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Advanced practice nursing role development in primary health care in Brazil and Germany: comparative perspective
Daria Andrea Bula1, Kerstin Hämel2, Elyne Montenegro Engstrom3
1Bielefeld University. Bielefeld, North Westphalia, Germany.
Objective:
To compare the advanced practice nursing development in primary health care in Brazil and Germany focusing on institutional, historical, and educational factors.
Methods:
We conducted a qualitative comparative study combining the analysis of policy documents, literature and secondary data on health systems.
Results:
In Brazil, long-standing academic nursing education, established responsibilities, and ongoing debates support advanced practice nursing development, although the absence of a regulatory framework remains a barrier. In Germany, its development reflects a vocational-based nursing tradition and a relatively recent shift toward academization, with few advanced practice nursing master's study programs. A physician-centered primary care model and insufficient legal regulations constrain implementation, despite growing political momentum.
Conclusions:
Advanced practice nursing development is country - and context-specific, meaning there is no one-size-fits-all model; rather, implementation should align with institutional structures, educational pathways, and professional role developments. Effective implementation requires context-sensitive strategies across multiple levels of the health system.
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