Franco Cassiano Mendes, Bula Daria, Toso Beatriz Rosana Gonçalves de Oliveira, Giovanella Ligia, Hämel Kerstin
Sergio Arouca National School of Public Health, Oswaldo Cruz Foundation , R. Leopoldo Bulhões, 1480, 21041-210, Rio de Janeiro, Brazil.
Faculty of Medicine, Federal University of Rio de Janeiro, R. Laura de Araújo, 36, Rio de Janeiro, 20211-170, Brazil.
BMC Nurs. 2025 Mar 7;24(1):259. doi: 10.1186/s12912-025-02885-5.
The increasing complexity of patients' health needs has led to the expansion of nursing practices in primary health care (PHC) globally. The corresponding rearrangements of the care process have promoted more horizontal relationships and interprofessional collaboration between nurses and physicians. Our study analyzes the current forms and prospects of nurse‒physician collaboration in the context of expanding nursing practice in PHC in Brazil and Germany.
We hosted 9 focus groups (4 in Brazil and 5 in Germany) featuring a total of 23 stakeholders who were involved in PHC policy making and 25 practicing nurses and physicians. Brazil and Germany were subjected to comparative analysis using the thematic coding approach suggested by Flick.
Regarding the current forms of nurse‒physician collaboration, focus group participants identified the opportunities and obstacles exhibited by the PHC models employed in their respective countries. In both countries, nurses' contributions to PHC were associated mainly with the task of meeting complex health needs; however, promoting nurse engagement is challenged by the predominance of physicians' power in health care policies and practices. With respect to future trends in the expansion of nursing practices in collaboration with physicians, all participants in Brazil supported a complementary approach that focused on increasing the autonomy of nurses in PHC; in Germany, mixed opinions were expressed regarding this issue, with medical stakeholders and some general practitioners (GPs) insisting on a delegation-based approach.
Our study contributes to the literature by highlighting the opportunities and obstacles associated with interprofessional collaboration in the context of expanding nursing practice in PHC. The study highlights the willingness of both nurses and physicians to increase their level of collaboration by encouraging broader nursing practices. However, the power imbalance and hierarchical relations hinder the progress of collaboration between PHC nurses and physicians based on the logic of interprofessionality. The contrasting perspectives, which emphasize an autonomous interprofessional relationship and collaboration based on a subordinate relationship in the context of persistent medical hegemony, reflect certain contextual aspects of these health systems and conceptual approaches to care practices.
患者健康需求日益复杂，促使全球初级卫生保健（PHC）中的护理实践不断扩展。护理流程的相应调整促进了护士与医生之间更横向的关系和跨专业协作。我们的研究分析了巴西和德国在初级卫生保健中护理实践扩展背景下护士与医生协作的当前形式及前景。
我们组织了9个焦点小组（巴西4个，德国5个），共有23名参与初级卫生保健政策制定的利益相关者以及25名执业护士和医生。采用弗利克建议的主题编码方法对巴西和德国进行比较分析。
关于护士与医生协作的当前形式，焦点小组参与者指出了各自国家所采用的初级卫生保健模式所呈现的机遇和障碍。在这两个国家中，护士对初级卫生保健的贡献主要与满足复杂健康需求的任务相关；然而，在卫生保健政策和实践中医生权力占主导地位，这对促进护士参与构成了挑战。关于与医生协作中护理实践扩展的未来趋势，巴西的所有参与者都支持一种侧重于增加初级卫生保健中护士自主性的互补方法；在德国，对此问题存在不同意见，医学利益相关者和一些全科医生坚持基于授权的方法。
我们的研究通过强调在初级卫生保健中护理实践扩展背景下与跨专业协作相关的机遇和障碍，为文献做出了贡献。该研究突出了护士和医生双方通过鼓励更广泛的护理实践来提高协作水平的意愿。然而，权力不平衡和等级关系阻碍了基于跨专业逻辑的初级卫生保健护士与医生之间协作的进展。在持续的医学霸权背景下，强调自主跨专业关系与基于从属关系的协作这两种截然不同的观点，反映了这些卫生系统的某些背景方面以及护理实践的概念方法。
