Nursing and preventive health care

By Rosemary Calder, Professor of Health Policy, Mitchell Institute, Victoria University

Source: APNA Primary Times Spring 2020 (Volume 20, Issue 2)

One in two Australians has one or more chronic conditions and these conditions disproportionally affect vulnerable groups, particularly people living in the lowest socio-economic areas, Indigenous Australians and people living with mental illness.

The global and national experience of COVID-19 has placed preventive health policies, services and practices at the centre of national responses.

A central learning from COVID-19 is the national reliance on individuals and communities to become involved in preventive healthcare for their own health protection as well as that of others – and that is just as important to prevent and protect individuals and communities from many chronic diseases.¹

A major weakness in Australian healthcare service arrangements is that there is no structured model of healthcare that prioritises preventive health care, for individuals and communities, in a systematic way.

There are government investments in preventive health services and approaches and limited support for individual engagement in preventive health actions and behaviours. The lack of systematic capacity to provide and support disease prevention further entrenches health inequalities and socio-economic disadvantage.

Our health service arrangements often impede effective management of chronic diseases and have been described as ‘too complex to navigate’² for consumers and health professionals alike.

Adding to structural weaknesses in health service arrangements are the relatively narrow and specific workforce roles that inhibit multi-disciplinary healthcare for both preventive and chronic and complex healthcare.

An integrated and comprehensive primary health care system has long been recognised³ as central to improved health care, requiring barriers between Commonwealth and state/territory funded health services and complex funding arrangements within and between these services to be dismantled.

Recent data on primary health care nurses⁴ shows that they comprise the largest group of primary health care professionals and are highly qualified and experienced. Australian evidence⁵ suggests nurses could contribute more to healthcare in the face of increasing demands by working to the top of their scope of practice, within the (actual rather than perceived) constraints of professional and contextual boundaries.

For primary health care nurses this includes providing direct education and self-management support to people living with or at increased risk of chronic disease. Extending the roles of primary health care nurses to enable nurse-led models of care has been associated with improved patient satisfaction, quality of life, and clinical outcomes.

One study⁶ showed patients’ satisfaction was higher with nurse-led care and an Australian study⁷ showed that when practice nurses combined their clinical skills with an educational role in chronic disease and self-management, patients reported feeling motivated and perceived the environment as encouraging and therapeutic.

Nurses were more likely than general practitioners to use the RACGP Smoking, nutrition, alcohol and physical activity (SNAP) health guide to assess patients’ behavioural risk factors, leading to improved health literacy and increased motivation in at-risk individuals to use relevant health information.

For primary health care to become more effective in supporting preventive health, service models and funding mechanisms should be implemented that enable primary health care nurses to work to the top of their existing scope of practice. Models of care delivery that give primary health care nurses greater flexibility and enhanced scopes of practice should be considered.

REFERENCES

1. Self-care and health: by all for all. Learning from COVID-19. Marcia Duggan. Mitchell Institute, Victoria University, July 2020
2. Australian Health Services: too complex to navigate. Rosemary Calder, Ruth Dunkin, Connor Rochford, Tyler Nichols. Policy Issues Paper, The Mitchell Institute, Victoria University, February 2019
3. Systemic National Challenges in Health Care, National Primary Health Care Strategic Framework, Australian Government Department of Health, 2013
4. A profile of primary health care nurses, Australian Institute of Health and Welfare, May 2020
5. Registered nurse scope of practice in Australia: an integrative review of the literature. Melanie Birks, Jenny Davis, John Smithson, Robyn Cant. Contemporary Nurse, 2016
6. Nurses as substitutes for doctors in primary care. Miranda Laurant, Mieke van der Biezen, Nancy Wijers, Kanokwaroon Watananirum, Evangelos Kontopantelis, Anneke JAH van Vught. Cochrane Database of Systematic Reviews, John Wiley & Sons, July 2018
7. A nurse-led model of chronic disease management in general practice: Patients’ perspectives. Jacqueline Young, Diann Eley, Elizabeth Patterson, Catherine Turner. Australian Family Physician, December 2016