"Talking on the Phone Is Very Cold"-Primary Health Care Nurses' Approach to Enabling Patient Participation in the Context of Chronic Diseases during the COVID-19 Pandemic

COVID-19; Chronic care; Patient participation; Primary health careCOVID-19; Atenció crònica; Participació del pacient; Atenció primària de salutCOVID-19; Atención crónica; Participación del paciente; Atención primariaStrengthening 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.This research was funded by the Stiftung Wohlfahrtspflege NRW (Public Welfare Foundation NRW) in the frame of funds for cross-sectional analyses regarding the subject of “Gesundheitskompetenz und Selbstmanagementförderung im Lebenslauf—Bedeutung im Kontext nutzerorientierter Versorgungsmodele (förges Q)” (Promotion of health literacy and self-management in the lifecourse—meanings in the context of user-oriented care models) (Ref.: SW-620 6852–6856) within the research network “Nutzerorientierte Versorgung: Förderung der Gesundheitskompetenz und des Selbstmanagements bei chronischer Krankheit und Pflegebedürftigkeit (förges)” (User-oriented care: Promotion of health literacy and self-management for chronic conditions and need of care)

“Talking on the Phone Is Very Cold” - Primary Health Care Nurses’ Approach to Enabling Patient Participation in the Context of Chronic Diseases during the COVID-19 Pandemic

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

Barriers to and enablers of the promotion of patient and family participation in primary healthcare nursing in Brazil, Germany and Spain: A qualitative study

Cuidador familiar; Educació del pacient; Participació del pacientCuidador familiar; Educación del paciente; Participación del pacienteFamily Caregiver; Patient education; Patient participationBackground: 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

"Pflege stationär - Weiterdenken!" Abschlussbericht der Wissenschaftlichen Evaluation des Modellverbunds

Röhnsch G, Hämel K, Vorderwülbecke J, Heumann M. "Pflege stationär - Weiterdenken!" Abschlussbericht der Wissenschaftlichen Evaluation des Modellverbunds. Durchges., leicht überarbeitete Fass. d. Erstberichts 2019. Bielefeld: Universität Bielefeld; 2019

Barriers to and enablers of the promotion of patient and family participation in primary healthcare nursing in Brazil, Germany and Spain: A qualitative study

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

Patient participation in the context of chronic diseases in primary healthcare nursing

Heumann M. Patient participation in the context of chronic diseases in primary healthcare nursing. Bielefeld: Universität Bielefeld; 2024.__Introduction:__ Research has shown that patient participation is associated with improved health outcomes. This is in particular relevant for patients with chronic diseases, as they experience problems with regard to receiving targeted healthcare and face challenges in their social lives. In the context of chronic diseases, strong primary healthcare (PHC) is crucial for supporting patient participation. It is regarded as a means of providing continuous, lowthreshold care. PHC nurses are often responsible for accompanying patients with chronic diseases. Research on how PHC nurses support patient participation in the context of chronic diseases and the factors that facilitate or hinder their attempts to do so remains scarce. __Study objective:__ This dissertation aims to analyse the approaches used by PHC nurses to strengthen patient participation in the context of chronic diseases and to investigate the barriers and enablers that PHC nurses face in their efforts to support patient participation. __Material and Methods:__ This dissertation involves three methodological approaches: (1) an integrative review; (2) a cross-country qualitative study conducted in Brazil, Germany, and Spain based on semi-structured interviews with a total of n = 57 participants who included both key informants (n = 23) and practicing PHC nurses (n = 34); and (3) an in-depth qualitative study in Spain investigating how PHC nurses adapted their approach to support patient participation during the coronavirus disease 2019 (COVID-19) pandemic. The latter comprised qualitative interviews with n = 13 practicing PHC nurses. All interview data were analysed using thematic coding following the approach suggested by Flick. __Results:__ The integrative review resulted in a conceptual framework that highlighted areas in which PHC nurses support patient participation. The cross-country qualitative study revealed two interpretive and practice patterns reflecting PHC nurses’ understanding of patient participation: "giving clients orientation in dealing with chronic diseases" and "supporting the integration of illness in clients’ everyday lives." Four categories were identified that provide information on enablers and barriers for PHC nurses’ ability to promote the participation of patients with chronic diseases: “establishing bonds with patients”; “cooperation with relatives and families”; “communication and cooperation within PHC teams”; and the “PHC working environment." The in-depth qualitative study offered insights into the ways in which PHC nurses adapted their approaches to support patient participation in reaction to challenges that emerged during the COVID-19 pandemic. __Conclusion:__ Strengthening patient participation must be recognised as an area of responsibility for PHC nurses. This goal requires structures that allow these nurses to establish trusting relationships with patients. In addition, research must be conducted to investigate the differences between PHC nurses and patients in terms of their understandings of patient participation and the ways in which it can be supported

“Talking on the Phone Is Very Cold”—Primary Health Care Nurses’ Approach to Enabling Patient Participation in the Context of Chronic Diseases during the COVID-19 Pandemic

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

Kooperative Versorgung in Stadtteil und Quartier. Die Bedeutung von Kooperationen bei der Entwicklung von Quartiers- und Gesundheitszentren für alte, hilfe- und pflegebedürftige Menschen

Heumann M. Kooperative Versorgung in Stadtteil und Quartier. Die Bedeutung von Kooperationen bei der Entwicklung von Quartiers- und Gesundheitszentren für alte, hilfe- und pflegebedürftige Menschen. Universität Bielefeld; Unpublished