We say we are doing primary health care but we're not: Remote area nurses’ perspectives on the challenges of providing primary health care services

Abstract

Background: Nurses are essential in global strategies to improve population health. However, there is a paucity of research that describes the application of primary health care from a nursing perspective. Australian remote area nurses work in primary health care clinics which are often the only health care service within the community. Services include acute care response as well as health promotion and public health activities. Question, Hypothesis or Aim:To explore the meaning and application of primary health care principles from the perspective of nurses in Australian remote settings.Methods: Telephone interviews were conducted with registered nurses and nurse practitioners working in Australian remote settings using constructivist grounded theory methods during 2014 and 2015.Findings: Nurses in remote settings considered primary health care to be an holistic social model of care that included caring for the community as well as the individual. However, they were unable to provide care consistent with their intention due to the resource-poor nature of the remote setting. Inadequate physical resources, limited specialist health services, and a lack of time were found to impact on remote area nurses' abilities to provide primary health care.Discussion: This study is unique in its description of a cause of remote area nurse stress as being the inability to provide primary health care in line with their expectations. Conclusion:Appropriate resourcing is essential for nurses to be able to provide a comprehensive array of holistic services in line with community-identified need that also reflect their own definitions of primary health care.

Exploring nurse practitioner practice in Australian rural primary health care settings: A scoping review

“…A lack of clarity about, and understanding of, the NP role by health professionals and the general public was also highlighted in several of the articles 18,31,35 . Finally, several sources included in this review assumed readers' knowledge and understanding of the role of the NP and did not include a description 37–41 …”

“…In addition, factors related to context such as risk of burnout due to lack of holiday relief and study leave 8,31,40 ; professional isolation 8,18 ; and lack of mentorship 8 were identified as further barriers to continuing in the NP role in primary health care. Additional barriers included a lack of integration within the wider health system 34 ; a lack of support from management staff and colleagues 18,40 ; lack of resources including the availability of human and physical resources, information technology infrastructure 37,38 ; and lack of time to give adequate primary care and nonclinical workload impacting clinical care 38 . The lack of awareness, clarity and understanding of the NP role by consumers and other health professionals was also identified as a barrier to gaining acceptance and support for the NP role 18,29,31 …”

“…14 Several sources reported NPs' descriptions of their role in primary health care that included providing care from a social and holistic perspective; with a focus on wellness, health promotion, prevention of ill health, management of chronic disease and encouraging community participation in health services. 37,38 Nurses in these articles also reportedly spoke about their goals of achieving equality in access to health services, and making a difference in the lives of individuals and the community. 37,38 A lack of clarity about, and understanding of, the NP role by health professionals and the general public was also highlighted in several of the articles.…”

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

“…In this study, nursing practice in remote areas is explored and the argument presented that remote area nursing practice is an advanced and specialised nursing role. The findings reported herein form part of a larger study of the PRIMARY HEALTH CARE role of nurses in remote Australian settings, [26][27][28] which aimed to describe the actions and interactions used by nurses, the contexts and conditions and the factors which enhanced or inhibited the delivery of primary health care in the remote setting. An overview of the theoretical framework developed in the larger study, with the findings of this study highlighted in bold text, is presented in Figure 1 below:…”

The Contribution of Intersectoral Healthcare Centres with an Extended Outpatient Care Model to Improve Regional Care-Structures—A Qualitative Study

“…For example, in Finland in 2015, 226 municipal (primary) health centers featured “inpatient hospital-type wards” [ 3 ] (p. 103). In those—especially in rural areas—physicians or nurses are present intermittently due to limitations in staffing, but also, about 50% of acute cases do not require physicians’ intervention and can be dealt with by a nurse [ 4 , 5 ]. In the US, so-called Micro-Hospitals are created that typically are licensed for a minimum of 8 beds, seeing 25 to 80 emergency patients a day [ 6 , 7 ].…”