Background Primary health care nurse practitioners (PHCNPs) can play a key role in chronic disease management. However, little is known about the challenges they face. Purpose The study aimed to describe PHCNPs’ perspectives on their role for patients with chronic health conditions, the barriers they face, and facilitating factors. Methods A qualitative descriptive exploratory study was conducted with 24 PHCNPs in the Canadian province of Quebec. Results PHCNPs believe that they are in an optimal position to address the needs of patients with chronic health conditions, especially in providing self-management support. However, PHCNPs reported feeling pressured to practice according to a biomedical model and to constantly defend their role in chronic disease management. They feel that they are frequently being diverted from their role to compensate for the lack of family doctors. PHCNPs made concrete recommendations to optimize their autonomous practice and quality of care: promoting strong interprofessional communication skills, genuine mentoring relationships between PHCNPs and partner physicians, managers upholding the full scope of PHCNPs’ practice, and a more flexible legislative framework. Conclusions The original conception of PHCNPs as health professionals with unique characteristics is at stake. The factors that should be targeted to support the autonomy of PHCNPs were identified.

IntroductionMost workers with a severe mental illness (SMI) experience brief job retention, usually under 6 months. Managing their clinical symptoms to maintain employment is a constant challenge. However, little is known about the personal initiatives these workers undertake to learn to manage their clinical symptoms at work. The study presented here documented, from an emic perspective, the self‐directed learning of work‐health balance strategies applied in the workplace.MethodsThe study was conducted with five adults with SMI employed in the competitive labour market and six support persons. Between March 2017 and May 2018, a dataset was constructed based on 21 semi‐structured interviews, eight observation sessions, and photographs taken of 15 objects used by the workers to manage their clinical symptoms. The analysis was guided by Mendez's retrospective and current temporal analysis of social processes.ResultsThe workers experienced four different self‐directed learning patterns (preparation, post‐crisis, active self‐directed learning, and identity transformation) and used five types of strategies to facilitate work‐health balance: preparation for work, reassurance, validation, assertiveness, and work–rest transitions.ConclusionThese workers with SMI, all of whom had job retention of 2 years or more in competitive employment, learned and applied work‐health balance strategies. Self‐directed learning was enhanced by customised pharmacological treatment, mindfulness activities, active listening by support persons and psychotherapy specific to the mental illness.

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Le nombre croissant d’étudiantes1 universitaires en situation de handicap en sciences infirmières est un phénomène récent et complexe auquel s’ajoutent de nombreux défis lorsque celles-ci se retrouvent en stage. Une étude multicas a été menée auprès de deux étudiantes et de deux superviseures cliniques pour rendre visible l’expérience de stage d’étudiantes en situation de handicap (SH). Les résultats montrent que le moment du dévoilement, l’authenticité dans l’expression de l’identité, la compréhension mutuelle et le soutien en vue d’une prestation de soins sécuritaires interviennent dans la création et le maintien du climat de confiance lors des stages. Les résultats sont présentés et discutés en prenant appui sur le modèle d’accompagnement de Curran et le modèle de développement humain – processus de production du handicap (MDH-PPH) en vue de proposer des modalités de stage favorisant l’équité pour les étudiantes en SH. Il en résulte que le modèle d’accompagnement de Curran pourrait s’appliquer à d’autres étudiants présentant un trouble d’apprentissage ou un déficit d’attention avec ou sans hyperactivité, et probablement aussi à ceux ayant un trouble de santé mentale.