In light of labour shortages, complex care needs and tough working conditions, creating health-promoting working environments in nursing homes is a challenge. Participation is a core principle of health promotion, and is highly relevant for workplace health management. In this study we focused on how management can promote workplace health with and for their employees through participation and what opportunities and challenges are associated with such approaches. For this qualitative cross-country study we conducted semi-structured interviews (n = 16) and focus groups (n = 11) with a total of 43 managers and staff working in different areas in nursing homes in Austria, the Netherlands and Sweden. The interviews were analysing using thematic coding. Analysis of the participants statements identified three central elements pertinent to promotion of employee participation and health in the investigated nursing homes. (1) A philosophy and core values of health- and participation-oriented cooperation between managers and staff. This is salient in (2) the orientation on employees’ personal and professional concerns, resources and problems – in particular by promoting skills and trustworthy handling of employees’ work situations, personal issues and sickness – and (3) in the orientation on discussions, empowerment and decision-making in teams mediated through promotion of cooperation and assumption of responsibility within and between teams and support for teams, including in challenging psycho-social situations. Health- and participation-oriented leadership in nursing homes is an ongoing process that demands strong reflective abilities and organisational skills of those involved.

Aim To explore the enablers of and barriers to implementing advanced practice nursing in primary health care in Germany and Brazil.Design A qualitative cross-country comparative study.Methods Nine focus groups were conducted: 4 in Brazil and 5 in Germany with 48 participants (23 primary health care policy stakeholders and 25 nurses practicing in primary health care and general practitioners) between May 2022 and June 2023. The data were analysed by content analysis using a deductive-inductive approach.Results Our findings reveal a need for clarity around the concept, specific roles and responsibilities of advanced practice nurses in primary health care. Although there is still no regulation in place for practising advanced practice nursing in either country, clear drivers can be observed, with Germany strengthening community health nursing and Brazil following clinical protocols in nursing practice. Dialogue among stakeholders-at both the policy and practitioner levels-is essential to bridge communication gaps. Additionally, involving patients in the implementation process is crucial for the holistic integration of advanced nursing roles.Conclusions Political, organisational and financial barriers persist, such as the need to establish both legal foundations and regulatory frameworks, enhance political participation within the nursing profession, and involve stakeholders in dialogue and consensus-building efforts. Giving advanced practice nursing a higher priority on political and research agendas-with policy adjustments and input from practitioners-can help integrate advanced practice nursing into primary health care.Implications for the Profession and/or Patient Care Our findings highlight that actively involving nursing as an equal partner in political discourse is seen by stakeholders as crucial to drive the implementation process forward sustainably.Impact This study addresses the lack of data on the enablers and barriers to implementing advanced practice nursing in primary health care in Germany and Brazil. It underscores the need for clearer definitions of advanced practice nursing in primary health care, as well as sufficient regulation and funding. Dialogue is essential to bridge gaps and foster mutual understanding. The findings support future practice development and research, especially in countries that have introduced advanced nursing practice roles in primary health care.Reporting Method The COnsolidated criteria for REporting Qualitative research (COREQ).Patient or Public Contribution No involvement of patient and public contribution.What Does This Paper Contribute to the Wider Global Clinical Community? Our study highlights the growing adoption of expanded nursing responsibilities even in countries that have not yet formally implemented advanced practice nursing roles.

Population Medicine considers the following types of articles:• Research Papers -reports of data from original research or secondary dataset analyses.• Review Papers -comprehensive, authoritative, reviews within the journal's scope.These include both systematic reviews and narrative reviews.• Short Reports -brief reports of data from original research.• Policy Case Studies -brief articles on policy development at a regional or national level.• Study Protocols -articles describing a research protocol of a study.• Methodology Papers -papers that present different methodological approaches that can be used to investigate problems in a relevant scientific field and to encourage innovation.• Methodology Papers -papers that present different methodological approaches that can be used to investigate problems in a relevant scientific field and to encourage innovation.

Population Medicine considers the following types of articles:• Research Papers -reports of data from original research or secondary dataset analyses.• Review Papers -comprehensive, authoritative, reviews within the journal's scope.These include both systematic reviews and narrative reviews.• Short Reports -brief reports of data from original research.• Policy Case Studies -brief articles on policy development at a regional or national level.• Study Protocols -articles describing a research protocol of a study.• Methodology Papers -papers that present different methodological approaches that can be used to investigate problems in a relevant scientific field and to encourage innovation.• Methodology Papers -papers that present different methodological approaches that can be used to investigate problems in a relevant scientific field and to encourage innovation.

Abstract Background Most health systems are insufficiently prepared to promote the participation of chronically ill patients in their care. Strong primary health care (PHC) strengthens patients' resources and thus promotes their participation. The tasks of providing continuous care to people with chronic diseases and promoting self‐management are the responsibility of PHC nurses. Recent research assessing enablers of or barriers to nurses' efforts to support patients' participation has mostly not considered the special situation of patients with chronic diseases or focused on the PHC setting. Objective To investigate enablers of and barriers to PHC nurses' efforts to promote the participation of chronically ill patients in their care. Methods We interviewed 34 practicing PHC nurses and 23 key informants with advanced knowledge of PHC nursing practice in Brazil, Germany and Spain. The data was analyzed using thematic coding. Results We identified four categories of barriers and enablers. (1) Establishing bonds with patients: Interviewees emphasized that understanding patients' views and behaviours is important for PHC nurses. (2) Cooperation with relatives and families: Good relationships with families are fundamental, however conflicts within families could challenge PHC nurses efforts to strengthen participation. (3) Communication and cooperation within PHC teams: PHC nurses see Cooperative team structures as a potential enabler, while the dominance of a ‘biomedical’ approach to patient care is seen as a barrier. (4) Work environment: Interviewees agreed that increased workload is a barrier to patient participation. Discussion and Conclusions Supporting patient participation should be acknowledged as an important responsibility for nurses by general practitioners and PHC planners. PHC nurses should be trained in communicative competence when discussing participation with chronically ill patients. Interprofessional education could strengthen other professionals' understanding of patient participation as a nursing task. Patient or Public Contribution This study is part of a research project associated with the research network ‘forges: User‐oriented care: Promotion of health in the context of chronic diseases and care dependency’. The study's focus and provisional results were discussed continuously with partners in health and social care practice and presented to and discussed with the public at two conferences in which patient representatives, professionals and researchers participated.

Information needs of family caregivers regarding new technologies for dementia care at home: A qualitative study Abstract. Background: New technologies can support family caregivers in the home care of people with dementia but are unknown to many. To reduce the information deficit, the information needed by caregivers must be determined. Aim: The aim of this study is to investigate the information needs of family caregivers regarding new technologies for dementia care at home, taking into account experiences in past research and future information needs. Methods: Episodic interviews were conducted with eight family caregivers of people with dementia and analyzed according to thematic coding. Results: Caregivers used both media-based and interpersonal channels for technology-related research and made heterogeneous experiences. The researched information content and causes of research varied across respondents. The amount of available online information was a barrier in some cases. With regard to future information needs, the diversity of information channels and the quality of information are of high importance. Conclusions: The individual situation-specific needs of family caregivers must be taken into account in the development of new information and counseling services so that information deficits can be eliminated, and the potential of new technologies can be exploited in the home care of people with dementia. Further research is needed on the information needs of people with dementia.

Strengthening patient participation is considered a crucial element of primary health care (PHC) nurses’ practice when working with chronically ill patients. The COVID-19 pandemic had extraordinary effects on PHC nursing routines and how chronically ill patients’ could be involved in their own care. This study investigates the adaptation of Spanish PHC nurses’ approaches to supporting the participation of patients living with chronic illness during the COVID-19 pandemic. To reach this goal, we interviewed 13 PHC nurses who practiced in PHC centers in Spain. The interviews were analyzed using thematic coding. Three themes emerged from the descriptions of the nurses: (1) High COVID-19-related workload, decreasing health promotion, and chronic care, (2) Emphasis on patients’ and families’ self-responsibility, (3) Expanded digital and telephone communication with fewer in-person consultations. Nurses felt especially challenged to uphold the support for vulnerable groups, such as older people or patients without family support. Future research should focus on how the participation of the most vulnerable chronic patients can be supported in the context of the growing relevance of remote care.

Editorial em inglês, do volume 8, número 1, da Revista Varia Scientia-Ciências da Saúde.

Editorial em Português, do Volume 8, número 1 da Revista Varia Scientia-Ciências da Saúde

Abstract Background Many chronically ill persons are challenged by integrating the illness in everyday life and making ‘competent’ decisions on their life and care. In multiprofessional primary care, promoting clients’ self-management and strengthening their abilities to participate in everyday life is increasingly recognized as a nursing task. This study investigates facilitating and inhibiting conditions that nurses experience when exercising this task. Methods Drawing upon a phenomenological approach, we conducted guided interviews with 34 practicing nurses and 23 key informants with advanced knowledge of primary health care nursing practice in Brazil, Germany, and Spain. The interviews were analysed using structuring content analysis. Results The interviewees see competencies of nurses to establish trusting relationships with chronically ill clients as key to greater client participation. Nurses, however, state that bonding with clients can be time-consuming and exhausting. They consider it fundamental that physicians and other professionals value nurses’ efforts towards stronger client participation as a way forward to reach for person-oriented primary care. They criticize that especially physicians value biomedical tasks more than enabling participation. Referring to primary health care organisation, nurses experience that pressure of time through a growing number of routine and administrative tasks inhibits their efforts to strengthen clients’ participation. Conclusions To promote the participation of clients with chronic illnesses in their everyday life and in care, relationship building with clients and self-management support needs to be acknowledged as an important scope of practice approached by nurses. To be able to unfold the potentials nurses need to be equipped with sufficient time and skills.

BACKGROUND:In the context of the advancement of person-centered care models, the promotion of the participation of patients with chronic illness and complex care needs in the management of their care (self-management) is increasingly seen as a responsibility of primary care nurses. It is emphasized that nurses should consider the psychosocial dimensions of chronic illness and the client's lifeworld. Little is known about how nurses shape this task in practice.METHODS:The aim of this analysis is to examine how primary care nurses understand and shape the participation of patients with chronic illness and complex care needs regarding the promotion of self-management. Guided interviews were conducted with nurses practicing in primary care and key informants in Germany, Spain, and Brazil with a subsequent cross-case evaluation. Interpretive and practice patterns were identified based on Grounded Theory.RESULTS:Two interpretive and practice patterns were identified: (1) Giving clients orientation in dealing with chronic diseases and (2) supporting the integration of illness in clients' everyday lives. Nurses in the first pattern consider it their most important task to provide guidance toward health-promoting behavior and disease-related decision-making by giving patients comprehensive information. Interview partners emphasize client autonomy, but rarely consider the limitations chronic disease imposes on patients' everyday lives. Alternatively, nurses in the second pattern regard clients as cooperation partners. They seek to familiarize themselves with their clients' social environments and habits to give recommendations for dealing with the disease that are as close to the client's lifeworld as possible. Nurses' recommendations seek to enable patients and their families to lead a largely 'normal life' despite chronic illness. While interview partners in Brazil or Spain point predominantly to clients' socio-economic disadvantages as a challenge to promoting client participation in primary health care, interview partners in Germany maintain that clients' high disease burden represents the chief barrier to self-management.CONCLUSIONS:Nurses in practice should be sensitive to client's lifeworlds, as well as to challenges that arise as they attempt to strengthen clients' participation in care and self-management. Regular communication between clients, nurses, and further professionals should constitute a fundamental feature of person-centered primary care models.

Background Opening nursing homes for and in the community not only promotes the inclusion of the residents. Likewise, older people living close to the homes could benefit if the nursing homes offer support for them as well. This article focuses on the extent to which "nursing homes" succeed in contributing to the continuity of care for older people in the community by developing into "centers". Methods Episodic interviews with users/relatives and expert interviews were conducted as part of the evaluation of the project "Long-term care institutions - further thinking!". A secondary analysis of interviews was conducted by means of structuring content analysis; the views of users and experts were triangulated on a metalevel. Results Users and relatives refer to three types of continuity of care in the facilities-management, relational and informational. In this respect, sustainable relationships with professionals in the facilities are just as important to them as "custom fitted" care offers even in the case of intensified need for support. Some family caregivers desire a more reliable flow of information between them and the professionals. It is also important for the experts interviewed that the facilities cover the entire spectrum of continuity of care; however, they underestimate the need of relatives in particular to be involved in care as informal carers. Conclusion Nursing homes can contribute to strengthening continuity of care in the community by expanding their range of services. They should take the diversity of different user groups into account.

Zusammenfassung. Hintergrund: Neue Technologien können Angehörige bei der häuslichen Versorgung von Personen mit Demenz unterstützen, sind jedoch vielen unbekannt. Um das Informationsdefizit abzubauen, müssen die von den Angehörigen benötigten Informationen erfasst werden. Ziel: Die Studie verfolgt das Ziel, die Informationsbedürfnisse Angehöriger zu neuen Technologien der häuslichen Versorgung bei Demenz zu untersuchen, wobei Erfahrungen bei vergangenen Recherchen und künftige Informationsbedürfnisse berücksichtigt werden. Methode: Es wurden episodische Interviews mit acht pflegenden Angehörigen von Personen mit Demenz geführt und anlehnend an das thematische Kodieren ausgewertet. Ergebnisse: Angehörige nutzten für technikbezogene Recherchen medienbasierte sowie interpersonale Informationsquellen und machten dabei heterogene Erfahrungen. Die recherchierten Informationsinhalte und Auslöser der Recherchen variierten zwischen den Befragten. Die Menge verfügbarer Online-Informationen stellte z. T. ein Hindernis dar. Mit Blick auf künftige Informationsbedürfnisse kommt der Diversität von Informationskanälen und der Informationsqualität eine hohe Bedeutung zu. Schlussfolgerungen: Die individuellen situationsspezifischen Bedürfnisse der Angehörigen müssen bei der Entwicklung neuer Informations- und Beratungsangebote berücksichtigt werden, damit Informationsdefizite abgeschafft und die Potenziale neuer Technologien bei der Versorgung von Personen mit Demenz ausgeschöpft werden können. Es bedarf weiterer Forschung zu den Informationsbedürfnissen von Personen mit Demenz.

BACKGROUND Primary healthcare nurses' potential to enable patient and community participation has been increasingly acknowledged. A conceptual understanding of their contributions within a broad range of participation processes is still lacking. AIMS The aims of this study were to develop a conceptual framework that provides information on the role of primary healthcare nurses in shaping participation processes with patients and communities in the context of chronic diseases and to identify conditions that enable or hinder the promotion of patient and community participation by nurses. DESIGN An integrative review was conducted. DATA SOURCES Twenty-three articles published from 2000 to 2019 were included in the analysis: 19 retrieved from PubMed and CHINAL and 4 added through other sources. REVIEW METHODS An inductive data analysis and quality appraisal of studies were conducted. RESULTS The analysis reveals four areas where nurses are involved in facilitating patient and community participation: (1) sharing understanding of health problems and needs, (2) developing resources and facilitating patient education for self-management, (3) raising patients' voices as an advocate in service development and (4) supporting individual and community networks. The conditions affecting nurses' engagement in fostering participation processes are as follows: (1) care priorities and overall workload, (2) nurses' attitudes towards participation and (3) users' acceptance of nurses as partners. CONCLUSIONS Future research can use the framework as a basis for empirical studies investigating nurses' involvement in pursuing patient and community participation. Interventions should focus less on indirect forms of participation, like patient education or advocacy, but should also focus on active forms of participation. Research is needed on nurses' involvement in community participation processes. IMPACT This framework can be used and adapted in future research on patient and community participation in primary healthcare. It describes areas of participation and the facilitators and barriers within the broad range of activities of primary healthcare nurses.

Eine Öffnung von Pflegeheimen für und in den Sozialraum fördert nicht nur die Inklusion ihrer Bewohner*innen. Ebenso könnten ältere Menschen im Quartier profitieren, wenn Pflegeeinrichtungen auch für sie Unterstützung vorhalten. Inwiefern es „Pflegeheimen“ durch Weiterentwicklung zu „Zentren“ gelingt, speziell zu Versorgungskontinuität älterer Menschen im Quartier beizutragen, steht im Fokus des Beitrags. Es wurden episodische Interviews mit Nutzer*innen/Angehörigen und Experteninterviews im Rahmen der Evaluation des Modellprojekts „Pflege stationär – Weiterdenken!“ durchgeführt. Die Interviews wurden sekundäranalytisch mittels strukturierender Inhaltsanalyse ausgewertet; Sichtweisen von Nutzer*innen und Expert*innen wurden auf Metaebene trianguliert. Mit Blick auf die Versorgung in den Einrichtungen beziehen sich Nutzer*innen und Angehörige auf Dimensionen von Versorgungskontinuität im Management, in der Beziehung und in der Information. Ihnen sind insofern tragfähige Beziehungen zu Fachkräften in den Einrichtungen ebenso wichtig wie „passgenaue“ Versorgungsangebote auch bei intensiviertem Unterstützungsbedarf. Einige pflegende Angehörige wünschen einen verlässlicheren Informationsfluss zwischen ihnen und den Fachkräften. Auch den befragten Expert*innen ist wichtig, dass die Einrichtungen das gesamte Spektrum von Versorgungskontinuität abdecken. Sie unterschätzen jedoch das Bedürfnis speziell von Angehörigen, als informell Pflegende in die Versorgung einbezogen zu werden. Pflegeheime können durch Erweiterung ihres Angebotsspektrums zur Stärkung von Versorgungskontinuität im Quartier beitragen. Sie sollten die Diversität unterschiedlicher Nutzergruppen berücksichtigen.