This paper aims to define the term primary health and explain its origins and development; also touching on the impact of primary health on the nursing profession. It will commence with an introduction to primary health and primary health care. Covered in this paper will also be the influence that primary health care has had on nursing and any alterations associated with its implementation.
Primary health care aims to provide a health care framework that steps away from the acute care focus and brings to the forefront the utilisation of disease prevention and health promotion (Keleher, Parker & Francis, 2010; Mackay, 2007; Nelson, Wright, Connor, Buckley & Cumming, 2009). The inspiration for primary health care is thought to have come from many different avenues, from the missionaries work in developing countries to the health policies of Communist China.
The utilisation of the ‘barefoot doctors’ – locally living health workers – in Communist China’s rural medical services in the 1950s, provided more inspiration for primary health care, as they combined the use of their traditional methods with Western medicine and had a emphasis on rural health care with a preventative focus, rather than urban health care with a curative focus (Wollumbin, 2012). With the forming of the United Nations in 1945, the concept of a health organisation that tackled global health issues was raised, thus three years later in 1948; the World Health Organisation (WHO) was created (World Health Organisation, 2013).
But it was not until 30 years later in 1978, that the Alma-Ata declaration was signed by policy makers and health experts from 134 of the WHO member states, with a common goal of achieving “Health for All by 2000” (Chan, 2008; WHO, 2013). This declaration provided governments with guidelines to follow in order to achieve this goal, covering the main topics including the organisation of each level of health care with an emphasis on prevention as much as cure and also the need for a more local focus with the expansion of access to health services for the community (Sachs, 2008).
Ideally, primary health provides a government with everything it needs to save on health costs, motivating the population to choose healthier lifestyles and in turn, avoid illness (McBride, 2009). In the community, primary health care provides the necessary link between the population and the health care facilities and care coordination services that they need in order to achieve and maintain good health (Davies, Perkins, McDonald & Williams, 2009). The general
practice was once the only facility to provide these services but through government initiatives, services are expanding to incorporate clinics led by nurses, and in turn, expanding their role (Davies et al. , 2009). As the population ages in industrialised countries, issues such as chronic disease is putting a strain on the health care system and as workforce shortages are limiting services, the role of the nurse has increased in importance to the point that they will become substantial contributors in the delivery of primary care (Keleher, Parker, Abdulwadud & Francis, 2009).
Alongside General Practitioners (GPs), nurses have been identified to be the solution for effectively implementing primary health reforms (Keleher et al. , 2010) and it is because of this that there has been a widening of the scope of practice and an increase in the creation of non-traditional roles and responsibilities for nurses within the primary health care framework (Mackay, 2007). Nelson et al.
, (2009), states in their article that with the introduction and implementation of primary health nurses, the population would be supported by a framework of care in which nurses were able to integrate with and in certain situations, substitute for GPs in many of the tasks they undertook. The nurse practitioner (NP) role has gained support internationally due to increasing evidence of its success in providing client-focussed, personalised care in the primary health environment (Mackay, 2007; Zand, 2011).
The NP has stepped up into innovative roles of primary health care and taken on responsibilities which were previously carried out by other health professionals such as general practitioners (Mackay, 2007; Zand, 2011). As the roles of the nurse increase and diversify with the implementation of primary health care, there are some barriers in achieving a smooth transition to ensure more nursing responsibilities in the community, as stated by Bryce (2008).
It is the nurses’ capacity for clinical decision making as part of a health care team that needs to be acknowledged by the wider health care and political community, so that growth in primary care is not just based on the experiences of general practice, but also on the contribution already made by nurses across the community in the primary health system outside of this (Bryce, 2008). However, while in a review of Australian university nursing courses, Keleher et al. (2010), noted that graduate registered nurses are ideally the best candidates to aid in the implementation of the new primary
health reforms, their preparation for this as provided by educational institutions lacked in certain areas. There was found to be a disproportionate focus on acute care and higher level acuity in illness, with very few courses that taught primary health nursing or wellness promotion on its own (Keleher, 2010). This lead Keleher et al. (2010), to suggest that in order for primary health care reform to be successful, the available university nursing education in Australia needs to be reassessed to include more information on primary health and health promotion in their courses, in order to reflect the role that it has on the population.
In conclusion, an increasing emphasis on primary health care in the community is of great benefit as it aids the population to gain an ownership over their health by living healthy lifestyles, which in turn prevent chronic issues that can put a strain on the health care system. The nurse has a significant role in implementing this as they are the largest group of health care workers who are present across a wide variety of environments and are within communities already, gaining respect for their work.
By educating nurses about primary health and the growing non-traditional roles available to them, they can be better prepared for and are more likely to choose to work in a primary health care environment. REFERENCES Bryce, J. (2008). Professional: more to primary health care than general practice. Australian Nursing Journal, 16 (3), 17. Retrieved from http://www. library. uq. edu. au Chan, M. (2008). Return to Alma-Ata. The Lancet, 372 (9642), 865-866. Retrieved from http://www. library. uq. edu. au Davies, G. P. , Perkins, D. , McDonald, J. & Williams, A. (2009). Integrated primary health care in Australia.
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