Sante Publique. 2021 Nov 22;Vol. 33(4):547-558. doi: 10.3917/spub.214.0547.
Advanced practice nursing (APN) became legally established in France in 2018. Acquiring competences in the medical domain, an advanced practice nurse (APN) will follow willing patients referred by a physician. An assessment of this innovation's impact in the organization of French health care will be submitted to the French parliament in 2021. This research study was carried out to collect data with the intention of supporting the implementation of this model and constituting the starting point for the model's monitoring over time.
To explore different actors' representations of the advanced practice nursing model pertaining to stabilized chronic diseases' management in primary health care, in the PACA (Provence-Alpes-Côte d'Azur region). Actors involved include patients, general practitioners, nurses and advanced practice nursing students.
In this prospective qualitative study based on grounded theory, 58 semi-structured individual interviews were conducted. Participants showed heterogeneous representations of the APN's role. They expressed vagueness about the model and pointed out the need for better communication to facilitate its integration. The monitoring of care plans, the home health care, the therapeutic education and prevention were identified as needs in which the APN could participate. Under-medicalized areas were suggested as suitable to its implementation. The main fear was the changes of the distribution of professional tasks with the risk of competition with other established positions. The APN's integration was perceived as easier in healthcare establishments as the roles seems well-defined there with less identity confusion between the various actors, unlike in the private ambulatory care sector. Collaboration among health actors was mentioned as a condition for the success of the APN model. A cautious attitude was noted and a need for a run-in period emerged, first APN being considered as precursors.
Mobilization of health actors is a criterion for successful integration of APN, therefore an awareness policy seems necessary. Training of health professionals in their curricula or in continuing education would make it possible to develop collaborative skills necessary for APN's integration.
高级实践护理（APN）于2018年在法国合法确立。获得医学领域的能力后，高级实践护士（APN）将跟踪由医生转诊的自愿患者。对这一创新在法国医疗保健组织中的影响的评估将于2021年提交给法国议会。开展这项研究是为了收集数据，以支持该模式的实施，并为长期监测该模式奠定基础。
探索在普罗旺斯-阿尔卑斯-蓝色海岸大区（PACA）初级卫生保健中，不同行为者对与稳定慢性病管理相关的高级实践护理模式的看法。涉及的行为者包括患者、全科医生、护士和高级实践护理专业学生。
在这项基于扎根理论的前瞻性定性研究中，进行了58次半结构化个人访谈。参与者对APN的角色表现出不同的看法。他们对该模式表示模糊，并指出需要更好的沟通以促进其整合。护理计划的监测、家庭医疗保健、治疗教育和预防被确定为APN可以参与的需求领域。医疗服务不足的领域被认为适合其实施。主要担忧是专业任务分配的变化以及与其他现有职位竞争的风险。与私人门诊护理部门不同，在医疗机构中，APN的整合似乎更容易，因为那里的角色似乎定义明确，各行为者之间的身份混淆较少。健康行为者之间的合作被提及为APN模式成功的条件。注意到一种谨慎的态度，并且出现了对磨合期的需求，首批APN被视为先驱者。
调动健康行为者是APN成功整合的一个标准，因此宣传政策似乎是必要的。在健康专业人员的课程或继续教育中进行培训，将有可能培养APN整合所需的协作技能。
