Table 1 Case vignettes: providing extended clinical practice

Expanding clinical skills

Mrs M. is an 87-year-old residential long-term care resident with chronic heart failure (NYHA IV), restrictive pneumopathy receiving long-term oxygen therapy. She has a low BMI and is developing dementia. After a stay in hospital due to cardiac decompensation, the APN visits her at the residential long-term care facility. Following a need-oriented anamnesis, the APN conducts cardiac and pulmonary checks, including auscultation, as well as an assessment of the patient's legs and neck veins and a survey of vital parameters. She checks her adjusted oxygen and educates Mrs M. regarding the supplementary drinks concerning indication, who takes over the costs, as well as how and when to take them. The evaluation of the patient's most recent hospital admission is as important as the APN’s active responsiveness to social narratives and question as well as information Mrs. M. wants to pass on to her GP. The APN concludes that the current medication and dosage should be maintained. While saying goodbye the APN ensures their next contact point. (APN_4, go-along)

The networked way of thinking (is) what is needed. [..] At the hospital you have delegated work processes. And here is the point where you have to start to network yourself; you have to think a step ahead. When you visit to draw blood. [..] Someone coughs; you go to auscultate. [..] Then you decide, I draw blood. You have to consider, what am I going to have examined in the sample? [..] Sometimes they receive antibiotics. [..] Maybe one should discern the kidney levels. [..] Afterwards I visit the GP and report about the situation, how the lungs sound, the vital signs, the laboratory levels are such. Then he basically just has to say, ok, yes, we have to administer antibiotics; and therefore, he prescribes them. (APN_2, interview)

Providing person-centered symptom control and prevention

An estimated 90-year-old resident with dementia has recurrent urinary tract infection. During these infections, she has visual hallucinations of snakes. Today, while visiting to evaluate the patient's blood coagulation, the APN also uses the meeting to inquire about the snakes to evaluate the presence of an infection. The resident reports that they are currently not there. (APN_4, go-along)