Primary Care Nursing - Essay Example

Running head: PRIMARY CARE Primary Care Nursing You're There are many factors that enter into the role ofa primary care nurse. In more recent years the knowledge that an interpersonal approach is detrimental to the patient's well being has become more and more clear. Therefore this is considered to be one of the necessities when establishing a patient care routine. The research will show that there are other variables that have to be considered as well, some having to do with socioeconomic factors, and others having to do with psychological factors, while yet still others have to do with the biological considerations that have to be made. Working in collaboration with other medical professionals is also crucial in the care of patients. There are many professionals involved with a patients routine care from the X-ray technologists to the nurse's assistances, and on up to the primary nurses and actual doctors themselves. All of these positions fit in to fill in the missing puzzle pieces in the patient care routine. So, nursing is far more than evaluating and assessing but has now become much more personal and complex. The conclusion summarizes all of the points in the body of this research and concludes that the primary care nurses role is fundamental in a positive patient outcome and with achieving a patients trust and approval throughout their care and treatment regimen. Primary Care Nursing Introduction Regardless of whether or not a nurse is in primary medical care or intermediate care, they both share very similar responsibilities. All forms of care and all nurses utilize a scientific and often a holistic approach in order to plan the care for patients. This philosophy does not deviate simply because there are different fields in nursing, although the care in these two might become more complex, specifically in the intermediate form of nursing care. Furthermore, in primary nursing care there has to be strong collaboration skills in order for the partnership with other medical professionals to properly influence the quality of care in a positive manner and provide improved patient outcomes (Teresi & Koren 1993, pg. 420). There are many definitions for 'collaboration' in primary care nursing but the Dept. of Health has the most profound meaning as it directly relates to the medical field and nurses interactions with each other and other professionals in medicine. The Health Dept. dictates it to mean, "a partnership of individuals and organizations formed to enable clients to increase their influence over the factors that affect their health and well-being" (Dept. of Health 1998). So quite realistically it is conceptualized as a body of power that can inevitably affect a patient's ongoing health care and medical treatment established for them. Therefore there has to be a strong collaborative approach between all medical professionals in this area of care. This is true for intermediate care as well but, research studies have concluded it is a more necessary approach in primary care because 90% of patient interaction takes place in this area increasing the necessity to have strong interpersonal and collaborative skills to work effectively with one another (Hardy et al 2000). The basic point in primary care is ensuring that the patients' needs are adequately met with high quality care and an interpersonal approach is utilized as well. Also, the mix of medical professionals working collaboratively together as a unified and efficient unit brings the most positivism in this area of nursing. The Main Issues in Primary Care The Primary Care Act of (1997) has brought an enlightenment to the medical world, with specific regard to the nurses so that they know exactly what the main goal of their profession is, with explicit points focused towards working with others and their immediate patients (National Health Service 1997, Chapter 46). The Primary Care Act of 1997, emphasized seven areas for action, among these was the inclusion of working partnerships and encouraging collaboration, which is being discussed in this literature. Those who are and have been in support of this Act have stated, and even been able to provide the validation to show that teams are more capable of providing comprehensive services to communities than nurses who work alone (Stange 2004, pg. 2). The NHS has come to realize that primary care is one of the strongest medical arenas in the health care regimen within the UK. Therefore one of the goals since 2000 has been to try and modernize primary care services to blend them in with community health care as well. Therefore, intermediate care is intricately intertwined with primary care although they are in two different sectors of the health realm within the medical profession (Wilkins et al 2001, pg. 1522). Although the goals, as said, are several there have been problems in achieving them. It is true that primary care provides services at a lower cost and that these services are more accessible than those found in intermediate care but there have been issues within the collaborative efforts of the professionals which have hindered the process of modernization. Nevertheless, primary care initiatives have changed the structure of health care in the UK. They have managed to build a good collaboration among one another and many different areas share resources, such as in the surgical area, intermediate area, and the community health care, so these are definite pluses in the NHS (Wilkins et al 2001, pg. 1523). The main reasons that nurses who work in primary care need a good interpersonal approach is due to the nature of the services that are rendered and the background of the patients that are cared for. Primary care try's to extend its services out to those who are in the most need and to cultures that are not competently understood at all times. They often work with patients who are refugees, homeless, and members of minority ethnic groups (Bodenheimer 2006, pg.861). These nurses in primary care face high stress situations as they deal with many different forms of illness, far surpassing any that are found in intermediate care or in an area where normally they would be referred to a specialist. Primary care works with a large amount of people who have multiple medical problems. Nurses have to be familiar with disease and illness ranging from urinary tract infections, upper respiratory infections, elderly patients with diabetes, coronary heart disease, arthritis, and even depression. Also, they have to try and develop a relationship with the patients so that they can work around the problems associated with limited language that poses a barrier in communication (Safran 2003, pg. 250). This brings in the idea for the need of cross racial primary care relationships so that no group or individual will feel neglected or feel as if their care is not being carried out satisfactorily. Of course this is something that is relevant in intermediate care and in all other fields of nursing and medical care as well (Benkert et al 2004, pg. 23). Mainly this relationship has needed developed because the NHS has uncovered many facts relative to the idea that those of a different ethnic background are faced with far more health disparities than anyone else which complicates their medical care. Racial differences definitely affect communication which is why primary care nurses have to be fundamentally able to tackle these issues more fluidly than in any other area since they have such a wide berth to cover in their nursing area. Again, these points emphasize a strong resounding need to ensure that an interpersonal approach is heavily utilized and that holistic health care is sometimes one of the best methodologies to follow through with for the more diverse groups of patients in particular (Larson 2003, pg. 110). It is believed that this concept and teamwork or collaboration among medical professionals can eradicate these problem areas and mend issues such as language barriers, misinterpretations about treatment, feelings of neglect, and the quality of care that is given by the primary care nurses as well (Sox 2003, pg. 230). Not only are all of these issues highly important in primary care but they are just as important in intermediate care. The social needs are detrimental to the patients well being and have to be met as adequately as the health needs must be in both of these areas. Therefore, yet again we see clear signs that holistic care which brings about sincere care and an improved understanding can diminish the many barriers being discussed. Also, as has been being stated repeatedly, the interpersonal approach is one of the best to use to surpass language and other communication problems with patients and nurses (Peplau 1997, pg. 162). It does however take collaboration among all nursing groups to ensure relationships like this can develop and to evolve the nursing care into a form that is of high quality and accessible to all people (Forchuck 1991, pg. 54). Cochrane & Slayers (2006) believes nursing can be greatly improved through collaboration and it has been found the importance of equal involvement and shared ownership cannot be overestimated. Collaboration in Nursing Many factors can influence the ability of the team to practice effective co-operation. Poor communication and ineffective documentation can lead to a breakdown and is a major source of problems between disciplines (Gonzalez 2006, pg. 40). Other factors that are pertinent are maybe competitiveness, lack of knowledge, and an inability to accept different perspectives as well. A number of research studies have verified that; issues surrounding "professional turf" hinder collaborative working. Medical Research suggests that success requires clear understanding of common barriers, and of the strategies needed to minimize or resolve them. Furthermore, it has been identified as a fact that when working with colleagues from different professional groups it is essential to encourage the building of good relationships through bargaining, negotiation and joint planning (Loomis 1982, pg. 65). It has also come to be realized that relationship building, and shared decision making are arguably the two most monumental features of the entire process of collaboration in these two fields of nursing, along with other medical professionals as well. Furthermore, through collaboration in primary care and intermediate care, both of these fields of nursing now realize how important it is to view the patient as a whole individual, such as holistic health care shows. The Transformation of Nursing in Primary and Intermediate Care As the role of the nurse is developing and changing rapidly so is that of the patient. It has been redefined from that of passive recipient of care to that of responsible, active participant in care. This change was stimulated by a development in nursing philosophy away from the medical model and towards holistic care, which requires that patients are treated as individuals (The British Holistic Medical Association 2005). Initiatives such as PALS, (Patient Advice and Liaison Service) are one such example of how patients are becoming partners in their care in both primary care and intermediate care as well. The 'Expert Patient' is an innovative programme about educating those with chronic illness about self-management (Department of Health 1998). It has now, more than ever come to be realized that patients need to be involved in all aspects of health. However, in order to empower patients they must be given knowledge which requires collaboration not only of all medical professionals but between the nurses and patients as well. Wells & Costa (2005) state in a collaborative relationship there is a team concept, with all professionals sharing in the partnership of care. Because authority is shared, this effort results in more integrated and comprehensive care in all areas of nursing and medical care. To promote collaborative practice, nurses need to be aware of the range of teams and agencies involved in health promotion and acknowledge the client as an equal member of the team. It is also the belief of many researchers that each member of the team has a special contribution towards the goal of the team. I agree that each discipline must have knowledge of others' roles to ensure each is aware of what the other can contribute. Nevertheless, no one group should take on a dominant role and each group must value the contribution of the others because otherwise this will lead to the creation of adverse interprofessional attitudes and the formation of barriers to clinical effectiveness. Management of Primary Health Care Primary health care can be viewed as a philosophy and a system response to reducing health inequities and ameliorating the effects of disadvantage. However primary care reforms seem to have little to do with the increase in concern about health inequities (Ham 2000) as primary care is drawn from the biomedical model, practiced widely in nursing, and allied health, but general practice is the heart of the primary care sector. As the research has been defining however, there is a strong collaboration growing between these field and many others, specifically with general and intermediate nursing care. Drawn from the biomedical model, primary care involves a single service or intermittent management of a person's specific illness or disease condition in a service that is typically contained to a time-limited appointment, with or without follow-up and monitoring or an expectation of provider-client interaction beyond that visit. The term of primary health care is commonly interchanged with primary care and intermediate care as if their philosophies and practices were the same. Similarly, the term health promotion is often substituted for health education especially in the general practice and intermediate practice environments (Johnson 1996, pg. 98). Furthermore, there is co dependency of primary health care and health promotion as both operate to change the social, political, environmental and economic determinants of illness in order to create better health in communities, regions or cities. Of course this can not be done efficiently without collaboration, which has been heavily discussed in this literature. Primary care managers are focused on early diagnosis and timely, effective treatment but have greater potential for referral to secondary, non-medical services than has been realized to date. Primary health care managers work from a social model of health, which is partly based on understandings that in order for health gain to occur, people's basic needs must first be met. These include for example, shelter, support, and safety from violence, empowerment, equity, social justice, self-reliance and reliable, affordable food supplies. This is where the differentiating ideas appear evident between primary care services and intermediate care services even though both draw on each other for support (Chanda 2001, pg. 158). All in all however, all health care service areas work well and now in collaboration with one another to make competent decisions concerning patient care and well being. Sharing ideas and decision making styles has worked well to strengthen the various areas in the NHS as it continues to transform the medical world in and around the UK. Conclusion Primary health care is diversified and holds a complex range of notions, theories, and principles. It is not a simple and vertical process. The nursing theories and activities are more complex and the interpersonal skills necessary are far more imperative to proper health care service than ever before realized. This is the same with the management within primary health care and even intermediate health care to certain degrees. However, within these complexities are the secret solutions and sacred answers that seek far-reaching solutions to problems that defy biological, genetic or biochemical solutions and problems that demand new thinking, innovative approaches and values of community development ensuring maximum participation among all medical professionals. This is the case be they doctors, nurses, X-ray technicians, or any other specialist working in the medical field (Malcolm 2000). It is very important to recognize that primary health care requires the participation of those most affected by the problem and health worker accountability for that participation, which is more than likely the practicing primary health care nurse. Also, recognition of the patients as people is the most formidable task that nurses in intermediate care and primary care have because they often forget this and take on the more conventional mode of care. The most important people in the health community are patients and the best way of managing them is by caring for them. To care for another person is a great tribute, which requires a large group of people with varied skills and responsibilities. Furthermore, both of these areas are organized to form a chain of command that provides the best possible patient care. The research has suggested the greatest guarantee of quality health care for the patients lies in the character of the provider and of course this takes collaborative team work. To provide excellence in patient care depends upon: the application of sound ethical principles, good communication, and the understanding of, participation in, and utilization of research findings shared between all medical areas. Although these are the main attributes there are many other factors that go into making a service, which gives the patients the best possible care, therefore aiding in a successful treatment and full recovery process. As the research has stated, the interpersonal approach provides all care and services to the patient in an unrestricted yet sincere and caring manner through both intermediate care and primary care nursing services. These services should remain unbiased and unrestrictive against personal attitudes or the nature of the disease or illness, and without discrimination, regardless of sex, race, creed, religion, or socioeconomic status. In finality, the health care team is made up of professionals that have undergone a high level of education and are sufficiently experienced to use independent judgment, and discretion at all times. The techniques, practices and methodologies should be continually improved by participating in educational and professional activities, whilst sharing the knowledge with colleagues, and investigating new and innovative aspects of professional practice. Though different nursing areas focus on specific treatment methods the point is there should always be strong collaboration so that the patient experiences the best possible patient outcome and their quality of life is maintained to a decent level. References Benkert, Ramona & Pohl, Joanne & Coleman-Burns, Patricia. (2004). Creating Cross-Racial Primary Care Relationships in a Nurse Managed Center. Journal of Cultural Diversity 15, 23-25. Bodenheimer, Thomas. (2006). Primary Care-Will It Survive The New England Journal of Medicine 355, 861-864. British Medical Holistic Association. (2005). Retrieved 14 August, 2006 from the World Wide Web at: http://www.bhma.org/modules.phpop=modload&name=PagEd&file=index&topic_id=0&page_id=42 Chanda, R. (2001). Trade in Health Services. Bulletin of the World Health Organization 80, 158-163. Cochrane, W. S. & Slayers, K. M. (2006). Collaborative Consultation Training: The Missing Link to the Enhancement of Nursing. 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Wilkin, David & Dowswell, Therese & Leese, Brenda. (2001). Modernising Primary Care and Community Health Services. Journal of Primary Care Groups 322, 1522-1524. Read More