| Themes | Subtheme | Quotations |
| Barriers to Effective Interprofessional Practice | Lack of knowledge and role recognition | “There is still a bit of fear or difficulty in defining the boundaries, therefore in defining the role, that is, where the doctor intervenes, where and how the nurse intervenes, and there is still a sort of ambivalence.” FG1_sg3 “Perhaps even a sort of hierarchy is still present in the minds of some, and this becomes a huge limitation.” FG2_sg3 |
| Communication and relational difficulties | “We lack a shared platform for entering information, which creates a problem.” FG1_sg2 “There are nurses that I don’t even know, that is, I talk to them on the phone and via… via WhatsApp, etc., but I don’t know who they are, I’ve never met them.” FG1_sg3 “… instead we use very rudimentary tools that…that we can’t perfect and can’t lead, to improve to say now that as a company we use the regional folder, after a year that we’ve been working together, someone could have said… but let’s develop a link for them, right? That’s frustrating, but it’s fundamental because it actually gives you an extra edge, also on many other projects that don’t only concern misfortunes, because the complex cases are our misfortunes, but the patients who are fortunate are the majority” FG4_sg1 |
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| Insufficient time for relationship development | “It’s a lot of work because they have so many things to do, so it’s hard to find the time to talk […] with them.” FG3_sg6 “The biggest obstacle I experience […] is the lack of nursing staff, because today we feel it a lot, in structuring a job with us that goes beyond assistance…” FG1_sg4 “Four words: skills, communication, learning to work in team working because you can’t improvise.” FG2_sg3 |
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| Structural and Organizational Misalignment | “They want to collaborate with us, but they must meet company commitments that do not always align with our expectations.” FG4_sg2 “If we had had an individual relationship, the transition would probably have been quicker”. FG1_sg4 “We come up against the fact that they too struggle to make themselves completely available and completely autonomous because they answer to the company” FG4_sg2 |
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| Facilitators of productive interprofessional collaboration | Willingness to collaborate and generational openness | “There are some young doctors… it is not a valid example… who are… more open to dialogue and therefore also…. They looked favorably on us when we arrived because at least they were no longer alone in managing certain things, and they knew that if they called us, we would be there for the patients…” FG3_sg6 “If every now and then we do things that they should do, I mean no…no…nothing happens, you know, if we meet them halfway, in this sense here, that is, if sometimes it happens that the family nurse can ask us or we see that he is in difficulty if we can do something, we do it in short, nothing happens.” FG1_sg2 “… a job… That is never perfect […] but it is the best possible” FG1_sg1 “Make a big effort to remove hierarchies and to truly put everyone on the same level” FG1_sg4 “If now and then we do things that they should do, I mean nothing happens, you know, if we meet them halfway” FG1_sg2 |
| Recognition of roles and expertise | “What do I expect from the relationship with the GP? Recognition. Recognition of our effort, our professionalism, and the great change we are making, because for us it is an epochal change, there is a mental, but also a physical change.” FG2_sg1 “For me, the doctor must be a resource as I must be a resource for the doctor, there is no question of hierarchy.” FG2_sg5 |
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| Shared goals | “I believe I can say that when the collaboration with the doctor meets certain criteria for goodness, it is when the patient becomes central for both. When the patient is central and we both share our positions, the relationship works, the objectives are aligned, and even if there are difficulties, it can be done.” FG2_sg3 “Always keeping the objective in mind, even overcoming some rigidities […] is an indispensable attitude […] it is not easy, but I believe that it has often been the key to success.” FG1_sg2 “… knowing that you are looking for the same thing” FG1_sg3 “The location is fundamental, if they worked here, dialogue and collaboration would inevitably be created, good relationships would be established.” FG2_sg4 “…living in the same house has greatly facilitated teamwork with nurses” FG1_sg4 “We share the same physical location as the family and community nurse, who lives right next door, so I wrote words of sharing, support, and team.” FG1_sg4 “Having had the opportunity to get to know each other and have coffee together, in my opinion, in the initial phase was fundamental.” FG4_sg1 |
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| Shared space and time | “Having the opportunity to get to know each other, to have coffee together, in my opinion, was fundamental during the initial phase” (FG4_sg1). “Living in the same facility greatly facilitated team work with the nurses” (FG1_sg4) |
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| Communication and interpersonal skills | “Good communication skills…and…therefore…how we communicate with each other is very important…” FG3_sg1 “Patience in terms of […] listening. I take a step back, I make this reflection, thinking above all about the most difficult situations to manage. So having […] the patience to listen to understand the difficulties the person on the other end is experiencing”. FG2_sg3 “Trying to bring out who does what and how we do it, even in a creative way” FG4_sg1 “Personally, the most important tool is Google Meet; without it, we would not make any progress, as that is where we hold meetings.”. FG4_sg1 |
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| Team formation process | Phases of team development | “Also allow them to get to know us, because only in this way, only by letting us know each other, can we break down resistance and mistrust”. FG3_sg5 “When you try to tiptoe in […] “Look, I saw this thing and I wanted to share it with you […] what if we do it like this?” Make them feel part of the decision anyway”. FG3_sg6 “We constantly visit together; they help us and we help them. If there is a problem, and we see that a situation does not make sense to us, we discuss it and assess it together. It is truly precious and a great opportunity for growth for everyone.” FG3_sg2 |
| Shared professional values | “In this relationship in which each person brings their piece, each piece supports the other in holding together to do the best job possible…”. FG1_sg1 “What do we do? What can I do?» And from there, various doors open”. FG2_sg1 “Indispensable because since I closely collaborate with the FCNs I can no longer do without it”. FG1_sg1 |
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| Problem-solving strategies | “The attitude to reflect and say: «Ok, what is going wrong? We are arguing…» or «We are tired». This means that this misfortune must teach us something [and] proceed, otherwise you end up arguing and then you don’t move forward.” FG4_sg1 “So, having the patience to listen and try to understand the difficulties the person on the other side is experiencing. Maybe it could be the difficulty of not being able to manage the complexity of a case at home, and so when you realize that this is the difficulty, you try to answer, perhaps concerning activating a service or a consultant”. FG1_sg3 |
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| Specific training needs | “Experience is needed because what is done in the hospital is completely reversed compared to what is done at home … because it still enters people’s homes”. FG3_SG1 “At that point, starting from scratch, all together, the difference between what I have to do and what you have to do is flattened: we started the path together. […] utopia, fantasies… but it would be useful. […] and it would help the relationship between family doctors and nurses a lot… there would be the family team, that is, the group of health workers and others who take care of that person”. FG1_sg1 |
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| Transformation of work practices | Health outcomes | “You can work in a team, with empathy, and find satisfaction [for] everyone: the patients, the doctor, and us. It is a good way of working together. When you manage to do it, [it is] truly a great satisfaction”. FG3_sg2 “Extraordinary things come out, that is, we are finally able to take charge of previously unthinkable cases, stabilize them, and manage them most appropriately. Here we have a series of patients […] that we are now able to manage through a network action that was previously unthinkable and not even imaginable”. FG4_sg1 “It is the team and the work together that relieves you of the responsibility of having a person in charge…so the weight you feel on your shoulders changes a lot when there is real work…when there is integrated work in a team where it is not only an exchange of performances but a transformation [towards] a decision that is shared on the person”. FG1_sg4 |
| Work methodologies | “Together, we decide on the path to take and we collaborate, in the sense that we are a small team of two people: he on medicine and I on nursing, and we also collaborate on diagnostic pathways at times, and we make decisions together. This is very, very nice”. FG2_sg2 “… a whole series of problems; therefore not only medical problems but also social care problems”. FG4_sg2 “We have coined the word fantasy within the relationship: what is needed for a collaboration with the doctor, but also with the citizen? Because in the face of equal needs with different people, the solution is sometimes imaginative. Because in the territory, what you find is that there is no path that is always the same for everything; therefore, on the contrary, it is always very personalized. So even the relationship that exists with the doctor and the nurse and the situation you are in charge of becomes very difficult if you do not have a bit of imagination”. FG2_sg1 “… we get to know each other in this protected perimeter” FG4_sg1 “Here, in my opinion, that was important because from there you can now move on to other projects.” FG4_sg1 |
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| Transformative dynamics | “Start making plans and that are not only as I said before are on the disease, on bad luck, on the complex case but that also concern axes such as prevention up to the promotion of health […]… let’s start doing things a little different: planning, knowing the territory, investigating it, seeing who are the actors that we can co-opt, creating alliances… in short this is what I expect from having community nurses”. FG4_sg1 “Having a good knowledge of the network…[…] to understand what beyond our roles […] can make a difference on the patient… [can] help both to activate further actors who can, for their little piece, enter the path and make the way to complete and… respond to the patient’s need”. FG3_sg5 |