with these stressful emotions, they actively seek help and support, inform themselves and acquire skills and competencies, talk to others, allow themselves time off and emphasize the positive and meaningful aspects of caring for someone at home. CONCLUSION: The burdens experienced by informal caregivers are highly subjective and depend on the coping strategies and the available resources. A main resource is the help and support provided by the informal social network.

Learning outcomes for health professions: the concept of the swiss competencies framework.

Modern conceptions of education are based on normative goals concerning learning outcomes in terms of competencies to acquire. The objective of the Swiss competencies framework was to define general and profession-specific learning outcomes for Bachelor's and Master's degree programmes in nursing, physiotherapy, occupational therapy (ergotherapy), midwifery, nutrition counselling, and technicians in medical radiology. In addition, national authorities needed an instrument that allowed the integration of the old professional trainings into a nationally-harmonised education system and that showed the specificities of the levels (higher vocational education; bachelor and master degree at university level). While the general learning outcomes were derived from legal bases, the profession-specific learning outcomes are elaborated according to the competency-based CanMEDS framework. In the CanMEDS framework, knowledge, skills, and attitudes are condensed into meta-competencies which in turn are divided into seven roles, including the medical expert (central role). Taxonomic characteristics and indicators were elaborated in an iterative process that involved regulators, the universities of applied sciences and professional organisations. For the degree programmes mentioned above, the framework developed focuses not only on professional expertise, but also on collaboration with other health professions. Moreover, the interface-management in care taking processes is a critical success factor. Based on this conception, three levels of objectives were identified: general competencies, profession-specific learning outcomes and learning objectives to be implemented in the universities of applied sciences. The general competencies are composed of four dimensions and apply to all health professionals. The profession-specific learning outcomes for the Bachelor's and Master's degree programmes are outlined with 3 to 5 indicators each in all seven professions concerned. The definition and identification of these learning outcomes allows locating the different study programmes on the correct level of tertiary education. The resulting competency framework can be applied to all health professions. The general and job-specific learning outcomes are a coherent, coordinated set of standards, which represent the objectives of Bachelor's and Master's degree programmes in a differentiated way and promote inter-professional collaboration.