NUM3511 Community Health Care in Nursing and Midwifery Practice

60 Pages·2022·14.246 MB·English

by  Edith Cowan University

NUM3511
Community Health Care in
Nursing and Midwifery Practice
NUM3511 #1 Introduction to Primary Health Care (PHC)
Objectives
At the end of this lecture students will be able to :
● Provide an overview of the elements of PHC to be discussed in this unit.
● Define the term Primary Health Care.
● Discuss the importance of PHC globally and locally .
● Discuss the Australian Governments commitment to the future development of PHC in Australia.
● Discuss the role of the nurse in delivery of PHC.
Models of Care(Recap)
Biomedical
● Conceptual foundation of modern scientific health
● Focus on individuals
● Focus on disease /Illness/ biological state
● Curative interventions through medications , surgery, immunisation, behaviour change.
● Reductionist as it ignores the complexities of health and illness.
● Victim blaming
● Cost in Australia is approximately 10% of GDP.
Social
Health and illness are a social construct that:
● Acknowledges an individual's living and working conditions and the effect they have on health.
● That there is social responsibility for health.
● Wellness is impacted by SDoH.
● Acknowledges that political, social and economic factors impact an individual's health
Interventions:
● Require public policy formation.
● Community participation.
● Structural, economic and political change.
Levels of Care Delivery (Recap)
Primary
● Primary care is typically the first point of contact people have with the health system.
● It is often delivered by a GP but other health professionals such as allied health workers,
community health workers, nurse practitioners, pharmacists, dentists, Aboriginal health
practitioners and midwives also deliver primary care.
Secondary
● Secondary care relates to care delivered in the traditional healthcare setting and i.e. hospital -
Here patients are assessed (x-rays, bloods), diagnosed and referred or treated.
Tertiary
● Tertiary care is specialist care that requires specialist interventions i.e ICU
● How does Australia's health system work? AIHW.
https://www.aihw.gov.au/getmedia/f2ae1191-bbf2-47b6-a9d4-1b2ca65553a1/ah16-2-1-how-does-austr
alias-health-system-work.pdf.aspx
Social Determinants of health
What is Primary Health Care?
● A Black Box
● Alma Ata Declaration (1978)
● The declaration of Alma Ata was adopted at the International Conference on PHC in Kazakhstan on
12thSept 1978.
● ‘The main goal of Governments and the World Health Organisation in the coming decades should be
the attainment by all people of the world by the year 2000, a level of health that would permit them to
lead a socially and economically productive life.’
● that access to basic health services were a fundamental human right. Identified primary health care as
the key to attainment of health for all
● https://www.who.int/data/gho/data/themes/topics/topicdetails/GHO/world-health-statistics
Alma Ata definition of PHC.
● “Essential health care based on practical scientifically sound and socially acceptable methods
and technology made universally accessible to individuals and families in the community
through their full participation and at a cost that the community and country can afford to
maintain at every stage of their development in the spirit of self reliance and self determination”.
Australia’s Response
Australia:
● Is a signatory on the Declaration of Alma Ata
● Has indicated an International commitment to PHC. The most significant initiative by the
Australian Government was the initial introduction of a universal health care scheme by the
Whitlam Govt. This was set in stone in 1984 by the Hawke Government and included the PBS.
● Medicare. Ensuring access to care and quality of care for all Australians.
Primary care vs Primary Health care
● Do not confuse Primary Health care with Primary Care.
● Primary Care is typically the first point of contact people have with the health system and a one off
intervention.
Primary Health Care :
Encompasses a wide range of activities which encourages health and wellbeing in communities.
Talbot & Verrinda (2016) p 25.
PHC - A philosophy of care
Aims
● To redress inequalities in health
● To recognise that health is dependent on a range of social, physical, environmental, economic
and political factors
PHC Interventions
Primary Intervention:
● Occur prior to the onset of a health related problem - prevention activities like vaccination
Secondary Intervention:
● Early detection and treatment of existing health problems. This might include screening i.e. pap
smears.
Tertiary Interventions:
● Management of existing illness, through support, preventative measures and rehabilitation. Eg.
Diet/exercise/to improve and maintain wellness.
Principles that underpin PHC
● Accessible health care.
● Appropriate technology.
● Increased emphasis on health promotion
● Inter sectoral collaboration
● Cultural sensitivity and cultural safety.
● Community participation and empowerment
Essential components include
● Education: About prevailing health problems, their prevention and control.
● Adequate nutrition and food supply
● Adequate supply of safe water and basic sanitation
● Maternal and child health including family planning
● Immunisation against infectious diseases
● Prevention and control of endemic diseases
● Treatment of common infections
● Essential drugs.
● Wellness and mental health.
Alma Ata Declaration (1978).
● Changes in global health since the Declaration of Alma Ata
● There has been a global increase in the number of people moving out of poverty .This has resulted in
changes to morbidity and mortality data across the world.
● Many people are living longer
● Access to health care has improved in many poorer Nations
● There is significant improvement globally in access to clean water, sanitation and food.
● An improvement in Antenatal care.
● Widespread vaccination programmes
Global concerns remain
● Improvements in health have been unequal
● Urbanisation and increased travel has increased spread of communicable disease
● The ageing population in many countries has led to an increase in chronic conditions
● Many countries have allowed an unregulated commercialisation of health
Ottawa Charter for Health Promotion
See p. 8 & Appendix 2 in your text
Eight Millennium Development Goals
1. To eradicate extreme poverty and hunger
2. To achieve universal primary education
3. To promote gender equality and empower women
4. To reduce child mortality
5. To improve maternal health
6. To combat HIV/AIDS, malaria, and other diseases
7. To ensure environmental sustainability
8. To develop a global partnership for development
What is primary health care
● https://www.youtube.com/watch?v=_EXy9DTDJu8&frags=wn
Primary health care is about caring for people, rather than simply treating specific diseases or conditions.
Good primary health care is made up of three parts: empowered people and communities who can take care
of and advocate for their health; ensuring multi sectoral policy and action to systematically address social,
economic, environmental and commercial determinants of health; and primary care and essential public health
functions as the core of integrated health services. Primary health care can meet the majority of a person’s
health needs throughout their life. With a strong foundation of primary health care, together we can achieve.
● https://www.youtube.com/watch?v=a3UhtiAwbogcare
Community Nursing
Nurses who work in community health help to assess the service needs of the community and
coordinate relevant care delivery
Community Nursing and Midwifery
● Community health nurses and midwives work to improve the health and wellbeing of communities
around the world.
● Using the PHC principles laid down in the Alma Ata Declaration nurses and midwives provide
education and care across the lifespan.
○ Illness and disease prevention.
○ Safe health practices.
○ Maternal and child health.
○ Nutrition.
○ Wellness
Community Health Nursing is:
● Community focused and based
● Oriented towards health promotion, disease prevention and treatment.
● Involved in management and administration of care.
Roles/Skills
Are those of a Registered Nurse/Midwife and include:
● Leader
● Educator
● Clinician
● Advocate
● Manager
● Counsellor
● Research and data collection.
Primary Health Networks.
PHNs have been established with the key objectives of increasing the efficiency and effectiveness of medical
services for patients, particularly those at risk of poor health outcomes, and improving coordination of care to
ensure patients receive the right care in the right place at the right time.
https://www1.health.gov.au/internet/main/publishing.nsf/Content/PHN-Home
The Dept of Health PHC policy initiative
https://www1.health.gov.au/internet/main/publishing.nsf/Content/health-care
Community nursing across the lifespan
● Community Midwifery.
● Children and family .
● Schools
● Youth and schools
● Communicable diseases
● Adults
● Minority groups
● Older adults
Community Empowerment
● Refers to the process of enabling communities to increase control over their lives. "Communities" are
groups of people that may or may not be spatially connected, but who share common interests,
concerns or identities.
● These communities could be local, national or international, with specific or broad interests.
● 'Empowerment' refers to the process by which people gain control over the factors and decisions that
shape their lives. It is the process by which they increase their assets and attributes and build
capacities to gain access, partners, networks and/or a voice, in order to gain control.
● WHO ( Adapted from the Final report of the WHO Commission on Social Determinants).
● https://www.who.int/healthpromotion/conferences/7gchp/track1/en/
Understanding health promotion
● https://www.vichealth.vic.gov.au/about/health-promotion
Reference List
● McMurray, A, & Clendon, J. (2014). Community health and wellness 4e. Primary health care inpractice.
(5th ed.). Sydney: Elsevier, Churchill Livingstone.
● Talbot, L., & Verrinder, G. (2018). Promoting health. The primary health care approach (5th
ed.).Sydney: Churchill Livingstone.
● Victorian Healthcare Association http://www.vha.org.au
● WHO Primary health care. http://www.who.int/topics/primary_health_care/en/
● WHO Report (2008) Primary health care now more than ever. http://www.who.int/whr/2008/en/
● WHO World Health Statistics 2020 : Monitoring health for the SDG’s
https://www.who.int/gho/publications/world_health_statistics/2020/en/
NUM3511 #2 Health & Wellness Concepts
Objectives
● Describe health as a socio-ecological concept and not just an absence
● of disease.
● Define health and wellness from a PHC perspective
● Discuss the determinants of health in relation to their impact on the
● health of an individual and the community.
● Describe the importance of social justice in health and health care
● delivery.
Defining Health
● Alma Ata : A state of complete physical, mental and social wellbeing and not merely an absence of
disease WHO. ( 1948)
● Aboriginal Health: The social, emotion and cultural wellbeing of the whole community. National
Aboriginal Health strategic working party( 1989).
● Environmental Health: A sustainable state of wellbeing within sustainable ecosystems within a
sustainable biosphere. Hanari & Boleyn, 1999
Health from a PHC Perspective.
Defining health using PHC principles it is recognised that health is multifaceted and includes
● Mental wellbeing.
● Physical capability
● Spiritual acceptance
● Social acceptance
It addresses the majority of a person's health needs throughout their lifetime. This includes physical, mental
and social well-being and it is people-centred rather than disease-centred. WHO, 2018.
Health and Human Rights
Article 25
“Everyone has the right to a standard of living adequate for the health and wellbeing of himself and his
family including food, clothing, housing and medical care and necessary social services...”
● Universal Declaration of Human Rights, United Nations 1948.
● read the declaration. Appendix Three in your Text ( Pp 429-433)
Illness - Wellness Continuum
Wellness
Wellness is Multidimensional
Wellness is about more than just physical health. Most models of wellness include at least 6 dimensions.
Physical
● A healthy body through exercise, nutrition, sleep, etc.
Mental
● Engagement with the world through learning, problem-solving, creativity, etc.
Emotional
● Being in touch with, aware of, accepting of, and able to express one’s feelings (and those of
others).
Spiritual
● Our search for meaning and purpose in human existence.
Social
● Connecting with, interacting with, and contributing to other people and our communities.
Environmental
● A healthy physical environment free of hazards; awareness of the role we play in bettering
rather than denigrating the natural environment.
Equity, Equality and Social Justice
Inequalities in Health
● Health inequities are differences in health status or in the distribution of health resources between
different population groups, arising from the social conditions in which people are born, grow, live, work
and age
● Health inequities are unjust and do not support the declaration of human rights
● Inequality exists in our society based on a number of factors many of which could be addressed when
assessing and planning the health needs of individual clients or those of a community.
Australia’s population
● Low socio-economic status is a major risk factor for poor health.
● Policies which address the health impacts of social and economic conditions will significantly improve
all aspects of society and contribute directly to a prosperous, productive and healthy nation.
● https://www.vu.edu.au/sites/default/files/australias-health-tracker-by-socioeconomic-status.pdf
Factors for consideration.
Power disparity
● Structural disadvantage based on gender, race/ethnicity
● ‘Others’; groups or individuals who are different or disadvantaged
● Privilege; may be social, financial, gender related
● Cultural: leading to stereotyping
Structure vs Agency Debate
● Considers the extent to which human behaviour is determined by social structure
● Are interdependent.
A Salutogenic Approach
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7014834/
Pathogenic Salutogenic
Extreme ill Perfect
Health Homeostasis
(dis-ease) (health-ease)
Salutogenesis defined
https://jech.bmj.com/content/59/6/440
● Derived from "salus," which is Latin for health and well-being and “genesis” meaning origin.
● Salutogenesis, therefore, is the opposite of pathogenesis.
● The salutogenic model focuses on the causes of global well-being rather than the aetiology of
specific disease processes.
Aaron Antonovsky (1923-1994)
● https://en.wikipedia.org/wiki/Aaron_Antonovsky
● https://jech.bmj.com/content/59/6/511
● https://www.ncbi.nlm.nih.gov/books/NBK435860/
● An American Israeli medical Sociologist
● Developed and introduced his salutogenic theory “sense of coherence” as a global orientation to view
the world
● Sense of coherence explains why people who have gone through stressful situations stay well and are
in some instances able to improve their health
● Derived from interviews with Israeli women from the concentration camps of WW2
● Seen as an innovative new direction for Public Health research.
Social Support
Two types of social support outlined in this framework.
Formal
Provided by persons who are specifically qualified to provide support services. This includes health
professionals, financial advisors, ministers and counsellors to name a few.
Informal
Examples of which might be friends, family, co-workers, and neighbours.
Empowerment (Structural support)
● Fundamental to any social justice strategy
● Relates to increasing the power of disadvantage of individuals or groups
● Individuals or groups taking control.
Community empowerment
● Refers to the process of enabling communities to increase control over their lives. "Communities" are
groups of people that may or may not be spatially connected, but who share common interests,
concerns or identities
● These communities could be local, national or international, with specific or broad interests
● 'Empowerment' refers to the process by which people gain control over the factors and decisions that
shape their lives.
● It is the process by which they increase their assets and attributes and build capacities to gain access,
partners, networks and/or a voice, in order to gain control. WHO ( Adapted from the Final report of the
WHO Commission on Social Determinants).
● https://www.who.int/healthpromotion/conferences/7gchp/track1/en/
Secondary factors
● Ecological sustainability