gms | German Medical Science

Background: Increasing numbers of people with chronic diseases and decreasing number of General Practitioners (GPs) in rural areas pose challenges to health care. Academically qualified nurses could be one way to tackle this situation. Collaborative, integrated care models positively impact patient outcomes in different primary care settings [1]. In the “HandinHand” project, expert nurses (EN) take over extended tasks in the care of older people with chronic diseases in cooperation with GPs in a rural area of Germany. As part of a mixed-methods process evaluation, we examined the understanding of EN roles from the perspectives of ENs, GPs, patients and relatives.

Methods: Based on the MRC framework for complex interventions [2], a logic model was developed and applied as the basis for data collection. Eighteen semi-structured interviews were conducted with ENs (n=10), GPs (n=4), patients (n=2), and relatives (n=2) shortly after the start of the intervention and inductively analysed using qualitative content analysis [3].

Results: Analyses revealed three main categories across participant groups:

1.

“skills, competencies, tasks”;

2.

“role attributes”;

3.

“differences to other health professionals”.

In addition, “similarities with other health professions” was identified among ENs, GPs and patients. The category “uncertain/unclear role perception” was only found among ENs.

Conclusions: Even if individual tasks and specific role attributes, attributed to nurses with expanded competencies, can be identified, a clear distinction of the EN role from other health care roles is still missing. Participants’ understanding of the EN role will be further investigated during the course of the project.

Conflict of interest: The authors declare no conflict of interests.