What is primary health care nursing?

APNA's definition of primary health care nursing has a number of components.

What is health?

Primary health care nurses adopt the definition of health in the Declaration of Alma-Ata that health is a state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity.

They reaffirm health as a human right and see economic and social development as a prerequisite to the attainment of health for all. They see the promotion and protection of health, including the reduction of social exclusion and disparities in health, as having positive effects on economic and social development and on world peace.

Primary health care nurses see the participation of people as a group or individually in planning and implementing their health care as a human right and duty. One way of expressing this is through a phrase that originated in the disability movement, Nothing about me without me. Primary health care nurses acknowledge the dignity, culture, values, beliefs and rights of individuals/groups.

What is the scope of practice?

Primary health care nurses are enrolled nurses, registered nurses and nurse practitioners eligible for registration by the Australian Health Practitioner Regulation Agency whose competence, as specified by the registering authority's license to practice, educational preparation, relevant legislation, standards and codes is specific to (though not exclusive to) the primary health care context.

Like nurses in other settings, primary health care nurses have professional, legal and ethical responsibilities which require demonstration of a satisfactory knowledge base, accountability for practice, functioning in accordance with legislation affecting nursing and health care, and the protection of individual and group rights.

What is primary health care?

Primary health care is the first level of contact that individuals, families and communities have with the healthcare system. In Australia, this:

• Incorporates personal care with health promotion, the prevention of illness and community development
• Includes the interconnecting principles of equity, access, empowerment, community self-determination and inter-sectoral collaboration
• Encompasses an understanding of the social, economic, cultural and political determinants of health.

Grounded in their scope of practice, nurses provide socially appropriate, universally accessible, scientifically sound, first level care. They work independently and interdependently in teams to:

• Give priority to those most in need and addresses health inequalities
• Maximise community and individual self-reliance, participation and control
• Ensure collaboration and partnership with other sectors to promote public health.

Read the article and associated video from What is primary health care? Why is it important?  from PHCRIS (published November 2015).

In what settings do primary health care nurses work?

Primary health care nurses work in a range of settings, each sharing the characteristic that they are a part of the first level of contact with the health system.

In Australia, those settings can include:

• Community settings including the community controlled health services, the community health sector and roles within social service settings
• General practice
• Domiciliary settings in the home, including residential aged care, custodial/detention settings, boarding houses and outreach to homeless people
• Educational settings including preschool, primary and secondary school, vocational and tertiary education settings
• Occupational settings, occupational health and safety and workplace nursing
• Informal and unstructured settings including ad hoc and Good Samaritan roles in daily life, like sports settings and community groups.

What are the roles of a primary health care nurse?

A model of the roles of nurses is that their work may cover:

• Health promotion
• Illness prevention
• Antenatal and postnatal care
• Child and family health nursing
• Treatment and care of sick people
• Rehabilitation and palliation
• Community development
• Population and public health
• Education and research
• Policy development and advocacy.

Recent research within the Australian general practice setting describes the following roles of primary health care nurses; patient carer, organiser, quality controller and improvement agent, problem solver, educator, and agent of connectivity.

The relevant importance of these roles will depend on both the nursing context and the accountabilities and responsibilities of the nursing position.

Read the definition of primary health care nursing below.

How can a nurse contribute to my practice?

Patient carer

Clinical activities including:

• Wound management
• Triaging patients for urgent appointments
• Injections, application and removal of casts
• Suturing
• Preventive health checks including cervical screening and immunisation
• First aid and emergency management
• Diagnostic services including ECGs, stress tests, urine drug screening, hearing tests, peak flow, spirometry and mood and memory assessment
• Providing outreach services such as home assessments for the elderly, immunisations at workplaces and childcare centres.

Organiser

Coordinate organisational aspects of patient care such as: 

• Maintaining, monitoring and improving patient information systems including patient register and recall systems
• Brokering referrals to community services
• Coordinating and undertaking patient health assessments
• Triaging patients
• Maintaining treatment room equipment and resources
• Sterilising instruments, managing contaminated waste
• Identifying and understanding the role of community agencies and service providers and networking with these services 
• Planning and coordinating care including routine monitoring and follow up of patients with care plans.

Quality controller

Managing quality and risk activities such as: 

• Infection control
• Maintaining cold chain for vaccines
• The safe disposal of sharps
• Contributing to practice accreditation 
• Arranging patient follow up of pathology results with evidence of audit trails
• Writing and/or updating practice and clinical policies and procedures 
• Participating in/leading a team approach to managing adverse events.

Problem solver

Solving problems that arise on a day-to-day basis such as:

• Managing high patient demand on busy days
• Supporting receptionists’ decision making 
• Solving issues with practice software systems
• Sourcing information such as referral options.

Educator

Providing education in various ways, including:

• Other members of the general practice team including GPs
• Students who enter the practice for clinical placement
• Patients in areas of prevention and health promotion, management of specific health conditions 
• Participation in local and/or national disease prevention campaigns (e.g. influenza).

Agent of connectivity

Connecting different disciplines within the practice, between patients and clinicians, between administrative staff and GPs and between the community setting and hospitals:

• Liaising with local hospital networks and other health services
• Building and maintaining relationships across the practice team
• Arranging appointments, managing internal and external referral processes and procedures, arranging case conferences and providing information and feedback between the services, patients and GP
• Planning and coordinating care including routine monitoring and follow-up of patients with care plans
• Patient advocacy.

_{Phillips CB, Pearce CM, Dwan KM, Hall S, Porritt J, Yates R, Kljakovic M, Sibbald B. Charting new roles for Australian general practice nurses: Abridged report of the Australian General Practice Nurses Study. Canberra: Australian Primary Health Care Institute, 2008. Available from aphcri.anu.edu.au and www.apna.asn.au.}

To find out if your practice is eligible to receive funding support for the employment of a nurse or nurses in general practice visit our Practice Nurse Incentive Program (PNIP) page. 

Nursing in general practice, it’s a choice

Providing a snap shot of a ‘day in the life’ of three nurses across different geographical areas in Queensland this video showcases the diverse role of the general practice nurse across immunisation, wound management, women’s health, health assessments, patient education, data management and the management of chronic diseases.

APNA kindly acknowledges General Practice Queensland for use of this resource.