‘Thinking outside the box’: advanced geriatric nursing in primary health care in Scandinavia

Abstract

Background Older people are frequent users of primary health care (PHC) services. PHC services have been critiqued, mainly regarding limited accessibility and continuity of care. In many countries, investment in nurse practitioners (NPs) has been one strategy to improve PHC services. In the North of Europe, the NP role is still in its infancy. The aim of this study was to explore the feasibility of introducing geriatric nurse practitioners (GNPs) in PHC in Scandinavia, from multiprofessional and older persons’ perspectives. Methods The study had a qualitative design, including 25 semi-structured interviews with nurses, nurse leaders, physicians, politicians and older persons from several communities in Scandinavia. The material was analysed by means of qualitative content analysis. Results The results highlight current challenges in health services for the older population, i.e. comorbid older patients with complex care needs aging in place, lack of competent staff, and organisational challenges. The results present an envisioned GNP scope of practice in health services for the older population, including bringing advanced competence closer to the patient, an autonomous role including task-shifting, and a linking role. The results also present factors influencing implementation of the GNP role, i.e. GNP competence level, unclear role and scope of practice, and openness to reorganisation. Conclusions The results indicate that it is feasible to implement the GNP role in primary health care in Scandinavia. Notwithstanding, there are factors influencing implementation of the GNP role that should be considered. Electronic supplementary material The online version of this article (10.1186/s12912-019-0350-2) contains supplementary material, which is available to authorized users.

Complexity as a factor for task allocation among general practitioners and nurse practitioners: a narrative review

“…Boman et al [28], NO/FI "The GNPs were also envisioned to take on a linking role between patient and health services, taking on a case management role especially for patients with comorbidity and complex care needs. "…”

“…As can be seen in Table 3 [24,57], five from the Netherlands [26,27,49,54,56], one from Norway and Finland [28], five from Canada [29,30,36,41,59] and one from the UK [60]. Eight studies are qualitative in design [23][24][25][26][27][28][29][30] and twenty-one are quantitative [31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][47][48][49][50][51][52].…”

“…Patient populations are either specific or unspecific. Twelve studies included specific patient populations, two of which were older adults [27,28], seven diabetics [31,33,39,40,43,51,52], two chronically ill [47,48], and one home-bound [45], whereas twenty-five studies included unspecific patient populations consisting of general primary care patients.…”

“…In geriatric care NPs have been reported to be competent in performing assessments in adults requiring complex care, despite this however, the reality of introducing NPs into general practice may be that GPs focus on more complex geriatric care [27]. Alternatively, they may take on autonomous roles within their scope of practice managing complex geriatric care cases [28]. In diabetes care, complexity can be used to distinguish between medically complex patients, those with Compared to physicians, NPs as usual providers treat more socially complex patients and similar clinical complexity.…”

“…In teams consisting of more than two types of health professionals, including other nurses, NPs are among the highest qualified, thus substituting GPs as lead clinicians providing complex care [25,27,28,51] or managing complex patients within a shared care model [45]. In teams consisting of more than two health professionals and NPs are the only type of nurse or perform similar tasks to a nurse, they may treat less complex patients [26,30,56,58] and improve overall access for them [59].…”