New horizons for nurses in primary health care

New policy for primary health care urges a shift from hospital-based care to the promotion of health and prevention, with a strong contribution from nurses and midwives.

A broad range of nursing and midwifery organisations, including the Australian Nursing Federation, have released a paper outlining a vision for primary health care in Australia.

The paper urges a shift from the narrow perspectives of hospital-based care with its treatment and cure of already-established disease to the promotion of health, the prevention of disease and injury and the reduction of health inequities of all Australians across their lifespan.

The report, Primary Health Care in Australia. A nursing and midwifery consensus view, stresses the strong contribution nurses and midwives can make to a new primary health care policy in Australia. In particular, it highlights health promotion and prevention for infants, children and youth and chronic and complex care management in the community.

Community mental health care, family health services and community aged care are other areas where nurses have an important role to play in a refocussed health policy.

In this model of care, nurses and midwives will be critical in helping communities and people of all ages become more self reliant and better able to manage their own health care needs.

The report advocates a holistic approach to health. It stresses that the physical, social, emotional and cultural wellbeing of the whole community, as well as the individual, is the key to good health, not just the absence of disease, injury or disability.

This consensus view of health supported by 22 nursing and midwifery organisations challenges the status quo.

The report’s vision of primary health care is based on a model of collaborative trans-disciplinary care rather than being led by any one professional group.

The report is frank and fearless in identifying the political obstacles to the implementation of such an approach.

Health ministers, principal advisers and policy developers, and medical practitioners have had a disproportionate say in the way health services are delivered and funded. Inevitably medical practitioners act as gatekeepers.

This power is linked to an almost complete commercial monopoly created through the restriction of access to funding sources, which has led to a number of distortions in the way the health system functions in Australia.

These distortions preclude one of the fundamental principles of primary health-care – that of trans-disciplinary teamwork.

The report also argues that Australia’s fee-for-service system creates an incentive for more rather than better services. It creates an incentive to provide many services, not make people better.

Another major defect is the limited incentives built into this predominantly market-based, fee-for-service system to encourage health promotion, disease and injury prevention or support strategies.

The whole report – Primary Health Care in Australia.  A nursing and midwifery consensus view – can be downloaded from the ANF website –

Nurses, doctors meet to discuss the road to collaborative health reform

Peak nursing, midwifery, medical and consumer groups met on 16 June to discuss a stronger, collaborative approach to health reform in Australia.

The AMA joined discussions with the ANF and other groups for the first time to develop a collaborative plan for a stronger primary health care plan that will deliver the best health outcomes for all Australians.

There was strong support among the 22 health care groups represented for a shift in focus from hospital-based primary care to health promotion and prevention.

The groups agreed a working group will meet in August 2009 to progress work on health reform in Australia.

Case study 1:

MERV improves men’s health

Andrew Whale, Nurse Unit Manager for primary health care community nursing at the Greater West AHS, spends much of his time working from a caravan providing primary health care.

The Men’s Educational Rural Van (MERV) is a mobile men’s health check-up and information service that travels to workplaces and community sites in the Mudgee district.

Men have their blood pressure, blood glucose and cholesterol levels checked, followed by a discussion with a community nurse about men’s health issues.

They are provided with information about heart disease, alcohol consumption, smoking, prostate cancer, bowel cancer, sexual health, testicular self examination, healthy eating, exercise and mental health.

MERV aims to raise the profile of men’s health issues and increase the number of men accessing health services in the Mudgee area.

‘The response that MERV has received not only in Mudgee but throughout the GWAHS has been overwhelming,’ said Andrew.

Since the service started in 2005, 1246 men have accessed MERV and 51 visits have been conducted to local worksites or community events.

About half the men who have visited MERV are aged 41-60 and more than one third had not seen a GP for a full health check up in the past year.

Of the men who have accessed MERV, 83% came a second time and have followed most of the recommendations made on their first visit.

Case study 2:

Debbie delivers to the elderly

Debbie Deasley works as an aged-care nurse practitioner treating the elderly in their homes and keeping them away from the ED at Port Macquarie Base Hospital.

‘If someone is aged over 70 and can’t access their GP, I’ll go out and help treat them for a variety of things, including pneumonia, infections, delirium or checking catheters.’

Debbie says her role as a nurse practitioner gives the elderly more choices in their healthcare.

‘They like the one-on-one service. They can ask questions and I’m not as rushed as a GP. I’m also looking at it from a nursing perspective so I take into account the family, the environment, medications and the education I can provide,’ she said.

‘It also empowers the residential facilities by enabling them to get a nurse practitioner in straight away to take care of something straightforward like dehydration.’

Nurse practitioners like Debbie are not only improving care but saving thousands of dollars by reducing hospital admissions, an ACT Health report shows.

A six-month snapshot of a nurse practitioner working in both a major tertiary hospital and in the community in Canberra saved at least 350 bed days at a cost of $1265 per day or $442,750.

Case study 3:

Community dialysis service meets Indigenous patients’ needs

Another effective nurse-led health model is a regional community dialysis service that supports around 300 Aboriginal and non-Indigenous clients living within the 31,000 sq km covered by Lower Sector Hunter New England Health. The service provides patients with renal replacement therapy for end-stage kidney failure in the form of haemodialysis or peritoneal dialysis.

The program is run by Aboriginal nurse practitioner Lesley Salem and patients are cared for either at home or in one of five community satellite dialysis units. None of these settings has an onsite medical practitioner present.

The aim of the program is to provide renal replacement therapy and prevent complications of the outcomes, co-morbidities and causal diseases of kidney disease and renal replacement therapy, while maintaining the quality of life that suits the person receiving care.

Lesley Salem is not only the first nephrology nurse practitioner in Australia but also the first Aboriginal nephrology nurse practitioner.

Lesley covers all the centres with phone contact 16 hours a day; renal nurses staff the satellite dialysis units and run a home visiting service; a nephrologist visits one centre once a week; a dietician visits one centre once a week; and a social worker visits one centre three times a week.

Case study 4:

Coachstop outreach project brings hope to lives in chaos

The Coachstop caravan park in Maitland is home to 150-200 people classified as ‘at risk’ families and individuals. Many park residents have been homeless, in prison and juvenile institutions, a number are from mental health facilities or refuges and some are transient moving from park to park in search of affordable housing.

With funding from the NSW Health Primary Healthcare and Partnerships, a two-year project was initiated with an onsite outreach van being staffed by an early childhood nurse, a registered nurse as project officer, and a psychiatric nurse specialising in clinical drug dependence.

At its core, the project aimed to help residents set their health priorities and plan strategies to address them.

The projects’ indicators of success were based on a holistic approach that reduced social isolation and improved housing options, increased personal skills and a sense of a supportive community, improved access to health services and increased maternal and child health outcomes.

Coordinated by Loretta Baker RN, the project has been successful in engaging socially and economically disadvantaged families and individuals living in the caravan park and delivering a high quality health service on minimal funding. The project has been successful in returning family members to housing, work, employment and health services.

The women now attend antenatal care and the children have access to childcare and preschool. And the broader community is now aware of the residents’ plight.