The value of advanced practice nursing in Danish primary care: a case study of communicative and integrative mechanisms in community-based care

TL;DR

This study explores how Advanced Practice Nurses in Denmark improve communication and coordination in complex healthcare settings.

Contribution

The study provides process-oriented evidence on how APNs create value through communication and competence integration in community-based care.

Findings

APNs act as strategic communicators and coordinators, facilitating dialogue and stabilizing fragmented care trajectories.

APNs integrate fundamental and advanced nursing competencies to address patients' perceived problems effectively.

The study empirically supports the Fundamentals of Care framework and contributes to global visions for integrated healthcare.

Abstract

The growing prevalence of multimorbidity and complex care needs places increasing demands on primary healthcare systems. In Denmark, Advanced Practice Nurses (APNs) have been introduced in municipal community-based healthcare to strengthen continuity, coordination, and patient-centered care. While international evidence demonstrates positive outcomes of APN-led care, limited research has explored how APNs create value in everyday practice.

To explore how APNs contribute to communication, collaboration, and competence integration in complex, cross-sectoral care trajectories in a Danish municipality.

A qualitative case study was conducted in Aalborg, the third-largest city in Denmark (224,537 inhabitants). Data comprised interviews involving 24 participants (patients, relatives, primary care professionals, and general practitioners) and a reflective workshop with six APNs and their leader (n = 7). Data were thematically analyzed and interpreted using the Chronic Care Model as a framework for integrated and people-centered care.

Two interrelated themes emerged. First, APNs acted as strategic communicators and accountable coordinators, facilitating dialogue, stabilizing fragmented trajectories, and enabling collective sensemaking across professional and organizational boundaries. Second, APNs demonstrated competence integration from fundamental to advanced nursing, combining relational engagement, fundamental care, and advanced clinical reasoning within the same encounter. By grounding interventions in patients’ perceived problems, APNs uncovered how fundamental needs often underpin complex trajectories. These findings extend theoretical understandings of care integration and empirically substantiate the Fundamentals of Care framework.

APNs strengthen integrated, people-centered community-based primary care not only through advanced clinical expertise but by managing the communicative and relational infrastructure that sustains collaboration and continuity. This study contributes with process-oriented evidence addressing international knowledge gaps and demonstrates how local practice innovations, such as the APN triage, can operationalize global visions for integrated, equitable, and sustainable primary healthcare.

The online version contains supplementary material available at 10.1186/s12875-026-03207-7.

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