Der Beitrag von Advanced Practice Nurses in Schweizer Hausarztpraxen
Multiple Case Study Design
Abstract
Zusammenfassung.Hintergrund: Die Zunahme chronischer Erkrankungen, Multimorbidität sowie Fachkräftemangel machen eine Anpassung der Primärversorgung unabdingbar. Neue Versorgungsmodelle sind nötig, die sich an den Patientenbedürfnissen orientieren und somit umfassende Betreuung von chronisch Kranken sicherstellen. Dabei besteht in Schweizer Hausarztpraxen Potential hinsichtlich des Einsatzes von Advanced Practice Nurses. Ziel: In dieser Studie untersuchten wir den Beitrag von Advanced Practice Nurses im interprofessionellen Kontext in zwei Hausarztpraxen. Methode: Wir untersuchten anhand eines Multiple Case Studies Designs zwei Advanced Practice Nurses, angesiedelt in Hausarztpraxen in einer ländlichen Gegend und einer Bergregion. Dabei kamen qualitative und quantitative Methoden zur Anwendung. Als Zwischenschritt wurden Within-Case-Analysen durchgeführt und die Daten induktiv zu Fallvignetten zusammengeführt. Ergebnisse: Die Cases zeigten, dass Advanced Practice Nurses einen Beitrag in den Bereichen Förderung des Selbstmanagements, Prävention und Gesundheitsförderung bei komplexen, stabilen und instabilen Patientensituationen leisten, die bis jetzt durch andere Gesundheitsberufe in den Hausarztpraxen nur unzureichend abgedeckt wurden. Sie stärkten durch die hybride Anstellung und eine flexible, adressatengerechte Kommunikation das Schnittstellenmanagement. Schlussfolgerungen: Gemeinsamkeiten und Unterschiede zwischen Hausarztpraxen mit und ohne neue Berufsrollen sollten herausgearbeitet werden, um Lücken in der Versorgung von chronisch kranken Menschen konkret aufzuzeigen.
Abstract.Background: The increase in chronic diseases, multimorbidity and shortage of health professionals make it essential to adapt primary health care. New models of care are needed which are oriented towards patient needs and thus ensure comprehensive care for chronically ill people. In this context, there is great potential for the use of advanced practice nurses in Swiss family practices. Aims: In this study we investigated the contribution of advanced practice nurses in the interprofessional context in two family practices. Methods: We conducted a multiple case study design. We investigated two advanced practice nurses, located in family practices in rural and in mountainous regions. We used qualitative and quantitative methods. As an intermediate step, within-case analyses were performed and we summarized data inductively to create case vignettes. Results: The cases showed that advanced practice nurses contribute to self-management, prevention and health promotion in complex, stable and unstable patients. These areas have not been covered adequately by other health professionals in family practices. They strengthened interface management through hybrid employment and flexible, addressee-appropriate communication. Conclusions: Similarities and differences between family practices with and without new professional roles should be elicited to specifically identify gaps in care for the chronically ill.
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