Implementation of advanced practice nursing in primary health care in Brazil
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Western of Paraná State University, Paraná, Brazil
Western of Paraná State University, Brazil
Bielefeld Universitat, Germany
Oswaldo Cruz Foundation, Brazil
Publication date: 2023-04-27
Popul. Med. 2023;5(Supplement):A1721
Background/Objective: The demographic and epidemiological transition challenges health care systems worldwide, also in Brazil. Consequently, primary health care (PHC) has to increasingly address complex patient demands. To reach this goal, several countries have encouraged the expansion of the nurses’ roles in PHC, through Advanced Practice Nursing (APN). However, in Brazil – although discussions have already begun – the implementation and research initiatives on the subject are still scarce and in early stages. Since little is known about the obstacles and chances of the implementation of APN in PHC, this study investigates them from the perspective of nurses, physicians, and other stakeholders in Brazil. Methods: We conducted 4 focus groups with healthcare professionals, representatives of health and professional entities, e.g. the federal council of nurses, state health secretariat, physician national federation, health national council, and representatives of physicians’ and nurses’ associations. Data was analyzed by means of thematic coding. Results: The results show how nurses and physicians currently collaborate in primary care. Work overload resulting in nurses’ reluctance to take over more advanced tasks, a deficit in training for interprofessional collaboration, lacking management support and possible non-acceptance of the population for the roles of APN are seen as the main barriers. Nevertheless, the implementation of APN in PHC may improve patients’ access to care, strengthen the nursing profession and enhance organization as well as longitudinality in the regional healthcare networks. Professional nursing organizations were reported to be essential for the development of APN in PHC. Thus, the discussions should be expanded to the professional councils, to create legislation and guidelines to support nurses’ role development. Conclusions: The implementation of APN roles in PHC can be enabled by an ongoing dialogue between politics, professional representatives, and patients. The role of the APN should be clarified to strengthen its perception in the population.