Table 2 Case vignette: Being an on-site specialist

House calls, residential long-term care visits and consultations at MediZentrum

During rounds at a residential long-term care facility, a GP calls the APN to share the background concerning a patient who urgently needs a home visit that afternoon. The geriatric patient has been experiencing reduced overall health for the last week, has signs of a cold and drinks nearly nothing. The patient was seen last week by the same GP. Having worked with the patient and her family for some time, the APN knows that in this multi-generational household the son and his wife normally take care of the patient.

At the practice the APN and the GP discuss the case.

During the visit the APN speaks to the patient and the daughter-in-law about a possible course of action. Following the GP's instructions, as the patient is unable to swallow pills, the APN brings an antibiotic suspension. While administering a 0.9% intravenous NaCl infusion she documents the added information to the anamneses and the interventions. The APN informs the patient that she might soon need to use the toilet several times, as she has received fluids. Although the toilet is not far away, the patient is weak at the moment and could ring for assistance from her daughter-in-law anytime. With the patient and daughter-in-law, the APN arranges for a timely follow-up visit. (APN_1, go-along)

They [the residential long-term care residents] appreciate it [blood transfusions at the MediZentrum practice] tremendously; and they are more willing to accept such a measure to diminish symptoms and less likely to just want to die quickly because everything is so bad. (APN_4, interview)