Background To improve health care in rural areas, especially for increasing numbers of people with chronic diseases, academically qualified nurses could take over expanded roles to meet the challenges of an ageing society and a decreasing number of General Practitioners (GPs). In the project “HandinHand” (HiH), qualified nurses (Expert nurses, ENs) will carry out home visits to older people with chronic diseases over a period of six months. ENs will prepare a care plan in cooperation with GPs to stabilise the care situation and avoid unplanned hospital admissions and GP visits. The process evaluation aims to provide an in-depth analysis of the implementation process and gather important information on barriers and facilitators to the implementation of ENs as a complementary health care structure in primary care, taking into account several context factors. Methods Based on the Medical Research Council (MRC) Framework for complex interventions, a logic model was developed and applied as the basis for data collection. Qualitative and quantitative data will be collected during the study. A mixed methods approach should allow to gain important insights from participants (e.g. ENs, GPs, patients) involved in the study as well as relevant stakeholders. Semi-structured interviews and surveys will be conducted. Data analysis will be based on the logical model, combining qualitative and quantitative data. Qualitative data will be analysed inductively-deductively using qualitative thematic framework analysis. Discussion The process evaluation will provide guidance and conclusions on further development and transferability. Of particular interest is the expanded role of ENs in primary care, which has barely been implemented in Germany and can be seen as a precursor to the development of an Advanced Practice Nursing (APN) role in primary care.

Zusammenfassung. Hintergrund: Die Zunahme komplexer Versorgungssituationen aufgrund einer steigenden Anzahl älterer Menschen mit chronischen Erkrankungen bei gleichzeitigem Mangel an pflegerischem und medizinischem Fachpersonal erfordert innovative Versorgungskonzepte. Im Rahmen der Implementierung und Entwicklung neuer, innovativer pflegerischer Rollen gilt ein unklares Rollenverständnis als Barriere. Fragestellung/Ziel: Beschreibung des Rollenverständnisses von Pflegeexpert_innen (PE) in der Primär- und Akutversorgung in Deutschland. Methode: Mittels Fragebögen werden PE zur Rollenklarheit, -kompetenz und -ausübung sowie zur wahrgenommenen Handlungsautonomie und interprofessionellen Zusammenarbeit im Querschnitt befragt. Die Auswertung erfolgt deskriptiv. Ergebnisse: Es haben acht bzw. 14 PE (Primär- bzw. Akutversorgung) an der Befragung teilgenommen. PE üben mehrheitlich oft/sehr oft sowohl die klinische Rolle (77,5% bzw. 85,7%) als auch die von Expert_innen (75% bzw. 78,6%) aus. Die Mehrheit gibt an, ihre Rolle gegenüber Patient_innen (75% bzw. 92,9%) und Ärzt_innen (87,5% bzw. 90,9%) erklären zu können. Ein hohes Maß an Handlungsautonomie wird eher von PE aus der Akutversorgung wahrgenommen. Schlussfolgerungen: Trotz Gemeinsamkeiten hinsichtlich des Rollenverständnisses können PE der Akutversorgung offenbar von bereits etablierten Strukturen profitieren, was sich u.a. in der wahrgenommenen Handlungsautonomie widerspiegelt.

IntroductionOlder age is associated with multimorbidity, chronic diseases and acute deteriorations and leads to complex care needs. Nursing home residents are more often unnecessarily transferred to emergency departments or hospitals than community dwellers—largely due to a lack of qualified staff and diffusion of responsibility in the institutions. In Germany, only few academically trained nurses work in nursing homes, and their potential roles are unclear. Therefore, we aim to explore feasibility and potential effects of a newly defined role profile for nurses with bachelors’ degree or equivalent qualification in nursing homes.Methods and analysisA pilot study (Expand-Care) with a cluster-randomised controlled design will be conducted in 11 nursing homes (cluster) in Germany, with an allocation ratio of 5:6 to the intervention or control group, aiming to include 15 residents per cluster (165 participants in total). Nurses in the intervention group will receive training to perform role-related tasks such as case reviews and complex geriatric assessments. We will collect data at three time points (t0 baseline, t1 3 months and t2 6 months after randomisation). We will measure on residents’ level: hospital admissions, further health services use and quality of life; clinical outcomes (eg, symptom burden), physical functioning and delivery of care; mortality, adverse clinical incidents and changes in care level. On nurses’ level, we will measure perception of the new role profile, competencies and implementation of role-related tasks as part of the process evaluation (mixed methods). An economic evaluation will explore resource use on residents’ (healthcare utilisation) and on nurses’ level (costs and time expenditure).Ethics and disseminationThe ethics committees of the University of Lübeck (Nr. 22-162) and the University Clinic Hamburg-Eppendorf (Nr. 2022-200452-BO-bet) approved the Expand-Care study. Informed consent is a prerequisite for participation. Study results will be published in open-access, peer-reviewed journals and reported at conferences and in local healthcare providers’ networks.Trial registration numberDRKS00028708.