Nurse‒physician interprofessional collaboration in the context of expanding nursing practice in primary health care: A comparative qualitative study of Brazil and Germany.

backgroundThe 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.

methodsWe 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.

resultsRegarding 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.

conclusionsOur 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.