Primary Health Care and Community Nursing Roles

Definition of primary health care (PHC)

The concept of primary health care began in late 1940s and the concept was first practiced in South Africa by two health practitioners namely; Dr. Sidney and Emily Kark (Ashcroft, Dawson & Draper, 2007, P. 359). The two practitioners developed a health care system that provided the rural community with health care services. There are many definitions of primary health care. Delaney et al. (2006), in their study defined primary health care as a means of planning and delivering health services.

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According to World health Organization & UNICEF (1978), primary health care is concerned with scientific and theory based principles that allow people to have access to cheap health services. According to World Health Organization & UNICEF (1978), primary health care should aim at promoting social cohesion and equality. Individuals and communities are thus strengths and they should be involved optimally. According to Delaney et al. (2006), the main components of primary health care include the following; Primary health care aim at educating people on how they can identify and control health related problems, PHC that aims at ensuring that people are supplied with proper food and nutrition. Also, communities should be supplied with safe water and sanitation (Ashcroft, Dawson & Draper, 2007, P. 359). PHC should educate communities on proper parenting methods i.e. maternal health and child care (Ashcroft, Dawson & Draper, 2007, P. 359). Immunization should be provided in order to prevent the occurrence of major illnesses. Both WHO and UNICEF (1978) encourage the adoption of information technology by healthcare professionals to treat some of the endemic diseases. The PHC should aim at providing communities with proper medication (WHO & UNICEF, 1978, P.1-48).

Primary health care refers to a health care system whereby health care professionals are often closer to their patients (Ashcroft, Dawson & Draper, 2007). In primary health care, the health care worker has the opportunity of knowing the patient more. This would allow the health care professional to provide his or her patient with the best medical services (Stanhope & Lancaster, 2004). Similarly a clear understanding of patient’s needs enables the health care professionals to shape views concerning the patients’ autonomy (Ashcroft, Dawson & Draper, 2007, P. 359).

Primary health care refers to the provision of health care outside hospital (Stanhope & Lancaster, 2004). As stated by (Stanhope & Lancaster, 2004), Over the past few years, there has been a marked shift in the provision of healthcare from secondary to primary care in both developed and developing countries. Primary health care has been emphasized and this has in turn resulted in an increase in the number of health professionals working in community settings (Ashcroft, Dawson & Draper, 2007). With this regards, primary health care professionals has formed professional bodies that guides them during the provision of health care services to the communities (Austin, 2010). For instance, Primary Care Groups (PCGs) and Primary Care Trusts have been established with a view of guiding healthcare professionals while commissioning their services (Thomas, Hardy & Cutting, 1977, P.149).

Definition of Primary Care (PC)

Primary Care is a model of the larger Primary Health Care which aims at enhancing the lives of individuals by reflecting on their values (Stanhope & Lancaster, 2004). According to the Family Medicine and General Practice in Barcelona, as stated by Bowman & Spicer (2007), PC refers to the first point of contact for persons with health issues and the means upon which they access hospital care. Primary care is usually found at the community level and this implies that it is locally accessible. Austin (2010) states that primary is concerned with comprehensive care services which include disease prevention, health promotion, rehabilitation and curative services. Also, it is usually planned implying that, a health care professional has to arrange with his or her patients on how they can meet and interact (Meads & Iwami, 2006, P. 21-26).

Differences between Primary care and primary health care

Both primary health care and primary care are usually interchanged by many people i.e. many people do not make a distinction about the main differences between the two health fields. According to Bowman & Spicer (2007), it is important for people to make a clear distinction between the two fields in order to meet the changing demands of people.

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Primary Care (PC) is a concept that aims at reducing the health inequalities that exists between the rich and the poor (Willis, Reynolds & Helen, 2008). They further note that the main cause of health inequality across the globe is globalization. Globalization has a major impact on health systems as a result of its own characteristics. Bowman & Spicer (2007) finds out that Globalization has the effect of increasing much pressure on social cohesion. Thus, the health services fail to respond to people’s health needs. On the other hand, Primary health care is broad and incorporates all aspects of health care (Barron, 2009, P. 340).

Primary care is individualized whereas primary health care is community oriented (Bowman & Spicer, 2007). Primary care is characterized by the doctor-patient relationship. With regards to primary care, Austin (2010) argues that the health care professional is supposed to help all patients irrespective of his or her familiarity with the patient’s problem. This implies that a primary care professional cannot shift patients on to other practitioners. In other words, the primary care professional must do all that is necessary to help his or her patient. On the other hand, a primary health care professional maintains a unique position in relation to his or her patients (Thomas, 2006). This unique position provides the primary health care workers with an opportunity of building a broad range of factors when dealing with the patients. Thus, a primary health care worker is not obliged to help all his or her patients. A practitioner can shift his or her patients on to other primary care health professionals (Casey & Byng, 2011, P. 315).

Ali & Atkin (2004), states that Primary care enhances the autonomy of healthcare professionals as opposed to primary health care. Primary care thus provides the health workers with confidence to challenge most clinical issues. As a result of increasing autonomy, effectiveness and efficiency of workers is enhanced. The patient’s-doctor relationship that exists in primary care provides the caregivers with a temporary dependence (Schermer, 2002, P. 154). For primary health care, the health care workers wait to be told what to do.

Primary health care usually provides more than a greater portion of the necessary care whereas primary care provides less portion of the necessary health care. According to a research which was done by Cleverley, Cleverly & Song (2010), primary health care provides more than 75% of the required health care. Primary healthcare is usually comprehensive and provides array of services. It is concerned with such aspects as disease prevention, health promotion, and curative services among others. They (Cleverley, Cleverly & Song, 2010) also clarify that Primary care on the other hand serves the remaining 20 % of the needs that lie beyond the primary health care. Primary care are therefore tertiary or secondary as far as disease prevention is concerned (Cleverley, Cleverly & Song, 2010, P.41).

Primary care is consumer surcharge whereas primary health care does not pose any costs to consumers. Primary health care usually provides free medical services to the uninsured poor people. According to (Willis, Reynolds & Helen, 2008, P. 36), the poor do not qualify for government assistance through Medicaid and therefore, primary healthcare increases people’s access to care

Where Primary Health Care and Primary Care overlap in community nursing

Both Primary Health Care and Primary Care overlap in community nursing. In both fields emphasis is given on individual’s health. In the words of Stanhope & Lancaster (2004, P. 68), the healthcare professionals in both fields use their experience to make decisions concerning their patients

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In both fiends, ethical issues emerge as far as patent’s health is concerned. As noted by Bowman & Spicer (2007, P. 174), although the health care workers can develop and maintain good relationships with their patients, ethical issues emerge when little or no success is yielded. Primary care workers tend to be discouraged when the treatments that they provide their patients with fail to yield much success (Barron, K. (2009). On the other hand, the primary healthcare workers are faced with the challenge of setting boundaries on the relationships with their patients. This is common in communities that have small populations in which the healthcare practitioner meets with the patient on regular basis (Bowman & Spicer, 2007, P. 174)

In both fields, trust and confidentiality are major issue. According to Bowman & Spicer (2007, P. 174), Confidentiality between the patients and the healthcare professionals often raises critical questions in both fields. This is because health information is usually personal and therefore, there should be reassurance from both parties that it should not be shared to anyone without consent. A difference in the relationship between the health professionals and the patients exists in both fields. According to Ashcroft, Dawson, & Draper (2007), Tensions exist between primary care and primary health care as far as nursing is concerned. Primary care adopts the individualized approach whereas primary health care adopts the community approach to nursing (Austin, 2010, P. 46). Whereas nursing is supposed to be holistic, most scholars believe that a clear-cut does not exist between the two approaches (Shelton, 2000). Most patients are thus confused on the best approach which can help to identify their health problems. No one discipline alone is capable of addressing all the health related problems in a particular community. According to Austin (2010, P. 46), emphasis should be given on both fields in order to ensure that there is zero health disparities and 100% health access

Primary care and community nursing roles

There have been many changes in practice and organization in primary care. These changes have the effect of providing the health workers with new challenges as well as opportunities (Ma, Sood & Rand Corporation, 2008). In the past few years, nursing has become a distinct and significant professional across the globe. Moreover, nurses play an important role as far as primary care is concerned. The role of primary care is changing following the development of policies. One of the main changes over the past decade has been the feminization of primary care. More females compared to males now enter the primary care training (Lundy & Janes, 2009). However, the daily routine of primary care practice is unlikely to change. The main objective of primary care is to manage patent’s care and also make necessary referrals for further investigation. On the other hand, the roles of primary care professionals may greatly change. Major reforms have placed primary care nurses in a much stronger position in relation to practice (Austin, 2010). For instance, the reforms have enhanced cohesion among nurses as far as their practice is concerned. For instance, the Royal College of Nursing in England was formed with a view of ensuring that high quality practices are achieved (Barash, et.al, 2009, P. 46).

Primary care is usually cost effective as compared to primary health care. A research which was done by Goroll& Mulley (2009), suggest that primary health care is not appropriate approach for solving community health problems. Primary care therefore acts as an ideal substitute.

Primary care enhances equity and access to health care. Thus, as stated by Austin (2010, P. 46), primary care approach is appropriate for addressing the needs of local people. In primary care system, resources are utilized in the most effective manner. Also, primary care workers are trained on how to identify and manage the health problems (Ali & Atkin, 2004, P. 38).

Primary health care and community nursing roles

According to Lundy & Janes (2009, P. 16), the impact of primary health care approach on community nursing can be considered within the national nursing associations. The World Health Organization and the International Council of Nurses have been on the forefront in supporting these associations

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Primary health care leads to patient’s satisfaction. In the past few years, health care market place has become competitive. According to Barash, et.al, (2009, P. 46), health care practitioners have thus discovered that they should manage quality in order to survive in the market. Satisfied customers usually return. The increased use of information technology in the provision of primary health care has enhanced patient’s satisfaction (Shelton, 2000, P. 17).

Primary health care aims at achieving 8 pillars. One of the pillars is Intersectoral collaboration. according to Schermer (2002), Intersectoral collaboration is crucial as it considers the fact that community’s health status results from good planning and action In addition this strategy recognizes that other sectors in the economy determine the health condition of communities. For instance, the use of wastewater for agriculture has an impact on people’s health. Therefore, coordination among the various sectors of the economy is necessary as far as community health is concerned (Thomas, 2006, P. 145).

Primary health care system often leads to efficiency. According to Ma, Sood & Rand Corporation (2008, P. 28), Efficiency is usually achieved through the nurses working together with the community members to solve health related issues. Like in primary care, healthcare nurses should be concerned about the wellbeing of the local communities. Thus, they should get in touch with what the local communities need

Reference List

Ali, S & Atkin, K. (2004). Primary healthcare and South Asian populations: meeting the challenges. Columbia: Radcliffe Publishing.

Ashcroft, R, Dawson, A & Draper, H. (2007). Principles of health care ethics. Hoboken: John Wiley and Sons.

Austin. (2010). Psychiatric and mental health nursing for Canadian practice. Philadelphia: Lippincott Williams & Wilkins.

Barash, P. et al. (2009). Clinical Anesthesia. Philadelphia: Lippincott Williams & Wilkins.

Barron, K. (2009). Health inequalities: written evidence. London: The Stationery Office.

Bowman, D & Spicer, J. (2007). Primary care ethics. Columbia: Radcliffe Publishing.

Casey, P & Byng, R. (2011). Psychiatry in Primary Care, Edition4. Cambridge: Cambridge University Press

Cleverley, W, Cleverly, J & Song, P. (2010). Essentials of Health Care Finance, Edition7. Sadbury: Jones & Bartlett Learning.

Delaney, C et al. (2006). Consumer-centered computer-supported care for healthy people: proceedings of NI2006, [Seoul], the 9th International Congress on Nursing Informatics. New York: IOS Press.

Goroll, A, & Mulley, A. (2009). Primary care medicine: office evaluation and management of the adult patient. Philadelphia: Lippincott Williams & Wilkins.

Lundy, K & Janes, S. (2009). Community health nursing: caring for the public’s health. Sadbury: Jones & Bartlett Learning.

Ma, S, Sood, N & Rand Corporation. (2008). comparison of the health systems in China and India. California: Rand Corporation.

Meads, G & Iwami, M. (2006). Primary care in the twenty-first century: an international perspective. Columbia: Radcliffe Publishing.

Schermer, M. (2002). The different faces of autonomy: patient autonomy in ethical theory and hospital practice. Berlin: Springer.

Shelton, P. (2000). Measuring and improving patient satisfaction. Sadbury: Jones & Bartlett Learning.

Stanhope, M & Lancaster, J. (2004). Community and public health nursing, Edition6. Elsevier: Elsevier Health Sciences.

Thomas, B, Hardy, S & Cutting, P. (1977). Stuart and Sundeen’s mental health nursing: principles and practice. Elsevier: Elsevier Health Sciences.

Thomas, P. (2006).Integrating primary health care: leading, managing, and facilitating. London: Radcliffe Publishing.

WHO & UNICEF. (1978). Primary health care: A joint report by the director general of the who and the; Executive; Director of the Unicef prepared for the international conference; On primary health care, alma-ata. Geneva: WHO & Unicef.

Willis, E, Reynolds, L & Helen, K. (2008). Understanding the Australian Health Care System. Elsevier: Elsevier Australia.

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