Community & Primary Health Care Nursing Week
Nurses where you need them 18–24 SEPTEMBER 2017
With thanks to the support of our official sponsor
Advancing nurse leadership
www.acn.edu.au/CPHCNW
www.acn.edu.au/CPHCNW
Contents 4 Welcome 5 Foreword 6
Why we need community and primary health care nurses
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Our Community and Primary Health Care Community of Interest
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Why do you need community and primary healthcare nurses?
With thanks to the support of our Official Partner
The opinions expressed within are the authors’ and not necessarily those of the Australian College of Nursing or the editors. Information is correct at time of print.
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Welcome I am pleased to present to you the 2017 Australian College of Nursing (ACN) Community and Primary Health Care Nursing Week eBook. Written by community and primary health care nurses from across the country, our eBook features a fascinating collection of stories that highlight the vital role nurses play in our communities. These registered nurses, enrolled nurses and nurse practitioners are leading and providing care in a broad range of service delivery settings in metropolitan, rural and remote areas throughout Australia. Their stories explore why community and primary health care nursing is so vital to the health and wellbeing of our society. From an engaging piece about meeting the physical and mental health needs of our patients by one of our passionate members, Barbara Williams MACN, to an intriguing article exploring Brett Hatfield’s most memorable experiences as a refugee health nurse, our eBook showcases the diverse skill set and scope of practice within the community and primary health care nursing workforce. Nurses working within primary and community care are well placed to meet the health inequalities experienced in the Australian population. They can help bridge the often fragmented health care system and support continuity of care. While community and primary health care nursing makes an important contribution to our health system, this is not well recognised by politicians and the general public. Future frameworks and policy reforms will need to respond, recognise and fully utilise community and primary health care nursing in order to improve access to quality care. Through this eBook, we are raising awareness about the importance of community nursing and supporting the shifting of care from the acute to the primary health care sector. Enjoy this inspiring read! Adjunct Professor Kylie Ward FACN, Chief Executive Officer of Australian College of Nursing (ACN)
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Community & Primary Health Care Nursing Week 18–24 SEPTEMBER 2017
Foreword With an aging population increasing the burden of chronic and complex disease, emerging infectious diseases and health and social inequalities between Australian subpopulations, it is evident that a community and primary health care response is required (International Council of Nurses, 2012). As community and primary health care nurses, we are well aware of these shifting complexities and why we need to be central to such policy progress and practice development. Our focus of this year’s eBook is appropriately Nurses where you need them: why you need them. By sharing these nursing experiences we add voice to the many reasons why our communities need the nursing services provided and the wonderful outcomes that can be achieved. Be it ensuring that parents are supported and affirmed in their roles; assisting with the integration of refugees into our communities; supporting older people to readjust after extended hospitalisation; or providing home based palliative care to those who are dying. So many reasons why nurses are needed… I hope you will be inspired by the many stories that are presented within this year’s edition aimed at highlighting the amazing work of our community and primary health care nurses. Kate Partington MACN, ACN Community and Primary Health Care Nursing Community of Interest Key Contact
Community & Primary Health Care Nursing Week 18–24 SEPTEMBER 2017
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Why do you need community and primary health care nurses?
Why we need community and primary health care nurses ACN supports and values the importance of community and primary health care nursing. We advocate for and work with nurses to ensure that the Australian community is receiving the highest standard of care from the primary health care sector.
• Rehabilitation and palliation
Community and primary health care nurses work in broad service delivery settings across Australia, such as:
• Education and research
• Community settings, including women’s health and social service settings
• Data management
• Workplace health and safety • Population and public health
• Correctional health
• General practices
• Policy development and advocacy (APNA, 2017).
• Domiciliary settings in the home, including residential aged care, prisons, boarding houses and outreach to homeless people
Community and primary health care nursing applies a social model of care that addresses the needs of individuals and communities while considering the social, economic and environmental factors impacting their health (Australian Nursing and Midwifery Federation, 2009). Community and primary health care nurses’ wide scope of practice enables them to coordinate care and liaise with other professionals across the health care system and between service providers from other sectors (McMurray & Clendon, 2015).
• Educational settings, including preschool, primary and secondary school, vocational and tertiary education settings • Workplace health and safety settings • Informal and unstructured settings, including roles at sporting events and community groups (Australian Primary Health Care Nurses Association (APNA), 2017). Their roles within these settings are diverse and may include: • Treatment and care of sick people • Illness prevention • Health promotion • Antenatal and postnatal care • Child and family health nursing • Immunisation • Women’s health • Management of chronic diseases
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• Community development
Given our increasingly ageing population, the rising rate of chronic and complex disease, workforce pressures, widening inequities in health outcomes and access to services (Department of Health, 2013), and growing health care costs, the role of community and primary health care nurses is integral in striving for optimal outcomes for all people across their lifespan. A high capacity, integrated primary health care system is at the centre of any effective health system (Department of Health, 2013; Department of Health, 2015). For this system to operate to its full potential, all nurses, including nurse practitioners, need to be able to work to their full scope of practice. There are significant opportunities to make better use of the clinical skills and knowledge nurse practitioners have, including enabling greater access to Medicare Benefits Schedule item numbers.
Community & Primary Health Care Nursing Week 18–24 SEPTEMBER 2017
Why do you need community and primary health care nurses?
Changes in the primary health care sector include the establishment of the Health Care Home model of care in 2015 as a new initiative to address chronic disease and complex conditions in Australia. The model enables eligible patients with two or more chronic conditions to enrol with a participating medical practice that will oversee the patient’s coordination, management and support of their conditions (Department of Health, 2017). It is intended for this scheme to alleviate pressures on the primary and community health sector, as this sector is often the main location where people with chronic diseases seek help (Bodenheimer et al., 2002). The Primary Health Care Advisory Group stated that nurse practitioners have the required skills to be one of the preferred clinicians within the Health Care Home model of care (2016). To meet Australia’s growing demand for community and primary care, nurse practitioners need to be able to deliver the care they are trained to do (Carter et al., 2015). Community and primary health care nurses help individuals achieve pronounced outcomes even beyond their own health. An example from Philadelphia, Pennsylvania and the United States identifies advanced practice nurses providing care in school settings, resulting in less absenteeism, discipline problems and course failures, as well as reduced emergency presentations and hospitalisation rates (International Council of Nurses, n/d).
References ACT Labor, ACT Labor’s Ten Year Health Plan, < https://d3n8a8pro7vhmx. cloudfront.net/actlabor/pages/477/attachments/original/1473998555/10_ year_health_plan_final.pdf?1473998555>. Australian Nursing and Midwifery Federation 2009, Primary health care in Australia. A nursing and midwifery consensus view, <http://anmf.org.au/ documents/reports/PHC_Australia.pdf>. Australian Primary Health Care Nurses Association (APNA) 2017, What is primary health care nursing?, <https://www.apna.asn.au/profession/ what-is-primary-health-care-nursing>. Bodenheimer, T, Wagner, EH & Grumbach, K 2002, ‘Improving primary care for patients with chronic illness’, Journal of the American Medical Association, vol. 288, no. 14, pp. 1775-1779. Carter, MA, Owen-Williams, E & Della, P 2015, ‘Meeting Australia’s Emerging Primary Care Needs by Nurse Practitioners’, The Journal for Nurse Practitioners, vol. 11, no. 6. Davies, A 2016, ‘Nurse Practitioner leadership in patient-centred collaborative care’, Australian Nursing and Midwifery Journal, vol. 24, no. 4. Department of Health 2017, Health Care Homes: Reform of the Primary Health Care System, Australian Government, <http://www.health.gov.au/ internet/main/publishing/nsf/content/health-care-homes>. Department of Health, Primary Health Care Advisory Group 2015, ‘Better Outcomes for People with Chronic and Complex Health Conditions through Primary Health Care Discussion Paper’, August 2015, Canberra. International Council of Nurses n.d., Education Plus Health, USA, <https:// www.icnvoicetolead.com/case-study/education-plus-health-usa/> McMurray, J & Clendon, J 2015, Community health and wellness: primary health care in practice, 5th edn, Elsevier, Chatswood. Primary Health Care Advisory Group 2016, Primary Health Care Advisory Group Final Report Better Outcomes for People with Chronic and Complex Health Conditions, Department of Health, < http://www.health.gov.au/ internet/main/publishing.nsf/Content/primary-phcag-report>. The Department of Health 2013, Systematic National Challenges in Health Care, Australian Government, < http://www. health.gov.au/internet/publications/publishing.nsf/Content/ NPHC-Strategic-Framework~systemic>.
An example of a successful Australian nurse-led model in primary health care, is the nurse-led walk-in centres in the Australian Capital Territory (ACT). The ACT is continuing to expand the service, with an extra two centres to be built in 2018 (ACT Labor). We must continue to invest in community and primary health care to support nurses and improve outcomes for the Australian community. If you are interested in transitioning to the primary health care environment take a look at the newly developed Australian Government funded, Career and Education Framework for Nurses in Primary Health developed by the Australian Primary Health Care Nurses Association (APNA): MyNursingFuture.com.au.
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Our Community and Primary Health Care Community of Interest ACN’s Community and Primary Health Care Community of interest (COI) aims to support nurses with a passion for this special area of nursing seeking to ensure good health outcomes for all people across their lifespan. The COI’s particular focus is on a social model of health that addresses not just the individuals’ health issues but also factors in their social, economic and environmental settings, which affect their wellbeing. The COI encompasses a wide spectrum of specialities across all geographical areas in Australia – from community nursing to practice nursing; working with refugees, children, the homeless; forensic nursing and many more places where nurses are needed across our community. By joining our Community and Primary Health Care COI you will be stepping into a collegial and welcoming professional group, which is passionate about challenging the status quo, celebrating our achievements and ensuring the best possible outcomes for our communities. Find out more: www.acn.edu.au/regions-communities
Why do you need community and primary health care nurses?
Care from birth to death Karen Gunner Community nursing has always had a place in our society assisting in maintaining health and wellbeing, however this has evolved and is now vitally important in not only supporting people and their care givers, but supporting the health care system. Medical advancements have reduced the length of patients’ hospital stays drastically, consequently, recovery now occurs at home. Community nurses are often involved in assisting with the acute medical management at home, lessening the exposure to iatrogenic illnesses. From birth to death, community nurses have the privilege to visit homes, gain insight into private lives whilst providing thorough nursing assessments that can prevent an acute admission and support early medical intervention. With the aging population, people are living longer but not necessarily healthier. The rise in chronic diseases places a strain on the hospital system, community and primary health nursing plays a vital role in providing supportive services and reducing hospital admissions.
“Community nurses are not only care givers, but assessors, educators and advocates.”
Today’s health care is also about choice — choice of services and treatments, by whom and where. Health care is a complex system for people to understand. Community nurses are not only care givers, but assessors, educators and advocates. Community nurses empower clients and carers by ensuring they are fully informed, and equipped to make decisions that best suit their needs. The challenges faced by rural communities in accessing health care are well known. The rural community nurses are the link, bringing health care to the homes of clients and their family and are the reason why community nursing is vital in today’s society.
Community & Primary Health Care Nursing Week 18–24 SEPTEMBER 2017
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Q/A: Community and Primary Health Care Nursing
Samantha Petric MACN ENL (Stage 4) Why do you think community and primary health care nursing is vital to the health and wellbeing of our society? Nurses are integral to service delivery. Nurses understand the unique challenges faced by our patients and clients because often we live and work in those very same communities. Community and primary health care nurses are vital to empower Aboriginal health workers in order to create balance and wellbeing within those communities we work and live in. Why is it important that others understand the important work of community and primary health care nurses? It is important because primary health care nurses face unique demands and challenges in their roles, which requires innovation, creativity and frank determination in order to complete many tasks that are required by us who work out bush. A lot of this work is without praise and is invisible to many, however, if people understood more of the complexities of the job and role, I think greater funding and education would increase the workforce, and the resources available to communities. Why would you encourage a nurse to work in this area of practice? Rural and remote area nursing is diverse, complex, challenging and fun. It has unique experiences and opportunities to think outside the box. Your role and scope of practice depends on not only policies, but circumstances, time and available resources. It gives a long-lasting, deep impression of Aboriginal Health and colonisation. Today, requirements of courses exist (REC, MEC, pharmacotherapeutics, vaccinations etc), but there are many opportunities to upskill. It is a great way to explore Australia! Where to next? What is your role and how is this valuable to the community? I am finding it difficult to put this answer into words. I am a remote area nurse (RAN) who works in an Aboriginal community. You hope that you’re valuable, but the truth is, that when you leave, there will be another to replace you. I think this is important to remember for there are many community members who do not have the opportunities, as we casual RAN’s do. I think the measure of ‘value’ is in the small moments, such as a “thank you sister” or invitation to dinner and a request to come back!
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What led you to pursue a career in community and primary health? I have always had an urge to head out bush and work in rural facilities and remote clinics. I have built up my career to guide this interest and now have been working and living within these communities. I grew up in Metropolitan Sydney to immigrant parents, so living in rural Australia or ‘out bush’ invigorates my personal and professional life on many levels. I think having fun and applying for contracts with an adventurous streak definitely helps! The flexibility of this work could include: Jervis Bay for the whales? Far North Queensland for the Great Barrier Reef? King Island (off the Tasmanian coast) to experience island life? Alice Springs for a desert experience? Margaret River in WA for the wineries? Can you provide an example of when you’ve felt your work is making a difference? Working within the Aboriginal Health Practitioners First Framework means that, as the remote area nurse on call, you are the second responder. Recently, I was having a chat with the Aboriginal health practitioner on call who said that I was the first nurse in many years to support and encourage her to make clinical decisions and perform clinical tasks without taking over. She said she liked working with me, as she had forgotten how to do an ECG and take bloods. I realised that, as that new ‘blow-in’ remote area nurse, I can make a little difference and empower Aboriginal health practitioners by not bulldozing, taking things a little slower and allowing space for team decision making.
Community & Primary Health Care Nursing Week 18–24 SEPTEMBER 2017
Why do you need community and primary health care nurses?
Nurse-led primary health Anita Erlandsen I studied nursing in my late 30s and during my first clinical placement in a hospital, I knew that it wasn’t for me. During third year, a placement at a nurse-led primary health facility (where I now work) suddenly made everything fall into place. I knew that primary health was for me. I did my graduate year at the Royal Women’s Hospital in Melbourne then tried to find a way to get back into primary health. I started in general practice in a large country clinic where 90% of the doctors were overseas trained. I was in the right place at the right time when practice nurses were being promoted and I managed to secure a scholarship to do a Post Graduate Diploma in Primary Care Nursing, then went on to do my cervical screening and immunisation accreditations.
“Community and individual empowerment is at the centre of everything we do and almost every day you feel like you have made a difference to someone’s life.”
Finally, a job opened up in at the primary health centre where I had done my final student placement (I had been told during this placement that someone had to die for a job to open up – thankfully it was not a death but someone moving away) and I applied and got the job. I started as the part time women’s health nurse and currently work full time doing women’s health and continence and occasionally stepping up to management. This centre is located in New South Wales on the Victorian border. It has this amazing group of nurses and Aboriginal health workers and support staff who go out of their way to help the local community stay healthy. Community and individual empowerment is at the centre of everything we do and almost every day you feel like you have made a difference to someone’s life. We help people to be well, we help people stay out of hospital and we help people die in a way they want to die. We provide exercise programs, falls prevention programs, health screening and monitoring, immunisations, ante and post natal care, child and family health – you can honestly say it is care from birth to death and everywhere in between.
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Why do you need community and primary health care nurses?
Coordinated, committed and connected care Anne-Marie Constant Care Coordination (CC) is nurse-led and part of the Community Chronic Conditions Service (CCCS) for the Sunshine Coast Hospital and Health Service (SCHHS). The aim is prevention of avoidable hospital presentations/admissions to SCHHS hospitals. Patients are sourced directly from Emergency Department Information System (EDIS) data, with eligibility defined to patients with cardiac, respiratory and diabetes chronic conditions. A monthly report is generated identifying potential patients who are triaged using available clinical information. For consenting patients, CC intervention incorporates holistic assessment, chronic disease management plan, referrals for supports, and health coaching. The patient is then referred for six months of case management by the CCCS nurses, who operate within a multidisciplinary environment; and often results in referrals to the allied health team. Ongoing emergency department (ED) presentations/admissions are monitored by CC and trigger additional contact/intervention. Development of the management plan with the patient/carer is aimed at either preventing or preparing for any further hospital presentations/admissions by ensuring patient understanding of any deterioration in their health status and appropriate action to manage their chronic disease. Monitoring is conducted for 12 months, including the number of ED presentations/admissions to hospital. Data collection has demonstrated a reduction in patient presentations to hospitals on average 72% over a six-month period and 63% over 12 months in the period April 2015 – April 2016. The reduction in ED presentations demonstrates improved outcomes for the patient and reduced demand on ED, which has a projected savings of $605 – $933 per presentation, this projection is based upon Triage Cat 3 Non-admitted vs Admitted (Department of Health Queensland, ABF & NEP Price Weights, 2016-17). Additional savings not identified may be occurring from admissions that are prevented for this group of patients. The success of CC is attributed to proactive nursing intervention, timely intervention, comprehensive assessment and patient centred care plans. The crux of CC is health education, improved health literacy, intensive follow up and targeted intervention. This includes engagement with general practitioners, non-government organisations/service providers, specialist services, ED staff and carers. The ultimate aim is to ensure patients have improved access to well-defined, transparent pathways that enable self-management of their chronic disease/s. Reference Department of Health Queensland ABF & NEP Price Weights 2016-17 V3.0 http://qheps. health.qld.gov.au/abf/html/015-abf-model.htm
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Community & Primary Health Care Nursing Week 18–24 SEPTEMBER 2017
“The success of Care Coordination is attributed to proactive nursing intervention, timely intervention, comprehensive assessment and patient centred care plans.”
Why do you need community and primary health care nurses?
Meeting the physical and mental health needs of our clients Barbara Williams MACN The primary health care sector plays an integral role in providing preventive physical and mental health care strategies, screening for illness, and early intervention. District nurses are an important part of the primary health care sector in Australia, working with a variety of people with diverse health needs. To get the best health outcomes for our clients, we must address both their physical and mental health. I have been lucky enough to work for the past 11 years as a mental health, clinical nurse consultant (CNC) at the Royal District Nursing Service (RDNS), a large Melbourne-based district nursing service that is part of the not-for-profit Returned and Services League (RSL) Care and RDNS Group. Our organisation supports more than 100,000 community care clients. Adopting a model of mental health care has allowed our organisation to provide more holistic care. We have done this by building the capacity of nurses to identify signs of possible ill mental health and obtain appropriate assistance, and by having access to expert mental health advice within the organisation to assist in addressing clients’ mental and physical health care needs. For example, Ms B, 72, was a single woman who lived alone. She had been living with paranoid schizophrenia for many years, which led to difficulties engaging with health services, and her health had deteriorated as a result. Knowing Ms B’s mental health history, our mental health CNC was able to advise visiting nurses around communication strategies that would minimise Ms B feeling suspicious or “paranoid” about RDNS visits, allowing nurses to engage her in managing her physical health. Using these strategies, RDNS could provide the care Ms B required until she was well enough to be discharged.
“Adopting communication strategies that enhance engagement of people living with mental illness so that we can assist them with their health needs leads to improved health outcomes”.
Identifying clients who are at risk of developing mental illness and intervening early has the potential to dramatically decrease their development of ill mental health and may also enhance their ability to look after their physical health. Adopting communication strategies that enhance engagement of people living with mental illness so that we can assist them with their health needs leads to improved health outcomes.
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Why do you need community and primary health care nurses?
Connecting and supporting refugees Brett Hatfield I have always wanted to work as a nurse in the humanitarian setting, hence why I trained as an emergency nurse at an inner-west Sydney hospital. It wasn’t until I finished my postgraduate degree in international public health that I found myself a job with the NSW Refugee Health Service. Within this nurse led team, we are the initial point of contact with Australia’s health care system for newly arrived refugees. We perform a comprehensive assessment on each patient to identify their many health needs, and then connect them with the appropriate services to ensure those needs are being adequately met. For those refugees who arrive with no literacy in English, navigating their way through Australia’s complex health care system alone can be near to impossible. Having the opportunity to meet and support newly arrived refugees by advocating for their health is why I have found a love for this exceptionally important nursing role. My most memorable experience as a refugee health nurse was earlier this year when I met with two middle aged sisters from Syria. After asking several of the standard health assessment questions they began to talk about their experiences in Iraq. One sister spoke for nearly 10 minutes with the interpreter hurriedly writing down notes and having to stop her every 30 seconds to interpret the story back to English for my understanding. She spoke of the abhorrent physical and verbal abuse that she received from strangers back home because she was of a Christian minority. At the end of the conversation the sister stopped, took a big breath, and said “wow that felt good. That was the first time that someone has asked us about our experience in Iraq, and us being able to answer without fear of judgment or feeling like we are being interrogated.” They were referring to the challenging refugee application process overseas that usually involves multiple questions about their traumatic experiences in order to determine whether they are a genuine refugee. It was extraordinarily special for these two women to completely open up in the interview. I then had the wonderful opportunity to connect them with a counselling service that specialised in supporting people from a refugee background.
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Community & Primary Health Care Nursing Week 18–24 SEPTEMBER 2017
“For those refugees who arrive with no literacy in English, navigating their way through Australia’s complex health care system alone can be near to impossible”.
Why do you need community and primary health care nurses?
With women Brigid Coombe MACN I sit with you…in silence… or in conversation making space...room for you. For your expectations your urgency your practicality your shock your anger your sadness your fear your hurt understanding...you are not a failure bearing witness to your decision tell me all, tell me nought – you know best. what might you be thinking but cannot, dare not ask? sensing what you need...responding where you are at....
“When you go home happy my job is done.”
a different way of thinking? Walking quickly slowly slowly so you can cope...quickly so that you don’t run out of time there is room for your laughter and questions are fine what do you need to hear? injections we can do sleep if you want wake as you are keep you safe then send you on your way we’re just a phone call away. Sometimes I shed a tear with you feel you lingering with me til evening…I might refill that glass of wine. How much a smile can mean a friendly gesture a hug of thanks when you go home happy my job is done. Work with heart why I came…why I stay.
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FEE-HELP
is now available for all of our gradua te certificate course s
SPECIALISE IN COMMUNITY AND PRIMARY HEALTH WITH ACN GRADUATE CERTIFICATE IN CHILD AND FAMILY HEALTH NURSING Child and family health nurses require an appreciation of the biopsychosocial, cultural and emotional needs of the family to promote a nurturing and supportive environment in which children can thrive and grow. This course takes all of these factors into consideration to prepare nurses for a rewarding career in this field. Career opportunities may include: • Specialist nursing within child and family health • Clinical education and consultancy roles • Management roles
Why study with ACN? ACN is a leading provider of postgraduate and vocational education for registered and enrolled nurses. When you study with ACN you can be confident that you have chosen a college that is recognised for providing courses with strong clinical focus and evidence based practice. Our comprehensive courses are designed and developed by nurse educators to ensure that they build your clinical skills and advance your knowledge in your specialty area of practice.
• Rural and remote nursing roles.
Advancing nurse leadership
www.acn.edu.au/child-and-family-health-nursing
Why do you need community and primary health care nurses?
“The best move I ever made…” Christine Ashley FACN As the population ages and rates of chronic and complex disease increase, community and primary health care (PHC) nursing is vital to the health and wellbeing of our society. This contribution not only comes about by providing excellent clinical nursing care, but also by creating new knowledge, developing and testing innovative models of care, and understanding the workforce and education needs of nurses in PHC settings. We are all aware of the rapid growth of the PHC nursing workforce in Australia over the last decade. However, despite this, there has been limited attention paid to how nurses transition into these settings. As a Doctoral candidate in the School of Nursing at the University of Wollongong, I have led a mixed methods study exploring the transition experiences of acute care nurses who choose to move to PHC employment. Nurses from across Australia who had recently transitioned, completed a survey which asked questions about their reasons for moving to PHC, difficulties experienced and their future career intentions (Ashley et al., 2017a). A purposively selected group of respondents were also interviewed to gain in-depth personal accounts of the challenges and opportunities created by their transition. Several study participants said that they had moved to PHC predominantly for personal rather than professional reasons. However, overwhelmingly, nurses spoke positively of their work in PHC, in particular they valued interactions with clients and families, the autonomous nature of PHC nursing and the diversity of their roles (Ashley et al., 2017a; 2017b). Most stated that they intended to remain in PHC at least in the short term. There were some down sides though. Rates of pay remain unequitable with the acute sector, and accessing leave or financial support to attend professional development activities was reportedly difficult. As many PHC nurses work alone in their roles they also described the value placed on having access to a mentor to provide guidance and support (Ashley et al. 2017). This study has reaffirmed that PHC nursing offers excellent career opportunities. Armed with the knowledge gained from the study findings, employers need to ensure that nurses have access to professional supports and learning opportunities in order to maximise the contribution they make to improving the health of the Australian community.
“Several study participants said that they had moved to PHC predominantly for personal rather than professional reasons.”
Authors of the study Christine Ashley RN, B.Hth Sc., MN, FRCNA, Doctoral Candidate, University of Wollongong Professor Elizabeth Halcomb, RN BN (Hons) PhD FACN. Professor, Primary Health Care Nursing, University of Wollongong Associate Professor Kath Peters, RN BN (Hons) PhD, Director of Academic Program (International), School of Nursing & Midwifery, Western Sydney University Dr. Angela Brown RN BSc (Hons) Cert Ed PG Dip MA PhD. Honorary Professorial Fellow, University of Wollongong.
Reference shley, C., et al., Experiences of registered nurses transitioning from A employment in acute care to primary health care – quantitative findings from a mixed methods study. Journal of Clinical Nursing, 2017. In press. DOI:10.1111/jocn.13930 shley, C., et al., Registered nurses transitioning from acute care to A primary health care employment: A qualitative insight into nurses’ experiences. Journal of Clinical Nursing, 2017. In press. DOI: 10.1111/ jocn.13984
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Q/A: Community and Primary Health Care Nursing
Dr Elizabeth Halcomb FACN Why do you think community and primary health care nursing is vital to the health and wellbeing of our society? Our world is changing rapidly and so too are the health needs of our community. This is creating a growing need to deliver health care within the community setting and address risk factors before disease symptoms occur. Nurses, as part of a multi-disciplinary primary health care team, are well placed to deliver the kinds of education and supportive interventions that can address many of these needs. Early intervention and health education are clearly important in improving long term health and wellbeing. Why is it important that others understand the important work of community and primary health care nurses? From the research that we have undertaken to date, we often hear how other nurses and the community see community and primary health care nursing as somehow less valuable than nursing in acute care. Understanding what community and primary health care nurses do within the community is the first step in valuing the important contribution that these nurses make to individuals, their families and communities. Valuing the contribution of nurses has the potential for positive impacts on recruitment and retention, job satisfaction and appropriate reward and recognition of the role. Why would you encourage a nurse to work in this area of practice? Working in community and primary health care allows nurses to work with a range of individuals, their families and communities to improve health and wellbeing. As our communities change, this work has become increasingly challenging and satisfying for nurses. The diversity of roles across community and primary health care settings offers nursesâ&#x20AC;&#x2122; a range of stimulating career choices that can facilitate nurses to work to the full extent of their scope of practice, often in fairly autonomous models of care. The often prolonged engagement with clients allows nurses to see the impact of the nursing care that they provide on the lives of individuals and their communities.
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What is your role and how is this valuable to the community? My role as a Professor of Primary Health Care (PHC) Nursing is to contribute to the development of new knowledge through the conduct of research around PHC and, secondly, to develop research and leadership capacity amongst others working in PHC. Such a role is valuable to the community as it helps to inform the delivery of services in PHC and subsequently optimises health outcomes, improves consumer experiences, minimises expenditure and promotes sustainability of interventions. Given the rapidly changing PHC landscape and the increased role of nurses in primary care it is important that nursesâ&#x20AC;&#x2122; voices are heard and that the capacity of nurses in PHC research and leadership is developed. What led you to pursue a career in community and primary health? I was fortunate enough to be mentored by Professor Patricia Davidson (now Dean at Johns Hopkins University) during my PhD in the early 2000s. When I had to change my Doctoral study topic, she suggested that there might be scope to investigate the growing nurse workforce in general practice. I soon discovered that this was truly an emerging area of nursing practice, and that it offered significant potential for nurses to contribute to the debate and discourse as it developed. Working in this area I have had the fortune to meet many outstanding nurses who make a huge impact on the lives of those for whom they care. I feel privileged to be able to continue to research and teach in the area of community and primary health through my role as Professor of Primary Health Care Nursing. The nurses, other health professionals and researchers who I work with constantly inspire me to continue to work in this space.
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Q/A: Community and Primary Health Care Nursing
Can you provide an example of when youâ&#x20AC;&#x2122;ve felt your work is making a difference? It is always difficult to be sure that your work is really making a difference. One area where I really see the difference that I make is through the research students I have the pleasure of supervising and the clinicians whom I mentor to undertake PHC research. By facilitating and mentoring these talented individuals I see them flourish into experienced researchers who make their own mark on the primary and community landscape nationally and internationally. Since taking up my role at the University of Wollongong I have led the development of a research strength in primary health care nursing. In these four years, four Bachelor of Nursing (Honours) and one PhD student have submitted theses related to community and primary health nursing. Currently, two Bachelor of Nursing (Honours) and four PhD students are working on projects around aspects of primary health care nursing. All of these PhD scholars have been successful in gaining competitive scholarships to support full-time study. Creating opportunity for nurses to undertake research training in this area of practice is making a significant difference. Not only is it opening career pathways for these individuals but it is also actively contributing to the body of knowledge around community and primary health and making the nursing voice heard.
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Why do you need community and primary health care nurses?
Living your best life Melanie Press MACN Few occupations are as comprehensive in scope as nursing, while few specialisations within the nursing arena are as all-embracing as community and primary health care nursing. Few locations for the delivery of our vocation are as versatile, flexible, challenging and rewarding as those in remote Australian settings. Community and primary health care nursing is vital to the health and wellbeing of our home town inhabitants as they offer the impetus to provide resources and support so our community members can self-care with confidence, born from the encouragement and education we provide. The community empowerment that is fostered in our society is not only uniquely tailored to each individual’s level of need, but is also actively encouraged by the health service team for the community as a whole. A recent example of this is a survey distributed throughout our community which asked ‘how do you envision living your best life?’ The dominant answer was spending time with family. In response to this community recognised priority, the health service held a movie and meal night for families to attend. And so they did. Over one hundred people of all ages attended our night, from children to grandparents. For a township populous of 700 people, to have an attendance of over 100 is a phenomenal result. Community and primary health care nursing roles are challenging, pre-emptive and energising. They are the epitome of health – not illness – care. The motivating goal is maintaining quality of wellness despite medical diagnoses and ongoing management. It is well known that, in remote communities, there is a high level of stoicism and self-reliance. These descriptors mean more than just resignation of the inevitable decline in functionality and stubbornness. These descriptors, when channelled appropriately by passionate, embedded health care teams translate to increased individual resilience and self-empowerment when health and wellness begins to decline, by increasing health literacy on an individual and collective basis. This is the power of community and primary health care nursing.
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Community & Primary Health Care Nursing Week 18–24 SEPTEMBER 2017
“The motivating goal is maintaining quality of wellness despite medical diagnoses and ongoing management.”
Why do you need community and primary health care nurses?
Community Continence CNC Claire Dobson MACN I am a continence clinical nurse consultant (CNC) with 25 years’ experience in the acute and community sector. It is estimated that 4.8 million Australians are affected by incontinence (Continence Foundation of Australia, n/d) and with an ageing population that figure is predicted to rise. The impact of incontinence is not only financial but also involves the caring element of looking after someone with a problem. There are taboos and myths relating to continence issues that hopefully can be dispelled by clients being referred to specialist services dealing with the issues. These include: continence nurses, physiotherapists and medical teams. Part of my role includes a clinical component – assessing clients in their home or a clinical setting from ages five to 105, and giving support and advice to assist in their bladder and bowel health. Incontinence does not discriminate, and urinary and faecal incontinence can affect people at any age. It can be overwhelmingly embarrassing and socially isolating.
“I am very passionate about my clinical speciality and also a very strong advocate for health promotion.”
My aim is to overcome the client’s embarrassment and to work with them or their carer to achieve goals by formulating individual plans and management strategies. To make a difference and improve a client’s and/or a carer’s quality of life and to put a smile back on their face is very fulfilling as a CNC. I am very passionate about my clinical speciality and also a very strong advocate for health promotion and when possible I am involved in continence awareness and continence education in the health and community sectors.
Reference Continence Foundation of Australia, n/d, Key statistics, accessed 11 July 2017, < https://www.continence.org.au/pages/key-statistics.html>
Community & Primary Health Care Nursing Week 18–24 SEPTEMBER 2017
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Q/A: Community and Primary Health Care Nursing
Karina Stewart Why do you think community and primary health care nursing is vital to the health and wellbeing of our society? • Primary health care nurses provide timely access to health care in GP practices and nurse led clinics • Primary health care nurses provide opportunistic health promotion, education, healthy lifestyle choices to patients • Primary health care nurses are responsive to the changing health needs in society, they are proactive and innovative, they are well positioned to support clients in maintaining and improving their health. Why is it important that others understand the important work of community and primary health care nurses? • They are often the first point of contact for patients who have health concerns • They are accessible • They are great listeners and trouble shooters • They view and care for the patient in a holistic way • They are experts in collaborating with other healthcare professionals to ensure positive patient experience and outcomes • They are autonomous • They are decision makers. Why would you encourage a nurse to work in this area of practice? • Excellent career path • Highly qualified nurses working autonomously in PHC • Team work. What is your role and how is this valuable to the community? My role is Clinical Nurse Consultant of the Tuggeranong Walk-In Centre in the ACT. There are two Walk-In Centres in Australia (both in Canberra) and they provide episodic primary health care to the community seven days per week, from 0730hrs-2200hrs each day. Our service is accessible to all clients who present. It is a free service that is completely nurse-led and provides assessment and treatment of minor illness and injury, and opportunistic health promotion. It is a valuable primary health care service that ACT residents love. Its value is evidenced by a multitude of positive consumer feedback that we receive, and the upcoming expansion of the service to three centres in 2018. This feedback
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and the upcoming expansion of service is testament to the expert primary health care clinicians that work in the service. What led you to pursue a career in community and primary health? I have always had a passion for community/home based nursing and keeping patients/clients in their own home/ environment. I first developed an interest in treating clients/patients in their own home when working for the Hospital in The Home Service – providing care to stable patients in their own home that they would otherwise receive as a hospital patient if the service was not available. During this time, I developed a keen interest in child and family health, undertook the required study and became a Maternal and Child Health Nurse. As a parent of three young children, I began using the Walk-in Centre service for typical illness and injuries that my young family encountered from simple fractures and lacerations to Otitis media and tonsillitis. I was so impressed with the skill and expertise of the nurses working in this primary health care facility, their ability to thoroughly assess and treat a wide range of conditions within their scope. It motivated me to apply for a position and undertake the rigorous training program required to work at the Walk in Centre. I am continually inspired by the diverse role of nurses in primary health care. Can you provide an example of when you’ve felt your work is making a difference? Prior to Christmas 2016, I assessed a 70-year-old female client with complex co-morbidities including insulin-requiring Type 2 diabetes. She presented on this occasion to the Walk-In Centre with a toenail infection. She had been inadvertently booked in for a physiotherapy appointment, when she should have been booked for a podiatry appointment several weeks prior. She was unable to secure another podiatry appointment for several months. The patient attempted to self-manage her ingrown toenails and subsequently developed a toe infection. In consultation with the Nurse Practitioner on shift I arranged for this client to commence antibiotics, and booked an appointment for review with her GP for two days time. I contacted the Community Health Intake (CHI) line to try and secure an earlier podiatry appointment because I was concerned that if this client did not receive good care she would be at risk of further infection of her toes leading to long term complications. CHI disclosed that there were no podiatry appointments until March. I then contacted the Allied Health Manager who was extremely helpful, and after several emails and discussions was able to secure an appointment the following week. This was a fantastic outcome for the client, and demonstrates a strong focus on client centred care.
Community & Primary Health Care Nursing Week 18–24 SEPTEMBER 2017
Why do you need community and primary health care nurses?
Promoting healthy lifestyles in fertility clinics Gillian Homan, Sheryl deLacey and Kelton Tremellen The association between lifestyle habits and pregnancy outcomes is well documented; for instance, increased body weight and smoking are associated with multiple reproductive impairments such as reduced conception, increased miscarriage and later adverse pregnancy outcomes. Pre-conception health counselling and support in facilitating change where appropriate, is essential for the best outcomes. Patients who attend a fertility clinic are generally very motivated to conceive, which presents a unique opportunity to promote primary health care, and maximise fertility and health outcomes. However, this opportunity is not being fully utilised. We conducted a study investigating current attitudes and practices to the promotion of healthy lifestyles in Australian fertility clinics, and the role of fertility nurses in this area. Nurse managers in 85 clinics were surveyed and asked a series of questions regarding information and resources provided to patients concerning lifestyle and reproductive function, plus the role of fertility nurses in this area.
“Pre-conception health counselling and support in facilitating change where appropriate, is essential for the best outcomes.”
The results of our study found that primary health care, defined as “the promotion of a healthy lifestyle to optimise reproductive outcomes,” was acknowledged as a key component of the role of a fertility nurse. Fertility nurses considered pre-conception counselling to be very important, and acknowledged that this should be addressed prior to offering assisted reproduction technology (ART) treatment such as IVF. However, whilst a range of lifestyle factors are routinely discussed with patients, only 25% of clinics offered a lifestyle modification program for their patients. Recommendations from the study included: 1. The need to develop and use effective pre-conception screening tools 2. Prioritising healthy lifestyle before offering ART 3. Offer resources to facilitate lifestyle modification where appropriate, including programs and support 4. Auditing the results of lifestyle modification programs 5. Utilising fertility nurses in this area by broadening their scope of practice, including further training and recognition of skills
Community & Primary Health Care Nursing Week 18–24 SEPTEMBER 2017
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Why do you need community and primary health care nurses?
An integral part of our health care system Sarah Moon MACN (ENL) I worked along community nurses in the rural hospital in Urbenville. Community and primary health care nurses are an integral part of our health care system. They represent a stepping-stone for patients to get the care they need when they are not in hospital. Community nurses provide care for people in their own homes without the resources of a hospital environment. Primary health care nurses also provide care and perform procedures without the resources of a large hospital. Despite the incredible job these nurses do, it is surprising that not many people know what their role is exactly. Their scope of practice can include wound care and palliative care, as well as effectively communicating and organising follow up appointments for patients and get them there safely. These nurses help keep hospital admissions down and shorter, ultimately freeing up critical hospital beds. I have worked beside some of the best rural community nurses, and they are truly the glue that held our rural hospital together. They had a way of making patients feel comfortable with care in their own home, and building trusting relationships within our small town.
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Community & Primary Health Care Nursing Week 18â&#x20AC;&#x201C;24 SEPTEMBER 2017
â&#x20AC;&#x153;I have worked beside some of the best rural community nurses, and they are truly the glue that held our rural hospital together.â&#x20AC;?
Q/A: Community and Primary Health Care Nursing
Jeff Fuller FACN Why do you think community and primary health care nursing is vital to the health and wellbeing of our society? Peopleâ&#x20AC;&#x2122;s health and illness is lived out in their daily lives, in their community. Nurses help people to stay healthy, to recover from illness and to manage the symptoms of disease. This means that nurses working in community and primary health care settings are vital so that people can be helped to maintain their health and that of their family as they live out their daily lives. Why is it important that others understand the important work of community and primary health care nurses? Nurses are one member of the health care team, that also includes doctors, physiotherapists, podiatrists, social workers and so on, as well as the person them self. For the health care team to be effective, each member needs to understand the skills and expertise of each member of the team, so that each can work to their maximum potential for the benefit of the person being cared for. Why would you encourage a nurse to work in this area of practice? In the community, the nurse will work with people in their usual situation. This is very different than when a person is in hospital for a relatively short time. A community and primary health care nurse gets to experience how they make a difference as people deal with their health care over time in their own community. What is your role and how is this valuable to the community? I recently retired as the Professor of Primary Health Care Nursing at Flinders University where I led projects to develop improved models of health care that used nurses in the management of common chronic diseases such as cardiovascular disease and diabetes. I continue to serve of health service committees to ensure that health care is based on evidence and responsive to community needs.
What led you to pursue a career in community and primary health? I was attracted to work in community and primary health care because the excitement and reward in developing health promotion programs from inception, through to implementation and evaluation. This work is done with communities and in multidisciplinary teams and has included areas such as community wide falls prevention, improving access to rural mental health care and developing improved service networks for older women who are experiencing domestic violence and homelessness. Can you provide an example of when youâ&#x20AC;&#x2122;ve felt your work is making a difference? My team recently completed a service development project to improve the mental health care of older people in rural communities by ensuring that mental health services, primary health care services and local social welfare services have the processes and tools to cooperate and better coordinate care. We have also undertaken similar projects in rural communities so that farming families experiencing psychological distress are able to be provided with immediate help and referred to health professionals by those with whom they are in regular contact, such as stock and station agents and rural financial counsellors.
Community & Primary Health Care Nursing Week 18â&#x20AC;&#x201C;24 SEPTEMBER 2017
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Q/A: Community and Primary Health Care Nursing
Lucy Taylor Why do you think community and primary health care nursing is vital to the health and wellbeing of our society? Quality primary health care is an important determinant of health. It encompasses the principles of equity, access and empowerment, leading to improved health outcomes for individuals and communities. Nurses are a vital part of primary health through the provision of care, as educators and as advocates for patients. There are emerging models of care that broaden the scope of nursing practice in the primary care space. Nursing roles are continually evolving in response to changes and pressures in the health system and they are assuming direct care and leadership roles in the primary care. Why is it important that others understand the important work of community and primary health care nurses? Understanding peopleâ&#x20AC;&#x2122;s roles in the health system helps individuals to navigate their way through the maze of health service providers. With a greater understanding, comes the ability to fully utilise each member of the health care team. Why would you encourage a nurse to work in this area of practice?
What is your role and how is this valuable to the community? I work as an Advanced Practice Nurse in a nurse-led primary health clinic. Our clinic provides one-off care of minor injury and illness to the local community. It is a valuable and well-utilised service and provides safe, patient centred and equitable care. What led you to pursue a career in community and primary health? I was drawn to primary nursing as I saw it as a great opportunity to provide care at the first point of contact between the user and the care provider. I was attracted to the role that primary care plays to reduce social exclusion and disparities in health in the community. I was excited by the autonomous nature of the role and could see opportunities in health promotion and illness prevention. Can you provide an example of when youâ&#x20AC;&#x2122;ve felt your work is making a difference? I feel like I make a difference when I provide solutions to health care access in the community. I am able to provide an alternative, efficient and timely episode of care to an individual that improves their journey through health system. This happened last week when I was able to suture a wound on a busy mother, providing quality care and saving her, along with her children, time in the emergency department.
Working in primary care opens up your nursing career and exposes you to wide range of different people and different experiences. It allows you to practice patient centred care and contribute to wider improvements in health outcomes and provision of health services. In a society where many health conditions are closely attributed to lifestyle factors, primary nursing allows you to focus on health promotion and illness prevention in your daily practice. Primary care also offers many unique educational and research opportunities.
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Community & Primary Health Care Nursing Week 18â&#x20AC;&#x201C;24 SEPTEMBER 2017
Why do you need community and primary health care nurses?
APAC: Hospital in the Home Annabel Pranic Acute and Post-Acute Care (APAC) is a hospital in the home service providing acute care to patients that would otherwise be in hospital within the Northern Sydney area. It’s a multidisciplinary service providing streamlined, patient focused support to our patients. Staff who do home visits include pharmacists, physiotherapists, occupational therapists, social workers and registered nurses who specialise in wound management, breast care, cardiac and respiratory care. We are linked to five local hospitals including Royal North Shore, Ryde, Mona Vale, Manly and Hornsby. Our staff are well supported by a medical team of staff specialists, registrars, on-call infectious disease consultants and a management team. APAC enhances the patient’s wellbeing and health by either completely avoiding hospital admissions or reducing their length of stay. Patients have more autonomy with their care, are more active, in control and less likely to have falls or hospital acquired infections. Patients discharged from hospital may feel anxious but soon realise that they are involved in the way their care is delivered. APAC staff explain the process, giving patients approximate times of their daily visits, so they can plan their routine or appointments around home visits. Patients visibly look relaxed when the nurse explains how it will work. I can say to a patient, “don’t worry APAC can do this,” knowing I have a strong, structured system supporting my decisions. I am proud to be part of the team that provides patients with specialised person centred care following hospital admission for breast, cardiac and orthopaedic surgery. Respiratory management, anticoagulation support and intravenous antibiotics are a few of the other clinical components of care we are involved in.
“APAC enhances the patient’s wellbeing and health by either completely avoiding hospital admissions or reducing their length of stay.”
As a registered nurse who has been part of the APAC team for more than 10 years, I often hear patients say, “APAC has been amazing, I can’t tell you what it means to me to be at home.” Or, “I can’t fault any staff, nothing is too much trouble.” APAC staff battle the crazy Sydney traffic, weather conditions, occasional disaster, event or complex social situations – and face it all with confidence as a team, ensuring we always deliver the care our patients deserve.
Community & Primary Health Care Nursing Week 18–24 SEPTEMBER 2017
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Why do you need community and primary health care nurses?
A Journey with Acute Post-Acute Care (APAC) Helen Guckian MACN, RN It’s Friday afternoon in the middle of June Patients are ready to go home soon The hospital is full no more can they admit APAC are here to do their bit Assessment completed many needs to be met Compacks in place we will be set Clinical coordinators have a plan in place Juggling lists to find some space Social work alerted to visit next week We can keep this patient on her feet Home safety assessed and looks good for all For patient and staff no room for a fall. The dog will be put out, the cat in his bed The home is safe it could be said The doctor is paged for med chart once more The patient is ready to go out the door The pharmacist will see her at home as well Is she taking her pills right, it is hard to tell? Long term hospitalisation has been the case The physio will do home visit and get her back to base The doctor next week is a big taxi fare Our community care aids will get you there The OT will help keep you safe and equipped A call button at least in case you tripped The reception staffs are only a phone call away A chat with them will make your day A nurse each day to give you your medication Caring professional and with dedication. Management support ensures the job is well done You, the patient, are number one.
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Community & Primary Health Care Nursing Week 18–24 SEPTEMBER 2017
“You, the patient, are number one.”
Why do you need community and primary health care nurses?
Providing vital support for patients Hollie Jaggard MACN As an acute care nurse, working in an emergency department, I see a diverse population of patients. The Mornington Peninsula has the second highest older population of over 65s, in Victoria. Daily, I look after patients who have no supports in place, including patients with a lack of case-management services, no regular GP, and no community contact. I watch these patients struggle when we try to connect them with yet another nursing service, or explain that they need to follow up with their GP; or when they don’t know which one they might see next, whether they can get an appointment this month, and how they will get there if they do. In stark contrast are those patients, who are linked to the community, more importantly to their health community and network. They have a regular community nurse or GP, who might be acting as their case manager, they are linked in to services which enable them to stay safe, healthy, and independent in their own homes. They have a far better outlook on their treatment, and are ready to engage in achieving their own health care outcomes. I believe this is because they know they have the support they need, and this shows them that good health is still possible and achievable. Community and primary care nurses, are the true front line of the nursing profession, serving people at their most vulnerable, and helping them through episodes of care to achieve health and wellbeing in their own environment.
“Community and primary care nurses, are the true front line of the nursing profession, serving people at their most vulnerable, and helping them through episodes of care to achieve health and wellbeing in their own environment.”
Community & Primary Health Care Nursing Week 18–24 SEPTEMBER 2017
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Q/A: Community and Primary Health Care Nursing
Sandy Eagar FACN Why do you think community and primary health care nursing is vital to the health and wellbeing of our society? To be a cynic, the whole model of care which we’ve had in Australia, which has been very hospital-centric hasn’t particularly led to better health outcomes for people. I think that’s where you have to step back and see that the logic will say “an ounce of prevention is worth a pound of cure”. It seems only logical that if you can keep people healthy, particularly by keeping chronic diseases stable, you’re less likely to end up in those towers of acute illness that we call hospitals, that are incredibly expensive to run. It’s almost a human right to be given proper information on health literacy to keep yourself and your family healthy. I think that’s where primary health services play a really unique role — whether it be the early childhood nurse who comes in for the visit to that new mummy, the diabetes nurse educator working in the community to educate people around their diet or a nurse taking a tougher line on someone who has got chronic emphysema but is still smoking. Why is it important that others understand the important work of community and primary health care nurses? It is very important in terms of convincing the important people with the dollars — politicians, health ministers and government. Because a lot of this work is quite hidden, so traditionally it’s been very hospital-centric, very sexy types of things that get funded. Another issue around it is that a lot of primary health care is delivered by non-doctors, and again there is a funding mismatch with that, even to the point of some the big research funders like the ARC and the NMRHC. They tend to fund research which is quantitative, medically driven research, rather than looking at more qualitative more nurse-driven research around patient outcomes. Why would you encourage a nurse to work in this area of practice? There are a couple of reasons. Being able to work amongst your community is incredibly powerful. Being able to work in a wellness model, rather than an illness model and where you get to use a lot of your nursing skills around health
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promotion, health literacy allows you to take a much more holistic view of that person in front of you who’s living in the community. It is a much more different view than a patient lying in a bed. It may be that you have someone living with diabetes in the community who you know is not adhering to their diet, but when you know that they live four kilometres from the shop and that there is no bus service to bring home fruit and vegetables, for instance, then sometimes that’s the sort of global thinking that you’ve got to do. I think it’s also a privilege to see people changing over time — whether that’s elderly people moving to the later stages of their lives, or if it’s a new baby growing up in the community and helping around immunisation and childhood development — it’s a privilege to be there amongst them. What is your role and how is this valuable to the community? I’m the Nurse Manager for the NSW Refugee Health Service, located in Sydney. I manage the Refugee Health Nurse Program — we do an interception on arrival health assessment in a nurse-led model for new refugees arriving in Sydney. That’s in response to knowing that the health systems are very complex, that people are often overwhelmed and bewildered when they first arrive, so we give them an opportunity to see us. We can take a long time with them — it’s not a 15-minute GP appointment. As I said, it’s a much more holistic view around their physical health, their mental health, their dental health, their sexual health, reproduction needs and torture and trauma issues. It’s an opportunity to introduce them to some preventative health measures such as PAP smears and breast checks for women, for instance. Then with our knowledge of the health system we able to link them in to where they need to go. I currently advise some evidence based pathology, and on arrival things like Vitamin D therapy to get them off to a good start. We also do health screening in selected intensive English centres, where we check teenagers and children’s hearing and vision to make sure that when they get to that intensive English environment they can see the board and hear the teacher. And if you’ve just come out of a war zone, it may be that you do have acoustic nerve damage. Our role is valuable because we know that we’re the best gateway into the very sophisticated model of health in Australia.
Community & Primary Health Care Nursing Week 18–24 SEPTEMBER 2017
Q/A: Community and Primary Health Care Nursing
What led you to pursue a career in community and primary health? Most of my early career was spent as a manager of an emergency department, then I moved into education in the hospital system. I was given an opportunity some years ago to manage the nursing side of Operation Safe Haven which was the uplift of the airlift of the Kosovars and the East Timorese into Sydney, which sparked my interest. Following that, for the old College of Nursing Australia (ACN predecessor) I was the appointed delegate for the Detention Health Advisory Group for the Commonwealth to reorganise and reset the health services in all the immigration detention centres across Australia and Christmas Island. I continued to do that work and then this opportunity came up at the NSW Refugee Health Service to start the Refugee Nurse program. Can you provide an example of when you’ve felt your work is making a difference? On global scale, myself and my staff make a difference every day when we meet these families in a culturally sensitive way with a big smile and a warm heart. What’s really important is that they have an opportunity to tell us their stories and what their dreams and hopes are and that we are able to give them a lot of information to help them along that settlement pathway into their new life. We also look after people seeking asylum, living in the community who have no Medicare coverage and no work-life, so they are incredibly vulnerable and impoverished and we make practical contribution to those families every day. We provide them with shoes, clothing, food, formula, supported medications and access into health services by being advocates. These are some nitty-gritty ways that we make a difference — between our nurses and early childhood nurses as well.
Community & Primary Health Care Nursing Week 18–24 SEPTEMBER 2017
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Why do you need community and primary health care nurses?
Community health nursing in a correctional setting Josie Luppi MACN In our community, nurses are often associated with hospitals and community health centres by the general public but there is a team of dedicated health care professionals who work in a place that many people wouldn’t directly associate with nursing and that is within correctional facilities. Correctional facilities can be home to many individuals, all of whom have access to health care professionals such as nurses, doctors and dentists. As nurses, we provide day-to-day care to clients and play a pivotal role in helping them to rehabilitate and reintegrate back into society. Their rehabilitation is a key priority. We provide medical attention without prejudice and work with clients to maximise their health and wellbeing. Another key priority is crisis interaction. Our clients respond differently in a crisis and my colleagues and I work with each client on a one-on-one basis to help them adapt to their surroundings and overcome any health concerns to assist them in their rehabilitation and support them on their pathway to eventual release. Correctional facilities are merely an extension of the community and as nurses in this environment we continue to ensure the most marginalised continue to be able to access equitable health services which is a universally recognised human right.
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Community & Primary Health Care Nursing Week 18–24 SEPTEMBER 2017
“We provide medical attention without prejudice and work with clients to maximise their health and wellbeing.”
Why do you need community and primary health care nurses?
Primary health care – the glue that binds communities together Rebecca Rendalls As I looked at the nurses’ appointment book I knew that this was going to be a mixed day of adventure. From the phlebotomy collections, the driver’s licence renewal health assessment with an electrocardiography, chronic disease health assessments, Aboriginal and Torres Strait Islander and age specific health assessments, spirometry, wound dressings, diabetes education and even to the first vaccinations for an eight week-old baby; a feeling of excitement washed over me. Today, I was going to work with and alongside the citizens, their family/carers and significant others from our local rural community and engage with them to offer continued support, guidance and services to promote their physical and mental health. As the day progressed and the dressing was removed from a chronic wound, signs of new granulation were a welcome sight. We both smiled and the elderly lady warmly squeezed my hand and said, “thank you!” We had been working together to get to this stage for weeks now and not only was her body slowly healing; we had kept her from a hospital admission. Although the baby cried, her face soon filled with a toothless smile and her mother sighed with relief feeling reassured that the immunisations just administered would not only protect her daughter’s health but also that of her family and the wider community as a whole.
“Primary health care is the glue that binds communities together and the foundational stone from which the physical and mental health and wellbeing of local populations can grow and flourish.”
As the practice door closed behind the last patient, I reflected on the positives of the day and realised again with pride that I had contributed as part of our small general practice team to the continuing improvement in health and welfare of our local community. Primary health care (PHC) is about having a genuine interest for each patient’s unique holistic health care needs and wants, and using innovation to utilise available resources to meet this; thus strengthening the ongoing bond-building with our patients and community as a whole. PHC is the glue that binds communities together and the foundational stone from which the physical and mental health and wellbeing of local populations can grow and flourish. For me, being a practice nurse isn’t just a job; it’s a privilege and my passion.
Community & Primary Health Care Nursing Week 18–24 SEPTEMBER 2017
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Q/A: Community and Primary Health Care Nursing
Emily Wardell MACN Why do you think community and primary health care nursing is vital to the health and wellbeing of our society? Community nursing allows people to stay in their own homes while their health care needs are being met. Whether being treated for an acute or chronic condition, patients can be cared for in a familiar environment, maintaining dignity and given respect for their choices and goals. Our aim is for inclusive care and to maintain their independence so they can therefore live a happier more fruitful life. It is an inclusive model that can also decrease the stress on the hospital system by preventing admissions and provide alternate discharge planning. Why is it important that others understand the important work of community and primary health care nurses? Awareness of this model of care is important for consumers and other health care providers to offer alternative management strategies to avoid inpatient or residential care. It is also an additional pathway to nursing practice that is different to the traditional setting and very rewarding. Why would you encourage a nurse to work in this area of practice? District nurses are experts at chronic and complex health care. They have a broad clinical skillset, as well as high proficiency with their communication skills, ability to think outside the box, and coordination of care. It is for nurses who enjoy autonomy, continual learning, inclusive patient care and health promotion. It is an extremely rewarding profession and you get to be outside! What is your role and how is this valuable to the community? My current role is Assistant Manager at Bolton Clarke, previously known as Royal District Nursing Service. I currently oversee the day to day operations of approximately 300 staff who service the Northern region of Melbourne. My underlying passion of nursing people in their homes drives me to support the staff who do this every day. I enjoy developing passionate individuals, which ultimately impacts the quality of care and experience delivered to our clients.
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What led you to pursue a career in community and primary health? I found hospital based nursing constrictive and task based. I was naturally lead to community nursing where I could nurse people in their own homes, without boundaries to the care I could give. Once I started, I was hooked, I felt it was a privilege and an honour to do this kind of work. Can you provide an example of when youâ&#x20AC;&#x2122;ve felt your work is making a difference? Thinking back to my first year as a district nurse, one particular client stands out. I saw him a few times a week for wound care and diabetic education. He didnâ&#x20AC;&#x2122;t like the new nurse coming in, but very slowly we built rapport and trust. This was the only way I was able to implement different strategies to assist his with his long term health issues. Together we developed new care plans aimed at achieving his goals with his foot care, diet, hygiene and incontinence so he could ultimately be independent. It was so rewarding to see this change in him over time.
Community & Primary Health Care Nursing Week 18â&#x20AC;&#x201C;24 SEPTEMBER 2017
Why do you need community and primary health care nurses?
A daughter and carer’s perspective Suzanne Lee Volejnikova-Wenger MACN When my father was not able to live on his own anymore, he moved in with us, a family of five (parents, two teenage children and a dog). Being a full-time carer was exhausting both mentally and physically, and only with the support of health professionals were we able to grant my father his wish of spending his remaining years and time of dying at home with us. Nurses were essential on this journey, from the practice nurse, who cared for Dad’s persistent leg ulcer and lifted his spirit with humorous interactions, to the palliative care nurses who were there in the last days and nights for Dad and for us as a family. (Dad liked his beer, and because I could see he didn’t like the lemon flavoured mouth-hygiene sticks, I dunked dry ones in his favourite VB and cleaned his mouth that way – the last visible interaction from Dad was him sucking on this and enjoying the last taste of something familiar). These nurses cared not only for Dad, but us, his family, and made it possible to experience a journey, which was exhausting but gratifying and provided us with the best foundation for healthy grieving. Experiencing the empathy and professionalism of these nurses helped me to consider university for the first time in my life and re-qualify once more as a nurse. Three years later, I am working as a community care nurse, enabling people, younger and older, to live at home as independently as possible, and supporting their carers on their own exhausting but fulfilling journey.
“Experiencing the empathy and professionalism of these nurses helped me to consider university for the first time in my life and re-qualify once more as a nurse.”
Community & Primary Health Care Nursing Week 18–24 SEPTEMBER 2017
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Why do you need community and primary health care nurses?
Time-on in the grand final of life
Our coaching methods include: •
providing formal training and education at the bedside
Will Hallahan
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modelling best practice in end of life and palliative care
Because Community and Primary Health Care Nursing Week 2017 takes place during the finals period for several football codes in Australia, it’s apt to use a sporting analogy to describe the work of the Metropolitan Palliative Care Consultancy Service (MPaCCS).
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mentoring and supporting primary health care providers to develop their understandings and skills
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facilitating case review and debrief
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helping with policy and procedure review
The field of play consists of over 200 residential care facilities (aged care, correctional, mental health and disability care) across Perth. Due to resource constraints, the playing field is far from level.
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supporting quality improvement and change management.
The overall objective of our season is to empower primary health care providers to consistently provide quality care at the end of life to residents, their families and carers. Our season is made up of 1,100 episodes of care each year. Every match during our season is a grand final which is only won if the team is able to orchestrate a good death for the resident and those close to them. The MPaCCS nurses, social workers and palliative care doctors are the coaches of a much larger squad: the primary care providers who actually play this all-important game by directly caring for the residents and families.
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So far, the scoreboard is encouraging. The playing group of GPs and facility staff, with the support of MPaCCS, kicks a ton of goals: less than 8% of residents registered with MPaCCS are transferred from their facility to another location and troublesome symptoms are very well controlled, while in the second half of 2016, over 98% of MPaCCS patients died at their preferred location of death. MPaCCS helps primary care providers in residential facilities to ensure residents who are approaching full-time in the game of life get a good run.
Community & Primary Health Care Nursing Week 18–24 SEPTEMBER 2017
Why do you need community and primary health care nurses?
Community Nursing Judi Greaves MACN Community nursing in palliative care: how more real can it get? As someone is ending their life you get a glimpse of what that life has been. You see the person. Not the smelly man in the PJs tucked up in a hospital bed with the sputum cup on the over-bed table. You see the photos; his wedding photo, so handsome and proud; his daughter on his arm at her wedding, so handsome and proud; the grandchildrens’ graduations, he tells you about them, so proud. You see the person. You pat the dog under the bed, trip over the cat, comfort his wife. You see the person – their life and all that they have lived. You’re part of that – for a brief moment they allow you into their lives and enrich you with theirs. You hope it’s reciprocal.
“You see the person – their life and all that they have lived.”
Community & Primary Health Care Nursing Week 18–24 SEPTEMBER 2017
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Q/A: Community and Primary Health Care Nursing
Dr Liz Hanna FACN Why do you think community and primary health care nursing is vital to the health and wellbeing of our society? For one very simple reason – plus some add-ons. People value their health – their ‘good health’. This allows them to live rich and fulfilling lives, engage in work, their society, recreational pursuits, loving their family and friends, with all the freedom that good health allows. The acute health sector, whilst being absolutely necessary, is only capable of returning a person back into the community, with ‘optimal’ functionality. In many cases, this is less than their pre-admission health state. So, our primary objective is to stay fit and well and out of hospital. Tips and guidance support us to do this, health checks, home supports, vaccinations are all part of it. Monitoring our nation’s health and working to optimise our local environment, which includes domestic and occupational environment, our living social environment and our broader physical (ecological) environment. These are the health determinants of maximal impact, if measured in contribution to ‘years of life lost’, or ‘quality adjusted life years’. So, in short, without community and primary health care (CPHC) nurses, the health and wellbeing of the nation suffers dramatically. And the acute health sector (I am an ex–intensive care nurse of 16 years!) has one reason for existence. Health restoration when all else has failed. It is the health system of last resort. CPHC helps us stay healthy and enjoy our lives, and prevents admission. Why is it important that others understand the important work of community and primary health care nurses? People are drawn to drama, speak of health drama, watch TV health drama shows, focus on major dramatic health events within their own and their families’ lives. Attention is therefore focused on the ‘worst case scenario’. Ministerial grief is caused by a poor child having to fly overseas for urgent high powered medical
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treatment, so Health Ministers are well aware of community emotion and outrage, and its consequences – for their own careers. Along with the disproportionate community attention, comes disproportionate funding, with very poor cost benefit ratios. Investments in disease prevention is economically much more sound, and infinitely more satisfying, as it buys a longer and healthier life. This is what people want. This is what their friends and family want. Why would you encourage a nurse to work in this area of practice? • Diversity of activities and knowledge base — can find an area that suits your interests • Recognise that the health sector is not restricted to hospitals, that is the sickness sector • Capacity to engage with people, and help people, en masse, and face to face • If you want to make a real long-lasting difference — influence policy What is your role and how is this valuable to the community? Whereas I no longer ‘see’ patients or clients, I spend my days influencing the world in which we live, to make it a better place. For nine years, I convened the Public Health Association of Australia’s Environmental Health Special Interest Group, and served on the PHAA board. In this honorary role, I developed PHAA policies which helped influence Australia’s health policies on a variety of Public Health matters. I am President of the Climate and Heath Alliance. We are currently shepherding a National Strategy for Climate, Health and Wellbeing through Parliament, so that Australia includes health into its climate change policies, across the nation. We launched the Strategy Framework at Parliament house in June 2017, to very warm reception of all three major political parties. The Federal Labor Party has vowed to take this Strategy to the next election.
Community & Primary Health Care Nursing Week 18–24 SEPTEMBER 2017
Q/A: Community and Primary Health Care Nursing
I have been a lead researcher into climate change and human health at the Australian National University (ANU) for nearly 10 years. I convened Australia’s National Climate Change Adaption Research Network, and directed several National Health and Medical Research Council research projects, all of which aimed to improve the health and wellbeing of the broader Australian and international community. I am regarded one of Australia’s very few experts on Climate and Health, so am regularly sought by the media to provide expert commentary as issues arise and receive invitations to provide key note addresses at international conferences. I am frequently invited to review documentation and reports for the Intergovernmental Panel on Climate Change and input into Australia’s multilateral legal obligations, for example into the United Nations Framework Convention on Climate Change. Three of my recent PhD students have been medical specialists and I teach into the ANU Medical Program – we have no Nursing School at ANU. What led you to pursue a career in community and primary health? I felt that 16 years in the intensive care unit (ICU) is wonderful, but sufficient, and ward work – post ICU – is not satisfying. Seeing the light – prevention is better than cure! And this world allows nurses the capacity to help MANY MANY more people than one-on-one. Additionally, my new role in community and primary health matched my own broad interests. I could keep my active involvement in physiology and expand into behavioural psychology, health law, policy and my love of environment and sustainability. Can you provide an example of when you’ve felt your work is making a difference? The Medical Journal of Australia has recently invited me to write a series of three articles to educate Australia’s doctors on climate change, associated health risks, and what they need to do to prepare their practice. If I can influence doctors to acknowledge that climate change is the biggest health threats facing humanity (as declared in The Lancet), they might reorientate their clinical practice, enabling them to respond appropriately when climatic upheavals affect their patients. But they are an influential group, and can help sway Australia’s politicians to adopt a stance that will protect the health and wellbeing of current and future generations, by slowing and ultimately reversing global warming.
Community & Primary Health Care Nursing Week 18–24 SEPTEMBER 2017
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Why do you need community and primary health care nurses?
The Outreach Refugee Clinic – a quality improvement project Karinne Andrich After reflecting a few years ago on how, “I could better service the refugee population in Newcastle regarding their health needs,” I came up with a project. I have been working as the Refugee Health CNS2 for the past eight years and am very proud to say that I commenced this project after the initial three-month trial in January 2016 and continue the clinics to this day. A Quality Improvement Project –The Outreach Refugee Clinic was a three-month pilot study in 2015, designed to provide an outreach service for refugees studying English as a second language at TAFE Tighes Hill (Newcastle) who wanted to discuss their health related issues. The project was created as a response to the identified issue that many refugees were struggling to navigate the health care system, particularly in finding the right referrals for their various medical conditions. The aim was also to improve their health literacy and empower the refugee clients to become more engaged with their own health care. The referral included services, such as family planning, dental, pharmacy, sexual health, optometry, hearing, and trauma and torture counselling. A key driver of this project was to provide information and skills to clients to take their time in learning how to arrange, negotiate and confirm appointments, and begin to understand the whole process. Currently, there is limited amount of time and staffing at the Refugee Health Clinic held on Mondays, and this outreach service would alleviate some of the pressures on this clinic and give refugees increased support and education. While it was originally proposed to be available for only refugees the service opened up to people from culturally and linguistically diverse (CALD) backgrounds. This later group compromised a broad range of individuals which also included migrants and international students. There was a feedback form given to clients, and 11 feedback forms were completed at the conclusion of the pilot that provided additional qualitative data to evaluate the project. Out of the 11 responses, 11 clients said yes to the question, “If you had more questions or problems with health care, would you come back
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“This outreach service could be a novel way to better allocate resources and empower refugees to take proactive steps towards the betterment of their health care.”
to this outreach clinic?”. All responses also said yes to the next two questions that were, “Would you recommend this outreach clinic to your family, friends and community for health care?” and, “did you find this visit helpful?”. Improvements to the clinic only had a few responses but they included, “more time”, “give more information about this clinic so that everyone knows and comes” and “it would be much better if the nurses had more power for getting quick appointments.” The data and outcomes from this study demonstrate that this is an effective referral service with a high rate of satisfaction amongst the clients who accessed the outreach clinic. This outreach service could be a novel way to better allocate resources and empower refugees to take proactive steps towards the betterment of their health care.
Community & Primary Health Care Nursing Week 18–24 SEPTEMBER 2017
Why do you need community and primary health care nurses?
Everyone deserves access to health care Kristine Datuin We all have heard and seen the refugee crisis all over the globe particularly the war against ISIS. We all have been touched by the images of young lives in turmoil; young families torn apart, homes destroyed. And sometimes when we feel overwhelmed, our natural instinct is to either flight or fight. So we turn our television off when the news shows the devastating effects of the war on people. Or we continue on with our busy life and ignore all other issues surrounding humanity. As a registered nurse and an Australian, I feel extremely blessed to be living in this country. And so I choose to use my skills and ability to provide the patient-centred-care model that is very much a foreign concept for refugees. I choose to be an advocate for the refugees and asylum seekers rights. And my aim is to give the best possible care for a refugee’s health in order to achieve the best possible outcome rebuilding their lives as an Australian.
“I choose to be an advocate for the refugees and asylum seekers rights.”
Community & Primary Health Care Nursing Week 18–24 SEPTEMBER 2017
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Q/A: Community and Primary Health Care Nursing
Nancy Arnold MACN Why do you think community and primary health care nursing is vital to the health and wellbeing of our society? I believe community is at the heart of everything that we do. I also think that nursing in this area provides upstream health, which keeps people within the community – and the community actually look after their own. It actually keeps people out of hospital and years ago we went to a medical model of care with health, and I think that it’s now time we revisit and look at the past to move towards the future. In the past everyone was actually nursed at home, and I think that’s vital. Why is it important that others understand the important work of community and primary health care nurses? I think it’s important because it actually gets the person in care out of the acute sector, which has huge financial implications for the health budget itself. It’s also important for people to understand that this is an important part of nursing, that it’s not a stand-alone. Quite often these nurses go out by themselves so they work autonomously, so I consider that these nurses are advanced practice nurses. Why would you encourage a nurse to work in this area of practice? Because you are autonomous. Community and primary health care nurses are multi-skilled and it’s a multifactual area of nursing where you make changes in people’s lives. You get to know your patients, and not only do you affect their health, but you affect their wellbeing as well because you’re looking at aspects of care, from social right through to medical nursing. It’s also keeping people in their home, where they want to be. It’s a real privilege, when you knock on that door, for people to let you in. What is your role and how is this valuable to the community? I’m the Director of Care of the District Nurses, so my role is around clinical governance. It’s about the quality of care that we provide to our clients/patients using evidence based practice. I also need to make sure that our nurses have the tools to provide that care, be that education or the latest equipment, for example we’re currently moving to a mobile service. So it’s around ensuring that our clients and patients are provided with the right care in the right time and place.
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What led you to pursue a career in community and primary health? I’ve got a background in emergency nursing and I’ve been an educator. While working in an acute environment and I saw people bed-locked and people also coming into the emergency department when we could actually provide care at home. In my role now, I feel like I can make a difference in the community, I also feel that in Tasmania we are on the cusp of really big things in community and primary health around lack of response, keeping people at home and out of the acute sector. Can you provide an example of when you’ve felt your work is making a difference? I think my work makes a difference every day! Not only to patients, but also to our staff. I’ve recently supported one of my staff members through someone who has been diagnosed with Lyme Disease. This disease isn’t actually recognised in Australia, so that involved one of our staff members presenting at one of our clinical staff meetings. It’s around giving her the confidence and the knowledge. In terms of making a difference to our patients, it’s also about thinking outside the box a little bit, in regards to the care of our clients, especially with our client care packages, like organising someone to walk someone’s dog, for instance. It’s about the big things, right through to little things. We make a difference by going to work every day with a smile on our face and remembering that we all get up in the morning to provide the best care. I feel that I’m prepared to walk in everyone’s shoes, and I think that’s where I make a difference.
Community & Primary Health Care Nursing Week 18–24 SEPTEMBER 2017
Why do you need community and primary health care nurses?
Ensuring the health of new Australians Merilyn Spratling FACN Earlier this year, Mohammad and Amena arrived with their four children from the Middle East after fleeing the war in Syria four years ago. Their settlement case manager referred them to the Refugee Health Nurse (RHN) for an initial refugee health assessment. All over Australia, RHNs provide advanced practice nursing care in the community for people of refugee and asylum seeker backgrounds, often as the first point of contact with the health system. RHNs assess and plan care for individuals and families who come to Australia after surviving traumatic journeys, and who have had minimal or no health care preceding their arrival. This early nursing assessment identifies a person’s health issues and referral needs for medical, psychological, allied health and other care services. Mohammad, Amena and their children had pre departure medical screening which showed no urgent concerns, and the family did not express any to their case manager, so the nurse visited them at home two weeks after arrival (RHNs visit sooner if needed and aim to assess everyone within four weeks of arrival). The nurse explained her role, reassured the family of confidentiality and with the help of a professional interpreter, teased-out each person’s health story. Mohammad’s history of 12 months of daily chest pain on exertion and breathlessness – which he had never spoken about before – led to the nurse’s immediate referral for urgent medical review: two weeks later he had a successful coronary artery bypass.
“Mohammad, Amena and their family are just one of many stories that demonstrate why Refugee Health Nurses are vital to the health and wellbeing of people in our community.”
The family’s other health issues were addressed in the following weeks including the treatment of one child for latent tuberculosis, after a positive reading from a routine Mantoux skin test performed by the RHN coupled with the identification of a close family contact who was recently treated for active tuberculosis. Amena is receiving trauma counselling with Foundation House, and all the children are now taking Vitamin D and spending plenty of time outside after they learned about the need for appropriate sun exposure from the RHN. Mohammad, Amena and their family are just one of many stories that demonstrate why Refugee Health Nurses are vital to the health and wellbeing of people in our community.
Community & Primary Health Care Nursing Week 18–24 SEPTEMBER 2017
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Why do you need community and primary health care nurses?
A bridge between patient and doctor Pooja Shankar Primary health care nursing is delivered in various settings such as community, domiciliary and general practice to name a few (APNA, 2017). Since I am a practice nurse, I would like to focus on Practice Nursing as a means of delivering holistic patient centered care based upon my experiences at work. Nurses are often seen as the bridge between patients and doctors. I find this to be particularly true as patients will often tell me pertinent information they deem unimportant for the doctor. Therefore one can surmise that a joint consultation with a doctor and practice nurse elicits a more holistic interaction. In the last few months, I have formed a trusting and therapeutic relationship with our regular patients. While parents are appreciative of my offer of a post paediatric immunisation follow up via the phone, I feel this relationship may be further extended to allow any practice nurse to casually call and follow up vulnerable patients who default appointments or those with long absences from the clinic. I believe this not only boosts patient morale, it also creates a safety net for them. According to the Royal Australian College of General Practitioners (RACGP), nurses are effective in applying preventive medicine principles to general practice (2017). Sexual health, women’s health including contraception advice and absolute neutrophil count, health promotion involving Smoking, Nutrition, Alcohol and Physical (SNAP), and well-baby and immunisation clinics led by nurses are more likely to be accessed by patients who do not wish to wait amongst sick patients. Nurse led chronic disease clinics that engage patients and significant others by educating them on natural disease progression, principles of self-management and recognition of early deterioration may reduce the likelihood of hospitalisation secondary to preventable complications. Reintroduction of legislation allowing nurses to bill Medicare for the above services may result in more practices dedicating resources to an essential primary care service. I think an excellent way of extending the scope of practice of the practice nurse would be in the formation of a liaison network with the local hospital and bodies such as Cancer Council, Aged Care Assessment Teams, palliative and domiciliary care. The linked practice nurse could then refer newly diagnosed patients to Breast Cancer and Bowel Cancer Associations. They could
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“In this way, the community would be more informed, better connected and there would be less occurrence of patients falling through the system.”
direct parents of special needs children to appropriate support groups and link those living with disabilities to the relevant service centres. Hence the evolution of the practice nurse from primarily supportive role to one that also complements GPs. In this way, the community would be more informed, better connected and there would be less occurrence of patients falling through the system. While medical services will still be required for obvious reasons, individuals would feel supported in their health journey and readily seek health services leading to a higher state of wellbeing for the patient and the society as a whole. References Apna.asn.au. (2017). What is Primary Health Care Nursing. [online] Available at: https://www.apna.asn.au/profession/what-is-primary-healthcare-nursing [Accessed 18 Jul. 2017]. Practitioners, T. (2017). RACGP - Practice nurses. [online] Racgp.org.au. Available at: http://www.racgp.org.au/your-practice/guidelines/greenbook/aframework-for-prevention-in-general-practice/key-strategies-for-improvedprevention-performance/practice-nurses [Accessed 18 Jul. 2017].
Community & Primary Health Care Nursing Week 18–24 SEPTEMBER 2017
Why do you need community and primary health care nurses?
The integrated role of the CPHC nurse Razz Oscroft Primary health care in community settings is integrated, accessible health care by clinicians who are accountable for addressing a large majority of personal health care needs, developing a sustained partnership with patients and practising in the context of family and community. The nurse in community and primary health care (CPHC) demonstrates competence in the provision of primary health care centred on individuals and groups in accordance with their education, professional nursing standards and relevant legislation. While the role of the nurse in CPHC varies according to the population profile of the community, the health care practice structure and employment arrangements, they provide a combination of direct clinical care and management of clinical care systems in an environment which is often isolated from other nurses. This requires that they work collaboratively with others to promote health care. In some CPHC practices the nurse autonomously conducts clinics, health assessments and Chronic Disease Management (CDM) programmes. They also play a pivotal role in health promotion, health maintenance and prevention of illness through provision of evidence based information and education to individuals, groups and communities. This requires a broad knowledge of resources available within the community and health care sectors. There is a requirement for highly developed information literacy, management and coordination skills to enable the development and management of systems that ensure safety and quality. This includes recall, infection control and quality improvement systems, clinical auditing and medication safety systems. The CPHC nurse strives to improve health outcomes by strengthening and developing the role of the CPHC nurse in the healthcare system by: 1. Management of chronic disease – with referral to appropriate allied health professionals, building partnerships, alliances and exploring collaborative models for improving health care
2. Participating in shared decision making about the care delivery with individuals, groups and members of the treatment team 3. Monitoring local, community and population health developments and resources for integration into the care of individuals and groups 4. Identifying priorities to strengthen PHC in community practice which include: • making health care more accessible • focusing on prevention and early intervention • encouraging better chronic disease management • supporting integration and multidisciplinary care 5. Service provision and clinical skills – used to provide quicker access and assist in patient assessment and treatment and these can include spirometry, electrocardiology (ECG), venepuncture, cardiopulmonary resuscitation (CPR), suturing, pap smears, immunisation and wound management. 6. Community education – providing either one-to-one education or group education clinics in chronic disease such as asthma and diabetes 7. Patient advocacy – the CPHC nurse is in the perfect position to provide advocacy for the patients and community
Community & Primary Health Care Nursing Week 18–24 SEPTEMBER 2017
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Q/A: Community and Primary Health Care Nursing
Gary Greer MACN
Why would you encourage a nurse to work in this area of practice?
Why do you think community and primary health care nursing is vital to the health and wellbeing of our society?
It’s fascinating being allowed to glimpse into others’ lives, and you’re often invited to become part of their very extended family.
Simply, hospitals are dangerous places once you start to become well and need to move about. Falls, infections and disrupted sleep are all chronic problems of the health system. Allowing people to access high quality care in their homes reduces the risks of all these things, and contributes to a person remaining a valued member of their community for longer.
What is your role and how is this valuable to the community?
Why is it important that others understand the important work of community and primary health care nurses? It has been seen for a long time as ‘bed, bath and pills’ service, perceived as low value and poorly regarded area of practice – not at all sexy like ED or ICU. No one has made a thrilling TV series about community nursing because it runs to a different rhythm, and is one of the last places in nursing where the relationship between clinician and client develops over time, and can often become the defining feature of the care episode. This regard for each other can often allow difficult subjects, such as domestic abuse or continence, to be safely and effectively discussed and dealt with.
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We are building a new community nursing service off the back of a nursing agency. It is in response to the simultaneous push from the health system to keep as many people out of hospital as possible, and the gradual disintegration of large current providers, such as RDNS. What led you to pursue a career in community and primary health? I got sick of the constant push to move people through the ward as fast as possible and the sinking feeling you get from helping someone out the door, only to turn around to see the bed already filled. I decided it wasn’t as much about quality as quantity. Can you provide an example of when you’ve felt your work is making a difference? Many. We had a client who had a terminal disease and chose to die at home. Working with the family to support their needs, we were able to support that family to celebrate their mother’s life in a way that few people are able to.
Community & Primary Health Care Nursing Week 18–24 SEPTEMBER 2017
Why do you need community and primary health care nurses?
Advocacy and Primary Health Care Nursing Sharon James Through advocacy of both our patients and profession, outcomes for the health and wellbeing of our communities have seen improvement. We nurses facilitate change for those who need preventative services, struggle with ill-health, or the social determinants of health. We do this because we want better outcomes for our patients. These are basic human needs, for which, we provide a pivotal role. Advocacy forms part of our practice guidelines and ethics. So, as nurses, it is something that is core to what we do. Through advocacy we act as conduits for other services, engage our patients in their care, empower our patients to undertake self-management, collaborate with other health professionals, provide treatment and plan ongoing care. Sometimes we do all of these things seemingly at the same time! As a profession, we advocate for one another through collaboration, effective patient care and seek opportunities to better our skills and knowledge. Advocating both clinically and professionally can improve patient outcomes.
“We do this because we want better outcomes for our patients.”
From the researcher’s perspective, advocacy of societal health and wellbeing continues as we act as the interface between clinicians, patients and policy. In this context, opportunities exist for clinicians to showcase innovative ways of service provision to meet Primary Health Care Nursing needs. Improving knowledge for enhanced patient and professional outcomes is an important step in this process. It is one where clinician led research feels like a privileged position to be in, where I can advocate for my patients and profession. In doing so, I will hopefully make a small contribution in improving the health and wellbeing of my community.
Community & Primary Health Care Nursing Week 18–24 SEPTEMBER 2017
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Why do you need community and primary health care nurses?
Promoting adolescent health in the community Sze Wai Wu MACN It is a great pleasure to be a mentor of the Community Health Advancement and Student Engagement (CHASE) program, a community health initiative by a non-profit organisation. The CEO of CHASE, Michael Lim is passionate about adolescent health and education. The program aims to promote adolescent health and wellbeing and enhance life skills through education and mentoring. CHASE program mentors conducted health education classes with a Year 11 VCAL class in their designated school during semester one, 2017. In these classes, mentors built relationships with students and provided a safe environment for students to discuss issues such as body image, healthy eating, supporting peers, self-care for better mental health, gender identity and alcohol and drug use. The classes aimed to enhance student understanding of the importance of good health and risk prevention, and empower them to take responsibility for their own health. If teenagers remain physically and psychologically healthy during adolescence, they are better equipped to meet the challenges of adult life and forestall the development of chronic disease later in life. In semester two, the mentors will work with groups of students to develop and implement a community project that is related to a topic they found interesting during their health education classes. The community project provides an opportunity for students to develop transferrable skills in collaborative decision making by participating in a team project for the benefit of the community. It is hoped students will develop a better understanding of their society and stronger connections with it through their participation in a project for the benefit of their community. Currently, CHASE is mentoring students in six different schools. The students collaborate with several organisations, including St. John of God, Hope Street, Western Health and local aged care facilities, to develop community projects. Last year, students of Copperfield College collaborated with the St John of God. They successfully organised a sports day for people with disabilities to raise awareness of disability within the community and to promote physical health amongst the disabled. Information about CHASE can be found at http://chaseprogram.org.au
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Community & Primary Health Care Nursing Week 18â&#x20AC;&#x201C;24 SEPTEMBER 2017
â&#x20AC;&#x153;It is hoped students will develop a better understanding of their society and stronger connections with it through their participation in a project for the benefit of their community.â&#x20AC;?
Why do you need community and primary health care nurses?
Providing care for thousands every day Tracy Aylen Bolton Clarke (the new face of RSL Care and RDNS) has a long history in community nursing and primary health care provision, starting with a single nurse on the streets of Melbourne in 1885. Today, more than 6,500 staff across the organisation deliver services and we support more than 25,000 people every day. Community nurses are at the frontline of client-directed care, working with clients in their homes to provide excellent clinical support and helping people stay active, independent and well informed about their health. Working with clients on their health goals and integrating current evidence based care are key clinical objectives. Two recent case examples from Victorian and Queensland based nurses help to illustrate this approach in practice. Our Melbourne South Diabetes Clinical Nurse Consultant (CNC) and nursing staff supported a client with disabilities and unstable diabetes to continue attending her respite program. Blood glucose (BG) monitoring, usually attended by the family carer, was not an option at the day program due to their staffing issues, causing the client and family some concern. Nurses, in conjunction with the Diabetes CNC, worked with the client, care team and family to find a better solution allowing more independence and safety attending the respite program.
“Working with clients on their health goals and integrating current evidence based care are key clinical objectives.”
In Mackay, a community nurse supporting a client with unstable diabetes and severe complications used her past diabetes studies and clinical experience to address client goals and reduce distress around the frequency of BG monitoring that interrupted the client’s sleep. Both these cases involved clients with existing diabetes care teams but requiring additional community support to take up more recent diabetes technology; alternative glucose monitoring via a sensor inserted into the skin (up to 14 days), a reader (monitor) swiped over the sensor and e-communication capacity. Monitoring BG levels this way meant the family in Melbourne could view their daughter’s current BG results and be in direct contact with the day program staff. For the client in Queensland and her partner it meant finally getting a good night’s sleep. Thanks to the team approach, clear client goals and appropriate clinical interventions, both clients are able to manage more independently and no longer need our services. For us, that’s the measure of success.
Community & Primary Health Care Nursing Week 18–24 SEPTEMBER 2017
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Why do you need community and primary health care nurses?
FEE-HELP
is now available for all of our gradua te certificate course s
SPECIALISE IN COMMUNITY AND PRIMARY HEALTH WITH ACN GRADUATE CERTIFICATE IN COMMUNITY AND PRIMARY HEALTH NURSING Community and primary health nursing is one of the most multifaceted area of specialty practice in 21st century nursing. Nurses work in specialties ranging from aged care dementia, primary health care for the homeless, palliative care, chronic disease, child and family health to refugee health. To cater for these diverse needs, this graduate certificate offers a wide range of electives, with more units under development. Career opportunities may include: • Specialist nursing within child and family health
Why study with ACN? ACN is a leading provider of postgraduate and vocational education for registered and enrolled nurses. When you study with ACN you can be confident that you have chosen a college that is recognised for providing courses with strong clinical focus and evidence based practice. Our comprehensive courses are designed and developed by nurse educators to ensure that they build your clinical skills and advance your knowledge in your specialty area of practice.
• Clinical education and consultancy roles • Management roles • Rural and remote nursing roles.
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www.acn.edu.au/community-and-primary-health-care-nursing
Community & Primary Health Care Nursing Week 18–24 SEPTEMBER 2017
Q/A: Community and Primary Health Care Nursing
Kitty Hutchison MACN Why do you think community and primary health care nursing is vital to the health and wellbeing of our society? With our aging population, increasingly complex needs of chronic disease and the resulting increase in pressure on our acute care system, our traditional acute and specialised care focused models of health care in Australia are no longer able to fully respond to the health needs of our society. Nurses are a largely untapped resource in this picture. Community nurses have a focus that is inclusive and understanding of the biological and psychosocial determinants of health. Person centred care is a model we have to use every day if we want our clients and patients to engage with us and get the health outcomes we are working with them for. Why is it important that others understand the important work of community and primary health care nurses? The value of nurses in this space is underestimated. Our ability to communicate and build rapport, assess the whole needs of the patient and our ability to coordinate person focused care is not fully utilised. I believe we play a key role in not only delivering care, but also in linking our primary and secondary health care systems. Unfortunately, we are not good at articulating our own value and until we do it will be difficult to help others understand our work. Why would you encourage a nurse to work in this area of practice? Nursing in the community can be very satisfying at the end of the day. We can (and have to) apply a fully person centred approach to developing and delivering our care. There is most often an autonomy in our decision making that is respected and valued by the other members of the interdisciplinary health care team.
What led you to pursue a career in community and primary health? I have always been drawn to a holistic approach to health. Community health nursing enables me to look at whole of a person and plan care that suits each individual. Can you provide an example of when you’ve felt your work is making a difference? In our workspace, we really value supporting undergraduate student clinical placements. I really enjoy seeing the light come on in the students’ eyes. It’s that possibility thinking around their career trajectory and options for the future that starts when they see the way our nurses practice.
What is your role and how is this valuable to the community? I have been working in community for twenty years now. My early roles were in post-acute care and coordination of care. For the past seven years, I have been working as a nurse educator – community, support and enhance practice. I also work as an adjunct lecturer in community at Griffith University. I am passionate about supporting our community nurses to maintain high standards of practice and to also be confident to share their innovation and experience with others.
Community & Primary Health Care Nursing Week 18–24 SEPTEMBER 2017
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Q/A: Community and Primary Health Care Nursing
Musette Healey MACN ACN Nurse Educator Why do you think community and primary health care nursing is vital to the health and wellbeing of our society? Community and primary health care nursing is vital to the health and wellbeing of our society as currently we have an increasing population that is aging, have increasing incidence of chronic disease and diseases related to lifestyle. Primary and community health care nurses are in a unique position to support the community where they are, allowing them to live the best life possible for them in the environment that is important to them by taking a primary health approach. Why would you encourage a nurse to specialise in this area of practice? Community and primary health care nurses are at the forefront and therefore are integral to health care delivery in Australia. This is a growing, challenging and dynamic specialty where no two days will be identical, where you have an opportunity to impact an individual, family and community’s health and wellbeing over a period of time and multiple interactions. Working in this area allows you to positively impact on people — whether it’s working in general practice dressing wounds, providing immunisations, performing health screening assessments or in the community supporting a young mother struggling with settling her new baby, supporting the mental health of a middle aged man or providing care and support to the family of a dying man — you will make an indelible mark on that patient, the family and community. What do you think our students gain from our Community and Primary Health Care Nursing Graduate Certificate? Through ACN’s Graduate Certificate in Community and Primary Health Care Nursing, nurses gain knowledge and skills to support people to improve their health and live their best life within the environment they call home. This includes an understanding of the health care system, models of care and current primary health initiatives such as health care homes. They learn skills such as motivational interviewing, patient education and support. The graduate certificate allows nurses to tailor the course to their areas of practice through specialty electives in primary health, practice nursing or chronic and complex care. Students can then increase
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their knowledge in areas of interest such as wound management, palliative care, aging or continence management through the choice of two electives. As a student you are encouraged to link the theory to your clinical practice by building on existing knowledge and skills through peer collaboration, reflection and workplace learning. You are able to build a professional network with other nurses with similar clinical interests and create a support network that extends past the bounds of the course. What do you think our students gain from our Child and Family Health Care Graduate Certificate? Through the Graduate Certificate in Child and Family Health Care, nurses gain the knowledge and skills to support families with children from birth to five years in the primary health setting. Students gain the knowledge and skills required to work with families in a partnership model that focuses on providing psychosocial support for parents, health and developmental surveillance of infants and young children. The course supports students to take a holistic view of child health and wellbeing by considering the bio-psychosocial, cultural and emotional needs of the family and the promotion of a nurturing, supportive environment where children can thrive. Students also have the opportunity to build professional networks. Why is it important that ACN provides a platform for nurses to expand their knowledge and skills in these areas through these graduate certificates? ACN is committed to ensuring that nurses are able to deliver exceptional nursing care to every individual that crosses their path and believe that education is a way of ensuring nurses have the skills and knowledge to do this in the dynamic and evolving contemporary world of health. Health care is a basic human right and as Australia’s preeminent nursing organisation we are committed to supporting every nurse to ensure that all Australians receive the highest level of health care from dedicated, educated, competent practitioners. Primary and community health nurses are integral to health care system and the provision of health care, particularly in vulnerable populations and the rural and remote areas of Australia, without nurses some of these people would receive no health care which impacts not only life expectancy but also quality of life.
Community & Primary Health Care Nursing Week 18–24 SEPTEMBER 2017
Q/A: Community and Primary Health Care Nursing
Why is it important that others understand the vital work of community and primary health care nurses? The impact of community and primary health care nurses is immeasurable. Community and primary health workers work across multiple specialty areas with multiple populations and therefore they often have a very broad knowledge. They are the nurses that visit patients at home to check on drains or do dressings when we discharge them from hospital two days after a major operation that 10 years ago would have seen them in hospital for a week or more. They are the nurse that provides advice to the distressed mother of a six-week-old baby with a fever on the phone. They are the nurse who allows your 96-year-old grandmother to continue to live in the family home despite her increasing frailty. They are the nurse that jumps on a plane to travel to a remote outback community to provide a health clinic. They are the nurse that supports the patient with emphysema to modify his energy expenditure so that he has the energy to attend his weekly trivia night at the bowling club. Without these incredible nurses, so many in our population would not have access to health care, they would not be able to recover in their own environment, they would not have the skills to manage their chronic disease so that they can do the things that are important to them. THANK YOU to the amazing, incredible, dedicated primary and community health nurses who look after us every day.
Community & Primary Health Care Nursing Week 18â&#x20AC;&#x201C;24 SEPTEMBER 2017
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Regal Home Health Advertorial
PEOPLE, FAMILIES AND COMMUNITIES “When you think about nursing in the community, you can look at it in two ways, ‘just visit patients’ or make an impact in their lives, your community and influence health outcomes. It’s simple really, most people choose to be cared for in their own homes until end of life, at Regal we have been doing that for over 50 years.” - Regal Home Health CEO Adjunct Associate Professor Anna M Shepherd MACN (Associate)
Adjunct Associate Professor Anna M Shepherd MACN (Associate) is a lifelong passionate driver and influencer for the recognition of the clinical, economic and wellbeing outcomes achieved by nurses in the community. In the words of Dr Tedros, Director General of the World Health Organization (WHO), there is “no health without nurses”. Regal Home Health provides care to thousands of Australians, including veterans, National Disability Insurance Scheme (NDIS) clients, private health fund members, hospital substitution program clients and the general community every year in greater metropolitan Sydney, via its highly trained and experienced team. Regal provides health care and support services to assist people to live safely and independently at home. Regal assesses a client’s individual needs and provides a cost effective and sustainable solution.
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Feedback from the mother of an NDIS client received and provided back to one of our nurses: We received a call just now from Mrs Jones* who wanted to provide feedback on how much your visits have helped their family. “It has worked so well! Sarah* looks forward to Sam* coming and sits excitedly watching for her car. It was hard for me to be comfortable with having someone in the home after what happened with another provider in the past and I am so grateful to Regal for arranging such a lovely nurse. I know that Sam is introducing Susan* tomorrow in a joint visit, so that Sarah will be comfortable with either nurse if one is away. I am so happy, I am going to call NDIS and tell them what a wonderful experience I’ve had with Regal Home Health.” Tailored support is the key to staying at home; care for different circumstances. Lawrence* is a 65-year-old man who was referred to Regal from an insurer following a period of high claims. Lawrence had been admitted to hospital for seven months following a neurological event and seizure following post radiation brain injury. The hospital had recommended Lawrence for placement in a residential aged care facility, however his wife wanted to look after him at home.
Community & Primary Health Care Nursing Week 18–24 SEPTEMBER 2017
Regal Home Health Advertorial
After determining suitability and assessing the risks to the client and his wife, a Regal nurse completed a health assessment and reported Lawrence was very emotionally flat and frustrated, he wasn’t able to transfer into bed or the car. The inability to mobilise also increased his risks of pressure injuries, deep venous thrombosis (DVT) and oedema. Regal arranged for a physiotherapy assessment and Lawrence was found to have recovered some neurological function since discharge and it was felt that some level of mobility and transfer ability was attainable, with the potential of Lawrence walking again! A referral was made for intensive in-patient rehabilitation supplemented by a step down program at home. A new Aged Care Assessment Team assessment was arranged which resulted in an upgrade of his community package to high care. Lawrence has regained significant neurological function and mobility, which has enabled him to stay safely at home and reengage with his community. This increased mobility has had a marked improvement on Lawrence’s mental health, independence and a reduction in carer stress to his wife. When Regal nurses are asked what they enjoy about working in the community they respond that they love the relationships they develop with their clients, they enjoy the flexibility of working autonomously and they appreciate the clinical variety. Community nursing is not ‘just nursing’. Every client and their circumstances are different, healing and support means different things
to different people and what helps people heal can be different. Community nurses need a holistic approach in working with clients to not only address their immediate needs, but to also make a long term impact on their quality of life. For many, there are huge benefits in receiving care within your own home, a familiar and comfortable environment, where a relaxed client generally recovers quicker than a stressed one. Often, its easier to rest at home than in a facility and with well rested client, their body is likely to heal faster. Many people also feel like they have greater control over their care and are more involved, which contributes to a sense of independence. Often, community nursing allows for continuity of care, with the same nurse attending regularly. This can make it easier for the nurse to build a rapport with the patient and to notice a change or slight deterioration in health. CEO Adjunct Associate Professor Anna M Shepherd MACN (Associate) says all at Regal have a passion for patient care and clinical excellence. “The focus is on finding innovative ways to tailor care to the values and needs of the individual so every individual is respected, empowered and treated with dignity and respect.” #iwanttobearegalnurse *names have been changed.
Community & Primary Health Care Nursing Week 18–24 SEPTEMBER 2017
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Community & Primary Health Care Nursing Week
Nurses where you need them 18â&#x20AC;&#x201C;24 SEPTEMBER 2017
www.acn.edu.au/CPHCNW