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 Nursing and Midwifery Board of Australia 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 address 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
Residential aged care
Domiciliary settings in the home, 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
Healthy ageing
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.

Grow your career, visit MyNursingFuture.com.au

Ever wondered what it was like to work outside of the four walls of a hospital? Interact with the community and improve the quality of health of people within the community? Find out about the rewarding and challenging career of nurses working in primary health care and why this workforce is vital to the health of the Australian people.