Practice Context, Essential Competencies, and a Synthesized Competency Framework for Family Nurse Practitioners in Thailand's Primary Health Care System: A Qualitative Study

Practice Context, Essential Competencies, and a Synthesized Competency Framework for Family Nurse Practitioners in Primary Health Care, Ubon Ratchathani Province: A Qualitative Descriptive Study

Abstract

Purpose: This study aimed to (1) explore the practice context of Family Nurse Practitioners (FNPs) within Thailand's primary health care system, (2) examine stakeholders' perspectives on the essential competencies of FNPs, and (3) analyze and synthesize a competency framework for FNPs congruent with the context of Thailand's primary health care system.

Methods: A qualitative descriptive design was employed. Data were collected through semi-structured, audio-recorded, in-depth interviews with verbatim transcription. Sixteen key informants were purposively sampled, comprising FNPs, nursing administrators and unit heads, interprofessional team colleagues, and patients, across sub-district health-promoting hospitals and a community hospital in Ubon Ratchathani Province. Data were analyzed using thematic analysis following Braun and Clarke¹. Trustworthiness was established according to Lincoln and Guba's² criteria for credibility, transferability, dependability, and confirmability.

Results: The sample comprised 17 informants including 5 nursing administrators/unit heads, 4 FNPs, 4 interprofessional team colleagues, and 4 patients. Three key findings emerged. First, the practice context of FNPs comprised two themes including practicing in workforce-scarce settings, which required FNPs to assume roles broader than the policy framework, and role ambiguity at the organizational and system levels. Second, stakeholders' diverse perspectives yielded four themes including clinical competency and decision-making, continuity of care, teamwork and leadership, and communication and trust. Third, a contextualized competency framework was synthesized, revealing three dimensions of strength including clinical competency, continuity of care, and ethics; and alongside three dimensions requiring further development including leadership, health information technology utilization, and evidence-based practice/research that the latter resulting from systemic barriers rather than individual capability.

Conclusion: These findings highlight the need to develop a competency framework and assessment instrument for FNPs that are specifically congruent with the context of Thailand's primary health care system, together with policy recommendations to close the gaps in leadership, health information technology, and research. These contributions are beneficial for nursing practice, administration, education, and future research on FNPs in the long term.