The Implementation of Advanced Practice Nursing in Primary Health Care: A Comparative Qualitative Study of Enablers and Barriers

Daria Bula; Cassiano Mendes Franco; Ligia Giovanella; Beatriz Rosana Gonçalves de Oliveira Toso; Marcus Heumann; Kerstin Hämel

doi:10.1111/jan.70172

The Implementation of Advanced Practice Nursing in Primary Health Care: A Comparative Qualitative Study of Enablers and Barriers

Daria Bula
, Cassiano Mendes Franco
, Ligia Giovanella
, Beatriz Rosana Gonçalves de Oliveira Toso
, Marcus Heumann
, Kerstin Hämel (Korresp. Autor*in)

Institut für Pflegewissenschaft

Veröffentlichungen: Beitrag in Fachzeitschrift › Artikel › Peer Reviewed

Abstract

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.

Originalsprache	Englisch
Seiten (von - bis)	5229 - 5243
Seitenumfang	15
Fachzeitschrift	Journal of Advanced Nursing
Jahrgang	82
Ausgabenummer	5
DOIs	https://doi.org/10.1111/jan.70172
Publikationsstatus	Veröffentlicht - Mai 2026

Fördermittel

This study was possible due to the joint project of the authors, ‘Strengthening Advanced Practice Nursing and Collaboration in Primary Health Care’. At Bielefeld University, this joint project is funded by the Federal Ministry of Education and Research (BMBF), Germany, within the framework of the Program for Project‐Related Personal Exchange (PPP) of the German Academic Exchange Service (DAAD) (Grants 57705653 and 57598578), at Western Paraná State University and the National School of Public Health (ENSP/Fiocruz), the project is financed by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES Foundation)—Finance Code 001 (Grant 23038.002326/2021‐82). The funders did not participate in the conceptualization, the design and data collection processes, the analysis and interpretation of the data, or the preparation of and decision to publish the manuscript. Responsibility for the content of this publication lies with the authors. Funding:

UN SDGs

Dieser Output leistet einen Beitrag zu folgendem(n) Ziel(en) für nachhaltige Entwicklung

SDG 3 – Gesundheit und Wohlergehen
SDG 8 – Menschenwürdige Arbeit und Wirtschaftswachstum

ÖFOS 2012

303024 Pflegewissenschaft

Zugriff auf Dokument

10.1111/jan.70172Lizenz: CC BY 4.0

https://phaidra.univie.ac.at/o:2359514Lizenz: CC BY 4.0

Andere Dateien und Links

Verknüpfung zur Publikation in Scopus

Zitationsweisen

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title = "The Implementation of Advanced Practice Nursing in Primary Health Care: A Comparative Qualitative Study of Enablers and Barriers",

abstract = "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{\textendash}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{\textemdash}at both the policy and practitioner levels{\textemdash}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{\textemdash}with policy adjustments and input from practitioners{\textemdash}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.",

author = "Daria Bula and Franco, \{Cassiano Mendes\} and Ligia Giovanella and Toso, \{Beatriz Rosana Gon{\c c}alves de Oliveira\} and Marcus Heumann and Kerstin H{\"a}mel",

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AU - Toso, Beatriz Rosana Gonçalves de Oliveira

AU - Heumann, Marcus

AU - Hämel, Kerstin

PY - 2026/5

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The Implementation of Advanced Practice Nursing in Primary Health Care: A Comparative Qualitative Study of Enablers and Barriers

Abstract

Fördermittel

UN SDGs

ÖFOS 2012

Zugriff auf Dokument

Andere Dateien und Links

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