APNA has long championed the advantages of keeping people well and out of hospital, and the good it does for our communities and for our healthcare system.
Primary health care is often the first level of contact individuals, families and communities have with the healthcare system. In Australia, this:
- incorporates acute care with health promotion, the prevention of illness and community development,
- includes the interconnecting principles of equity, access, empowerment, community self-determination, and intersectoral collaboration, and
- encompasses an understanding of the social, economic, cultural and political determinants of health.1
Everyone from governments to health professionals to consumers agree we should aim to keep people as well as possible for as long as possible, and out of hospital and residential aged care. To achieve this, we need to get better at caring for people in the community.
The rapport between nurse and patient can be very influential in affecting real behaviour and lifestyle change to improve patients’ health.
Primary health care nurses have a long history of practical engagement in community-based care. Nurses are the largest health workforce in Australia, and a significant and growing part of the primary health care workforce.
Nurses provide preventive health interventions, chronic disease management and coordination, management of long-term conditions, screening and vaccination, general care for the sick, and care for our older population.
This community-based, practical, patient-centred care is exactly what primary care should be. It is what we know keeps people well and out of hospital.
Prevention is better than cure
Our government wants to build a mentally and physically healthy Australia2 by focusing efforts on primary health care and preventive health, through their 10-year strategies released in August this year.
Shifting the focus from care of the sick to the ‘upstream’ idea of wellness and preventive health is inevitable. It is here we can really impact and be future-focused about containing healthcare costs. The benefit is not just savings and efficiencies from streamlined primary health care services, but gives patients greater and timelier access to managed care, and helps break the cycle of crisis presentations, and helps to give control and support for decision making by patients, their families and carers.
As nurses we work collaboratively to achieve the best outcomes for our patients and communities, and we want our abilities to be utilised within the practice team. When nurses work to the breadth of their scope in primary health care it’s better for patients, it’s better for their employers, and it’s better for nurses.
So what role do nurses play in patient-centred care?
- Data investigation and recall
With protected time a nurse can interrogate the data a practice has on its community to identify patients with a health need and improve recall and reminder systems.
Once target groups have been identified, nurses can manage practice population health activities (including identification of needs and of those at high risk, preparation for preventative health checks, and chronic disease management coordination). Not only does this improve access and screening for patients, it contributes to quality improvement targets and patient loading now that the QI PIP (Quality Improvement Practice Incentives Program) is in place, with the aim of improving health and health services nationally.
2. Health coaching and telephone counselling
The rapport between nurse and patient can be very influential in affecting real behaviour and lifestyle change to improve patients’ health. With the proven success of patient centred-care and improved patient self-care, nurses can be the support patients need to achieve their health goals.
With health coaching – either face to face or by telephone – nurses can help patients to navigate tough decision points and gain a deeper understanding of barriers, and also help them come up with solutions to move forward, in dealing with a chronic or complex disease, adherence to management plans, medications, and behaviours, mental health support, and lifestyle modifications, whilst keeping the patient’s lead clinician or doctor in the care loop.
3. Nurse care coordination
A nurse coordinating the care for high-frequency patients saves time connecting the dots between their recent hospital visit, X-rays, pathology, etc. and avoids inefficiencies and duplication. Nurses can connect different disciplines within the practice, between patients and clinicians, between administrative staff and GPs, and between the community setting and hospitals.
4. Health education
Nurses are able to identify health literacy concerns with patients and tailor follow-on education after a diagnosis or GP consultation; cardiovascular disease education and management, asthma education and management, diabetes education and management, sexual health education, and the list goes on.
Nurses can facilitate group learning or one-on-one education. Patient education sessions help patients’ health literacy, streamlines health promotion activity, and breaks down isolation among some of the higher risk patients – nurses can provide ongoing support for these important activities.
5. Nurse clinics
Nurse clinics offer an alternative model of care delivery where the nurse is the primary provider and coordinator of care for the patient. In the general practice setting, nurse clinic models support a team-based approach to care delivery, and closely involves the general practitioner and other members of the practice team.
Healthcare that responds to the needs of the community
There is no single or ‘right’ model for a nurse clinic. In Australia and overseas, clinics develop according to a range of factors such as the interests and specialities of the nursing team, the healthcare needs of the communities they operate in, budgetary constraints, and existing healthcare delivery models.
In areas experiencing health workforce shortages, including rural and remote areas with limited access to healthcare services, nurse clinics offer patients increased opportunities to access healthcare. Nurse clinics operating out of general practices facilitate the triage and prioritisation of care as well as the coordination of care.
The nursing services provided are holistic and patient-centred, with accountability and responsibility for patient care and professional practice remaining with the nurse.
Nurse clinics offer benefits to patients, such as:
- improved patient access contributing to increased patient satisfaction
- improved quality of life
- improved clinical outcomes
- increased understanding of chronic disease and support for self-care, and
- improved access to health professionals such as allied health referrals.3,4
Nurse clinics are especially effective in engaging patients to play an active, ongoing role in their healthcare and treatment. When the community works towards their own good health and wellbeing, that’s what will keep people healthy and out of hospital.
References
- Keleher H. Why primary health care offers a more comprehensive approach to tackling health inequalities than primary care. Australian Journal of Primary Health. 2001; 7(2): 57- 61.
- Department of Health. Building a Mentally and Physically Healthy Australia. https://www.health.gov.au/ministers/the-hon-greg-hunt-mp/media/building-a-mentally-and-physically-healthy-australia. [Accessed 16 October 2019]
- Gow, J, Collins E, Giles M, O’Brien T. Developing a nurse-led clinic for patients with Parkinson’s disease. Australian Nursing and Midwifery Journal 21.10 (May 2014).
- Hegarty K, Parker R, Newton D, Forrest L, Seymour, J, Sanci L. Feasibility and acceptability of nurse-led youth clinics in Australian general practice [online]. Australian Journal of Primary Health, Vol. 19, No. 2, 2013: 159-165).
