Primary health care as a philosophical and practical framework for nursing education: rhetoric or reality?

Nursing in a different world: Remote area nursing as a specialist-generalist practice area

OBJECTIVE

Remote area nurses provide primary health care services to isolated communities across Australia. They manage acute health issues, chronic illness, health promotion and emergency responses. This article discusses why their generalist scope of practice should be formally recognised as a specialist nursing practice area.

DESIGN

Constructivist grounded theory, using telephone interviews (n = 24) with registered nurses and nurse practitioners.

SETTING

Primary health care clinics, in communities of 150-1500 residents across Australia.

PARTICIPANTS

A total of 24 nurses participated in this study.

RESULTS

Nurses' perceived their clinical knowledge and skill as insufficient for the advanced, generalist, scope of practice in the remote context, especially when working alone. Experience in other settings was inadequate preparation for working in remote areas. Knowledge and skill developed on the job, with formal learning, such as nurse practitioner studies, extending the individual nurse's scope of practice to meet the expectations of the role, including health promotion.

CONCLUSION

Remote area nursing requires different knowledge and skills from those found in any other nursing practice setting. This study supports the claim that remote area nursing is a specialist-generalist role and presents a compelling case for further examination of the generalist education and support needs of these nurses. Combined with multidisciplinary collaboration, developing clinical knowledge and skill across the primary health care spectrum increased the availability of health resources and subsequently improved access to care for remote communities. Further research is required to articulate the contemporary scope of practice of remote area nurses to differentiate their role from that of nurse practitioners.

Australian student nurse's knowledge of and attitudes toward primary health care: A cross-sectional study

BACKGROUND

Nurses have a pivotal role in changing the focus of the health system toward a primary health care approach, yet little is known about the effectiveness of nursing students' educational preparation for this role.

OBJECTIVES

The aim of the study was to investigate undergraduate Australian nursing students' knowledge of and attitudes toward the primary health care approach.

DESIGN

A cross-sectional, descriptive research design was applied.

SETTING

Two Australian universities, one with a rural base and one in the metropolitan area of Sydney, were involved. Both universities offer undergraduate and postgraduate nursing courses on multiple campuses.

PARTICIPANTS

A convenience sample of 286 undergraduate nursing students, each of whom had completed a unit of study on PHC. All provided consent to participate in the study.

METHODS

Data was collected using the Primary Health Care Questionnaire via online survey platform SurveyMonkey for a period of three weeks in June 2015.

RESULTS

Total knowledge scores ranged from 19.68 to 95.78 with the mean knowledge score being 69.19. Total attitude scores ranged from 33.12 to 93.88 with a mean score of 70.45. Comparison of knowledge scores showed mean scores of students born in Australia were significantly higher than those of students who were born overseas (p=0.01), and mean scores of students enrolled in the metropolitan university were also significantly higher than mean scores of students' enrolled in the rural university (p=0.002). In terms of attitudes scores, mean scores of Australian-born students were significantly higher than those of students born overseas (p=0.001), and older students' mean attitude scores were shown to be significantly higher than younger students' (p<0.005).

CONCLUSIONS

Student's age, country of origin and university location were shown to be significant influences on student's knowledge of and attitudes toward primary health care.

Social representations of nursing students about hospital assistance and primary health care

RESUMO Objetivo: analisar como se estruturam as representações sociais dos cuidados hospitalares e comunitários em dois grupos de estudantes de enfermagem - 1º e 4º anos. Métodos: pesquisa qualitativa orientada pela Teoria das Representações Sociais. Utilizou-se um questionário com Associação Livre de Palavras. Os dados foram analisados no Software IRaMuTeQ 0.6 alpha 3. Resultados: aplicou-se o método da Classificação Hierárquica Descendente e obtiveram-se 4 classes. A classe 4 tem a maior representação social (30,41%) do corpus. Os dois eixos organizadores são enfermeiro e doença/doente no núcleo central. Na periferia destaca-se o cuidado e ajuda ligados ao enfermeiro e o tratamento e a prevenção associados à doença. Conclusões: as representações sociais centram-se na doença/doente e no papel do enfermeiro no tratamento, prevenção e cuidado. A promoção da saúde e os determinantes sociais da saúde estão ausentes das representações sociais dos estudantes.

The situation of nursing education in Latin America and the Caribbean towards universal health

OBJECTIVE:

to assess the situation of nursing education and to analyze the extent to which baccalaureate level nursing education programs in Latin America and the Caribbean are preparing graduates to contribute to the achievement of Universal Health.

METHOD:

quantitative, descriptive/exploratory, cross-sectional study carried out in 25 countries.

RESULTS:

a total of 246 nursing schools participated in the study. Faculty with doctoral level degrees totaled 31.3%, without Brazil this is reduced to 8.3%. The ratio of clinical experiences in primary health care services to hospital-based services was 0.63, indicating that students receive more clinical experiences in hospital settings. The results suggested a need for improvement in internet access; information technology; accessibility for the disabled; program, faculty and student evaluation; and teaching/learning methods.

CONCLUSION:

there is heterogeneity in nursing education in Latin America and the Caribbean. The nursing curricula generally includes the principles and values of Universal Health and primary health care, as well as those principles underpinning transformative education modalities such as critical and complex thinking development, problem-solving, evidence-based clinical decision-making, and lifelong learning. However, there is a need to promote a paradigm shift in nursing education to include more training in primary health care.

OBJETIVO:

avaliar a situação da educação em enfermagem e analisar o quanto os programas de educação em enfermagem, no nível de Bacharelado na América Latina e no Caribe, estão preparando graduados a contribuir para o alcance da Saúde Universal.

MÉTODO:

estudo quantitativo, descritivo/exploratório, transversal, realizado em 25 países.

RESULTADOS:

um total de 246 escolas de enfermagem participaram do estudo. O corpo docente com nível de Doutorado totalizou 31,3%; sem o Brasil o número fica reduzido a 8,3%. A razão entre experiências clínicas nos serviços de atenção primária à saúde e nos serviços hospitalares foi de 0,63, indicando que os estudantes têm mais experiências clínicas nos cenários hospitalares. Os resultados sugeriram necessidade de aprimoramento relacionada ao acesso à Internet; tecnologia da informação; acesso para portadores de deficiências; avaliação do programa, do corpo docente e dos estudantes; e aos métodos de ensino/aprendizagem.

CONCLUSÃO:

há heterogeneidade na educação em enfermagem na América Latina e no Caribe. Os currículos de enfermagem incluem, geralmente, os princípios e valores da Saúde Universal e da atenção primária à saúde, bem como aqueles princípios subjacentes às modalidades de educação transformativa, como o desenvolvimento de pensamento crítico e complexo, a solução de problemas, a tomada de decisão clínica baseada em evidências, e aprendizagem contínua. No entanto, é preciso promover uma mudança de paradigma na educação em enfermagem que inclua mais treinamento na atenção primária à saúde.

OBJETIVO:

evaluar la situación de la educación en enfermería y analizar en qué grado los programas de educación de enfermería a nivel de grado en América Latina y el Caribe están preparando a los graduados para contribuir al logro de la Salud Universal.

MÉTODO:

se llevó a cabo un estudio transversal, cuantitativo, descriptivo y exploratorio en 25 países.

RESULTADOS:

participaron en el estudio 246 escuelas de enfermería. El porcentaje de profesores con títulos de doctorado fue de 31,3%; pero, si se excluye a Brasil esta cifra se reduce a 8,3%. La proporción de la experiencia clínica adquirida en los servicios de atención primaria de salud en relación con la adquirida en servicios hospitalarios fue de 0,63, lo que indica que los estudiantes adquieren la mayor parte de su experiencia clínica en entornos hospitalarios. Los resultados mostraron una necesidad de mejorar el acceso a internet; la tecnología de la información; la accesibilidad para las personas discapacitadas; la evaluación de los programas, de los profesores y de los estudiantes; y los métodos de enseñanza y aprendizaje.

CONCLUSIONES:

hay heterogeneidad en la educación en enfermería en América Latina y el Caribe. En general, los programas de estudios de enfermería han adoptado los principios y los valores de la Salud Universal y la atención primaria de salud, así como los principios que sustentan las modalidades de educación transformadora, como son el desarrollo del pensamiento crítico y complejo, la solución de problemas, la toma de decisiones clínicas basadas en la evidencia y el aprendizaje a lo largo de toda la vida. Sin embargo, hay necesidad de promover un cambio en el paradigma de la educación en enfermería, a fin de que abarque más capacitación en la atención primaria de salud.

The nurse practitioner role: Solution or servant in improving primary health care service delivery

In New Zealand, as in many other countries, the demand for health services is escalating as chronic disease, population ageing and health disparities increase. It has been argued that a more comprehensive primary health care approach is needed combining biomedical approaches with a social determinants and social justice based approach. The contemporary development of the nurse practitioner (NP) role in New Zealand (NZ) offers the possibility of taking up a more critical approach to strengthen and extend primary health care services (PHC). Nurse practitioners could simply be utilised to shore up the nature and style of existing primary care (PC) service configurations or, more usefully, they could lead a revolution in traditional approaches towards genuine primary health care delivery.

Nursing curriculum development in remote southwest Uganda

PURPOSE/AIM

To describe an intercollaborative outreach between the USA and a school of nursing in Uganda.

INTRODUCTION

Ugandan nurses are essential providers of health care in remote regions. High vacancy rates in health centers impacts care in rural areas.

BACKGROUND

A 112-bed health center in southwest Uganda supports village health teams that visit remote villages and provides medical, surgical, and maternal-child services to a population of 250,000. A new Ugandan school of nursing has aligned with the hospital to prepare graduates to provide primary care in remote villages. A team from the USA visited the school and hospital to assess the curriculum and offer educational strategies and support to the school's leadership.

EVIDENCE

Provision of primary health care in the developing world is a longstanding global priority. Nurses are at the center of primary care in remote regions. Educational support for advanced nursing and strategic international relationships can positively impact nursing education in both high and low-income countries.

DISCUSSION

The USA team took part in assessments, teaching, simulation, and remote village outreach. Educational strategies and modalities were shared.

CONCLUSIONS

The Ugandan nursing school is established and affiliated with another Ugandan university. Standardized curriculum is in place, however continued collaboration is needed for program adaptation to accommodate the unique border region environment.

IMPLICATIONS FOR HEALTH POLICY AND NURSING

Intercollaborative sharing of information and resources between schools of nursing can have a direct impact on global health initiatives in both high-income and low-income countries.

Primary health care in the mental health workplace: insights from the Australian experience

In Australia, Primary Health Care and the mental health sector have always shared a philosophy. In 1978, Primary Health Care was first put forward as a strategy to improve "health for all." Recently, the Australian Government included mental health as a national health priority, identifying six strategies consistent with a Primary Health Care approach to address the mental health of all Australians. Throughout this time, Primary Health Care has been highlighted in all models of care. However, in reality, it appears that in mental health services, mental health nurses, despite good intentions, are not delivering care in a planned or systematised way and that much needs to be done to further improve the situation for individuals accessing the health care system. Services currently focus on those identified as seriously mentally unwell; in order to really make an impact it is argued that services should be broader, offered to the population at large and, further, that the emphasis on case work at an individual level should be changed to an approach that considers prevention, maintenance, and follow-up as well as crisis intervention. This article reflects the Australian experience and offers some insights from that experience.