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.

Objective: To explore the opportunities and challenges of shared care in primary healthcare from the perspectives of physicians, nurses, and key stakeholders, with the aim of reflecting on the implementation of Advanced Nursing Practice. Methods: This is an exploratory study with a qualitative approach carried out with primary care physicians and nurses (working in the states of Paran & aacute; and Rio de Janeiro) and representatives of associative entities of both professional categories (at regional and national levels). Three online focus groups and one in-person focus group were held in 2022, with a total of 29 participants. Content analysis was performed according to Bardin. Results: Professionals report that they already provide shared care, alternating consultations between physicians and nurses in the areas of childcare and prenatal care and chronic conditions and elderly care, thereby enhancing the overall quality of care. They identified that shared care is more harmonious in units with multiprofessional medical or nursing residences. They reflected that restrictions on shared care are promoted by power asymmetries between physicians and nurses, which can be deconstructed over time. They also emphasized the importance of better understanding each professional's role, naming work overload as a particular challenge. Conclusion: The activities currently shared between nurses and physicians in primary healthcare lay the groundwork for the implementation of Advanced Nursing Practice. However, it is essential to deepen the understanding of this practice among these professionals and optimize the conditions for its effective execution.

The need for long-term home care for older people with chronic health conditions is rising, and family members are bearing the brunt of this care work. Caring for a partner is a common scenario. Caregiving partners are often of advanced age themselves and have limiting health conditions of their own. Nurses need to consider the specific characteristics of partner caregiving to provide relationship-centred care. This review aims to analyse perceptions of the triadic relationship between older persons with long-term care needs, their caregiving partners and nurses and to identify approaches that can be supportive approaches that can help couples to cope with at-home care situations. This integrative review following the method outlined by Whittemore and Knafl focuses on qualitative and mixed methods studies. A systematic search in the PubMed and CINAHL databases served to identify studies dealing with experiences and perceptions of triadic care arrangements in home-based care from the perspectives of nurses, care recipients and caregiving partners. Eight studies met the inclusion criteria and investigated perceptions of the triadic relationship between nurses providing home care and older couples. They were analysed using thematic analysis. The results show that triadic relationships in home-based care are shaped by social dynamics, role conflicts and barriers to communication. Although many couples are initially reluctant to integrate nursing professionals into home caregiving, mutual trust can develop when personnel continuity is given and sustained relationship work is performed. Clear communication, clarity on the distribution of tasks and proactive knowledge sharing by nurses facilitate cooperation. Caregiving partners desire support with self-care to preserve their ability to continue in their caregiving roles in the long term. Understanding the dynamics of triadic relationships in nursing care and the care situation in couple relationships enables nurses to provide more targeted support to older couples. Proactive communication, role clarity and continuity of care can reduce the burden shouldered by caregiving partners and improve care quality. Further research focusing on strategies for strengthening relationship-centred interventions in home-based care is desirable. Not applicable.

Resumo Objetivo Compreender as possibilidades e obstáculos ao cuidado compartilhado na atenção primária à saúde sob a perspectiva de médicos, enfermeiros e pessoas chave com vistas a reflexão sobre a implementação da prática avançada de enfermagem. Métodos Estudo exploratório de abordagem qualitativa realizado com médicos e enfermeiros da atenção primária (atuando nos estados do Paraná e Rio de Janeiro) e representantes de entidades associativas de ambas categorias profissionais (em nível regional e nacional). Foram realizados três grupos focais online e um grupo focal presencial, em 2022, com um total de 29 participantes. A análise de conteúdo foi realizada segundo Bardin. Resultados Os profissionais mencionaram já realizar cuidado compartilhado, intercalando consultas entre médicos e enfermeiros nas áreas de puericultura e pré-natal e nas condições crônicas e atenção aos idosos, potencializando o cuidado. Eles identificaram que esse cuidado é mais harmônico em unidades com residências multiprofissionais médica ou de enfermagem. Refletiram que as restrições a essa expansão são condicionadas por assimetrias de poder entre médicos e enfermeiros que poderão ser desconstruídas ao longo do tempo. Eles também destacaram a importância de melhor conhecer as funções de cada profissional referindo a sobrecarga de trabalho como um desafio. Conclusão As atividades atualmente desenvolvidas e compartilhadas entre enfermeiros e médicos na Atenção Primária à Saúde possibilitarão implementar a prática avançada de enfermagem. Porém, é necessário ampliar o entendimento sobre essa prática entre esses profissionais e otimizar as condições para seu exercício efetivo.

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.

The increasing complexity of patients’ health needs has led to the expansion of nursing practices in primary health care (PHC) globally. The corresponding rearrangements of the care process have promoted more horizontal relationships and interprofessional collaboration between nurses and physicians. Our study analyzes the current forms and prospects of nurse‒physician collaboration in the context of expanding nursing practice in PHC in Brazil and Germany. We hosted 9 focus groups (4 in Brazil and 5 in Germany) featuring a total of 23 stakeholders who were involved in PHC policy making and 25 practicing nurses and physicians. Brazil and Germany were subjected to comparative analysis using the thematic coding approach suggested by Flick. Regarding the current forms of nurse‒physician collaboration, focus group participants identified the opportunities and obstacles exhibited by the PHC models employed in their respective countries. In both countries, nurses’ contributions to PHC were associated mainly with the task of meeting complex health needs; however, promoting nurse engagement is challenged by the predominance of physicians’ power in health care policies and practices. With respect to future trends in the expansion of nursing practices in collaboration with physicians, all participants in Brazil supported a complementary approach that focused on increasing the autonomy of nurses in PHC; in Germany, mixed opinions were expressed regarding this issue, with medical stakeholders and some general practitioners (GPs) insisting on a delegation-based approach. Our study contributes to the literature by highlighting the opportunities and obstacles associated with interprofessional collaboration in the context of expanding nursing practice in PHC. The study highlights the willingness of both nurses and physicians to increase their level of collaboration by encouraging broader nursing practices. However, the power imbalance and hierarchical relations hinder the progress of collaboration between PHC nurses and physicians based on the logic of interprofessionality. The contrasting perspectives, which emphasize an autonomous interprofessional relationship and collaboration based on a subordinate relationship in the context of persistent medical hegemony, reflect certain contextual aspects of these health systems and conceptual approaches to care practices.

Zusammenfassung. Hintergrund: Es bedarf einer Stärkung der interprofessionellen Zusammenarbeit von Hausärzt_innen und Pflegefachpersonen in der Primärversorgung von Menschen mit chronischen Krankheiten und Pflegebedarf. Ziel: Mit dieser Studie wurde untersucht, a) wie Hausärzt_innen und Pflegefachpersonen ihre Zusammenarbeit in der Primärversorgung wahrnehmen und b) welche Entwicklungsperspektiven der Zusammenarbeit aus ihrer Sicht existieren. Methoden: Es wurden Expert_inneninterviews mit sieben Hausärzt_innen und acht Pflegefachpersonen der ambulanten Pflege durchgeführt und mittels der inhaltlich strukturierten, qualitativen Inhaltsanalyse ausgewertet. Ergebnisse: Die Befragten beider Berufsgruppen berichten, dass ihre Zusammenarbeit durch eine schlechte gegenseitige Erreichbarkeit behindert ist. Sie betonen zugleich ihre Wertschätzung gegenüber dem fachlichen Austausch mit der anderen Berufsgruppe. Gleichwohl differieren die Wahrnehmungen zur Fachkompetenz der Pflegefachpersonen. Zur Verbesserung ihrer Zusammenarbeit empfehlen die Befragten die Etablierung interprofessioneller Besprechungen und eine Zusammenarbeit in räumlicher Nähe für den regelmäßigen fachlichen Austausch. Sie versprechen sich davon einen gemeinsamen Vertrauens- und Kompetenzaufbau und die Erweiterung des Verantwortungsbereichs von Pflegefachpersonen in der Primärversorgung. Schlussfolgerungen: Verbindliche Kommunikationsstrukturen, die Zusammenarbeit in räumlicher Nähe und Erweiterung des Verantwortungsbereichs von Pflegefachpersonen bieten hohes Potential für die Stärkung der Primärversorgung in Deutschland.

Background Primary mental healthcare (PMHC) allows for complex mental health issues in old age to be addressed. India has sought to improve PMHC through legislation, strategies and programmes. This study analyses the challenges and opportunities involved in strengthening PMHC for older persons in India from the perspectives of key stakeholders. Methods Semistructured interviews were conducted with 14 stakeholders selected from the PMHC system in India and analysed using thematic analysis. First, the analysis was organizationally structured in accordance with the six WHO mental health system domains: (1) policy and legislative framework, (2) mental health services, (3) mental health in primary care, (4) human resources, (5) public information and links to other sectors, and (6) monitoring and research. Second, for each building block, challenges and opportunities were derived using inductive coding. Results This study highlights the numerous challenges that may be encountered when attempting to strengthen age-inclusive PMHC. Among these challenges are poor public governance, a lack of awareness and knowledge among policy-makers and other stakeholders, and existing policies that make unrealistic promises to weak primary healthcare (PHC) structures with an excessive focus on medicalizing mental health problems. Thus, the mental health system often fails to reach vulnerable older people through PHC. Established approaches to comprehensive, family- and community-oriented PHC support attempts to strengthen intersectoral approaches to PMHC that emphasize mental health promotion in old age. Targeting the PHC workforce through age-inclusive mental health education is considered particularly necessary. Experts further argue that adequate monitoring structures and public spending for mental health must be improved. Conclusions In this study, we aim to elaborate on the mental healthcare developments that may serve to achieve equity in access to mental healthcare in India. Coordinated and collaborative efforts by public and private stakeholders involved in the care of older persons, both with and without lived mental health experiences, as well as their families and communities, are necessary to bring the vision of those policies for PMHC to fruition. The findings presented in this study can also inform future research, policies and practice in other low- and middle-income countries.

The aim is to conduct theoretical reflection on the inseparability among public health, planetary health and the nursing process in light of complexity thinking, with the aim of contributing to healthy and sustainable development. Study with a theoretical-reflexive approach that accessed bibliographical sources from contemporary authors who defend the inseparability between public health and planetary health and, at the same time, provide theoretical-systemic support to the nursing process, under an inductive critical bias. The nursing process is conceived as a complex phenomenon, which comprises interdependent dynamics, dialogical approaches, critical-reflective perception and prospective leadership. Theoretical reflection on the nursing process and sustainable development raises an expanded, contextualized and interdependent look at the role of nursing professionals in different health contexts, in order not to compromise well-being and environmental health.

RESUMO Objetiva-se conduzir reflexão teórica sobre a indissociabilidade entre saúde pública, saúde planetária e processo de enfermagem à luz do pensamento da complexidade, no intuito de contribuir para o desenvolvimento saudável e sustentável. Estudo de abordagem teórico-reflexiva que acessou fontes bibliográficas de autores contemporâneos que defendem a indissociabilidade entre saúde pública e saúde planetária e, paralelamente, conferem sustentação teórico-sistêmica ao processo de enfermagem, sob um viés crítico indutivo. Concebe-se o processo de enfermagem como fenômeno complexo, que compreende uma dinâmica interdependente, abordagens dialógicas, percepção crítico-reflexiva e liderança prospectiva. A reflexão teórica acerca do processo de enfermagem e o desenvolvimento sustentável suscita um olhar ampliado, contextualizado e interdependente sobre a atuação do profissional de enfermagem nos diversos contextos da saúde, a fim de não comprometer o bem-estar e a saúde ambiental.

HintergrundInternationale Anwerbung von Pflegefachpersonal gewinnt im Zuge der Fachkräfteentwicklung in Deutschland an Bedeutung. Unterschiede in pflegerischer Qualifikation und Praxis zwischen Herkunfts- und Zielland können das berufliche Selbstkonzept irritieren und die berufliche Integration erschweren.ZielsetzungZiel der Studie war es, die Entwicklung professioneller Handlungsspielräume für die Entfaltung des beruflichen Selbstkonzepts akademisch qualifizierter migrierter Pflegefachpersonen im Gesundheitswesen in Deutschland zu untersuchen.MethodeEs wurden acht Leitfadeninterviews in Anlehnung an das episodische Interview mit philippinischen Pflegefachpersonen via Zoom durchgeführt und thematisch kodierend ausgewertet.ErgebnisseZwei Einflussdimensionen auf professionelle Handlungsspielräume wurden identifiziert: wahrgenommene Systemzwänge im Transitionsprozess und Perspektiven auf die berufliche Entwicklung. Der Anwerbe- und Anerkennungsprozess ist mit hohen finanziellen und zeitlichen Unsicherheiten sowie beruflichen Abwertungserfahrungen verbunden. Der Berufsalltag in Deutschland ist von Kompetenzverlust und Fremdheitserfahrungen geprägt. Für die Wiedererlangung professioneller Handlungsspielräume werden Strategien der Weiterbildung und Fokussierung auf technikintensivere Pflegebereiche verfolgt; nur wenige können sich mit den Gegebenheiten von Pflege in Deutschland arrangieren und ihr berufliches Selbstkonzept adaptieren.DiskussionDie Studienergebnisse verweisen darauf, dass sowohl dem Kompetenzprofil als auch dem beruflichen Selbstkonzept international akademisch qualifizierter Pflegefachpersonen mehr Rechnung zu tragen ist, wenn migrierten Pflegefachpersonen eine für sie vielversprechende berufliche Zukunft in Deutschland eröffnet werden soll. Dies erweist sich insbesondere in der Langzeitpflege als strukturelle Schwierigkeit.SchlussfolgerungZur Gestaltung eines attraktiven Standortes Deutschland für international akademisch qualifizierte Pflegefachpersonen empfehlen sich die Ratifizierung internationaler Standards, eine transparente und unabhängige Informationsvermittlung, die Nutzung bestehender pflegefachlicher Kompetenzen sowie die Etablierung von Aufstiegsmöglichkeiten.

Community participation (CP) and empowerment (CE) have long been viewed internationally as cornerstones of comprehensive primary health care (PHC). Accordingly, policies for new PHC models in Italy, such as the Community Health Centres called “Case della Salute” in 2006 and “Case della Comunità” in 2022, highlight the importance of implementing participatory processes with communities and creating opportunities for CE. This study’s objective is to identify the understandings of CP and CE that emerge among practitioners and stakeholders who design participatory approaches in PHC practice and policy in the Emilia-Romagna region in Italy. Nineteen semistructured interviews were conducted with practitioners working on CP and CE processes in these Community Health Centres and with stakeholders involved in research on or the coordination of such processes in the context of these health centres. The data were analysed using qualitative content analysis in light of the following two questions, which emerged inductively from the data: (1) How to support CP and CE processes in practical doing (how do CP/CE)? (2) With which function or aim to support CP and CE (why do CP/CE)? This study shows that the participating practitioners and stakeholders exhibited various understandings of CP and CE in the context of PHC. Four main themes were identified: CP and CE as (a) a variety of forms of dialogue and cooperation, (b) tools for service development, (c) levers for empowerment, collectivism, and democracy and (d) stimuli for institutional change and a new level of professionalism. Moreover, the participants defined “the community” in different ways and often chose specific subgroups within the community to promote CP and CE processes. This study elucidates different perspectives on CP and CE and highlights the opportunities and obstacles for policymaking, research and practice that result from these understandings.

Nurses play a vital role in providing high-quality primary healthcare and health promotion services. The state of research highlights their often complex operational realities and shows the need for an evidence-based understanding of nurses' perspectives on health promotion practices, especially in low-resource settings. This study focuses on how community health nurses in rural primary healthcare centers in Nigeria perceive their health promotion role and the opportunities and challenges of, and potential entry points for strengthening, their practice. A sample of 10 nurses from eight rural primary healthcare centers in eight local government areas of Anambra state, Nigeria, was purposively selected. Data were collected via semistructured telephone and written interviews and analyzed by qualitative content analysis using a deductive-inductive approach. Nurses emphasized their commitment to supporting patients and communities to develop skills and take control of their own lives. Nurses described their role as facilitators of behavioral and environmental change, individual and community empowerment facilitators as well as social activists. Factors that enhance the health promotion practice of nurses include adequate skills, sufficient human and material resources and community support and participation. Inhibiting factors included insufficient funding, poor working conditions, staff shortages, high workload, lack of training opportunities and low participation of community members. Overcoming challenges and facilitating health promotion activities in rural communities require bolstering nurses by providing further training opportunities for enhancing their health promotion competencies and creating supportive environments. Future research should focus on how to strengthen nurses' health promotion efforts through interprofessional and intersectoral collaboration.

BACKGROUND:The recruitment of internationally educated nurses is gaining relevance in Germany in response to the growing shortage of nurses. Differences in nursing qualifications and practices between the country of origin and of destination can irritate the professional self-concept and hinder professional integration. PURPOSE:The study objective was to examine the development of the professional scope of action to unfold the professional self-concept of academically qualified nurses in Germany. METHODS:In accordance with the episodic interview, eight guided interviews were conducted with Filipino nurses who had migrated to Germany. Data was analyzed by thematic coding. RESULTS:The analysis shows two dimensions that impact the professional scope of action: perceived systemic constraints in the transition process and perspectives on professional development. The recruitment and recognition process is associated with high financial and time-related uncertainties and professional devaluation experiences. Migrant nurses experience both a loss of competence and a sense of foreignness in their nursing role in Germany. In order to regain professional scope of action, strategies of continuing education and focusing on more technology-intensive nursing care areas are pursued; only a minority can adapt their self-concept to the circumstances of nursing practice in Germany. DISCUSSION:The study results demonstrate the importance of paying attention to both the competence profile and the professional self-concept of academically educated nurses in order to offer migrant nurses professional career prospects in Germany. Especially in long-term care, this has proved to be a structural problem. CONCLUSION:To provide an attractive destination for international academically qualified nursing professionals in Germany, the ratification of international standards, the provision of transparent and independent information, utilization of existing nursing expertise as well as the establishment of career opportunities are recommended.

Interprofessional collaboration of general practitioners and nurses in primary care: A qualitative study Abstract. Background: There is a need to strengthen interprofessional collaboration of general practitioners and home care nurses in the primary care of people with chronic diseases and long-term care needs. Aim: This study investigated a) how general practitioners and nurses in Germany perceive their collaboration in primary care and b) which development perspectives of collaboration exist from their point of view. Methods: Expert interviews were conducted with seven general practitioners and eight home care nurses. The data were analysed using thematic-structured qualitative content analysis. Results: The interviewees from both professional groups report that their collaboration is hindered by poor mutual accessibility. At the same time, they emphasise their appreciation of the professional exchange with the other professional group. Nevertheless, the perceptions of the professional competence of home care nurses differ. To improve their cooperation, the interviewees recommend the establishment of interprofessional meetings and cooperation in spatial proximity for regular professional exchange. They expect this to lead to a joint development of trust and competence and to an expansion of the area of responsibility of home care nurses in primary care. Conclusions: Binding communication structures, cooperation in spatial proximity and an expansion of the area of responsibility of home care nurses offer high potential for strengthening primary care in Germany.

This study aims to describe and ana-lyze an interprofessional educational intervention for the qualification of prenatal care in the con-text of primary health care. Method: action -re-search comprising a prenatal care qualification course with 65 primary health care professionals. Collaborative learning activities were conduct-ed in synchronous and asynchronous meetings. Results: the reflexive thematic analysis of par-ticipants' experiences, views and perceptions on the meanings of the intervention revealed three categories: quality of prenatal care: conceptions and meanings; collaborative learning: strategy to overcome linear and isolated care; the need to evolve from acting locally to thinking globally. Conclusion: the analysis of the interprofessional educational intervention for the qualification of prenatal care in the context of primary health care showed that constructivist, participatory and interprofessional approaches are relevant and pertinent to broaden theoretical perceptions and give new meanings to the work process at dif-ferent settings of the health network.

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.

This study aims to describe and analyze an interprofessional educational intervention for the qualification of prenatal care in the context of primary health care.METHOD:action-research comprising a prenatal care qualification course with 65 primary health care professionals. Collaborative learning activities were conducted in synchronous and asynchronous meetings.RESULTS:the reflexive thematic analysis of participants' experiences, views and perceptions on the meanings of the intervention revealed three categories: quality of prenatal care: conceptions and meanings; collaborative learning: strategy to overcome linear and isolated care; the need to evolve from acting locally to thinking globally.CONCLUSION:the analysis of the interprofessional educational intervention for the qualification of prenatal care in the context of primary health care showed that constructivist, participatory and interprofessional approaches are relevant and pertinent to broaden theoretical perceptions and give new meanings to the work process at different settings of the health network.