|dc.description.abstracteng||Introduction: General practitioners (GPs) are an essential element in the care of nursing home residents. A differentiated understanding of the medical per- spective can help to create improved conditions for GPs working in nursing ho- mes and thus strengthen the care of nursing home residents in Germany.
Questions: The aim of this paper was to illustrate the perceptions and needs of GPs with regard to their work in nursing homes. For this purpose, three rese- arch questions were developed. They concerned perceptions and needs with regard to 1) GPs‘ own work situation, 2) the support and care of residents and 3) the working environment in nursing homes.
Methods: From August 2012 to August 2013, open guided interviews were conducted in three different cities in Germany (Göttingen, Hamburg, Mannheim) with 30 physicians involved in the provision of medical care to nursing home residents. The interviews were then transcribed, pseudonymised and evaluated according to the Grounded Theory method. For this thesis, the gained data was examined with regard to the three research questions. For questions one and two, a summary descriptive procedure based on open coding was chosen. In case of question three, a more detailed description following all coding steps of the Grounded Theory method was selected.
Results: As the central phenomenon concerning the work of GPs in nursing homes, "inner strife" could be identified. GPs have the overriding desire to do good work and to fulfill the existing demands. The demands of home residents, the cooperation with the nursing staff and the social and legal framework condi- tions are influential for GPs and contribute to the inner strife. GPs can feel that a conflict of roles affects them as physicians, businessmen and private indivi- duals. The skills of the nursing staff, for example in the correct assessment of health conditions, the behaviour in acute situations and in dealing with the resi- dents, are very important for the GPs perception of the nursing home working environment. For the residents, the GPs would like to have more time in care, dignified aging and the promotion of physical and cognitive abilities. Some GPs reported about the joy of working in nursing homes and about a positive experi- ence concerning the work in the team with the nursing staff. However, in the interviews, the working environment in the nursing home was described by the GPs as emotionally predominantly negative. Overstrain and stress caused by the concentration of multimorbid people, some of whose needs could not be sufficiently fulfilled, contributed to this. In addition, the administrative require-
ments and the reward situation were important and critically assessed factors for most GPs regarding work in nursing homes.
Conclusions: In order to strengthen the care of nursing home residents, it is essential to consider the perspective of the actors involved about the current situation and therefore also the knowledge of GPs' view on their work in nursing homes.
The many and varied demands placed on GPs today contribute to a feeling of inner strife for their work in the nursing home. In order to strengthen the motiva- tion to work in nursing homes for the future and to place the view of GPs in a more positive light, it would be useful to ensure a better compatibility of the dif- ferent requirements.
The qualification and competence of the nursing staff are particularly important for the GPs in the nursing home and can support the work of the physicians. Nurses should be further encouraged in these areas, also in order to strengthen their own independence and self-confidence. Critical points such as administra- tive burdens and rewards should be the starting points for further improve- ments. Finally, the framework conditions, such as the design of a home doctor's concept or the possibility of more diagnostics and interventions in the nursing home could be specified on the basis of the perceptions and needs of the GPs described above.
It is to be hoped that the position of GPs in nursing home care will be seen and strengthened. Considering the demographic change, meaningful concepts and changes in the field of nursing home medicine, based on the perceptions and needs of GPs, are essential to ensure good care for nursing home residents.||de