CNA's Work

Primary Health Care

The role of the Nurse in Primary Health Care

Primary health care and its underlying principles of accessibility, public participation, health promotion, appropriate technology, and intersectoral cooperation are a natural extension of nursing practice. All nurses, therefore, play a vital role in the implementation of primary health care.

The Role of the Nurse

The goal of nursing is to improve the health of clients through partnerships with clients, with other health care providers, related community agencies and government. Nursing practice involves a variety of roles including direct care provider, educator, administrator, consultant, policy advisor and researcher. The principles of primary health care apply to nurses in all these roles.

Primary Health Care

Primary health care is essential care (promotive, preventive, curative, rehabilitative and supportive) that is focused on preventing illness and promoting health. Primary health care is both a philosophy of health care and an approach to providing health services. It has been adopted by the World Health Organization and by Canada as the key to enabling people to lead socially and economically productive lives. Clients of primary health care can be individuals, families, groups, communities and populations. The principles of primary health care are accessibility, public participation, health promotion, appropriate technology and intersectoral cooperation.⁽¹⁾

Since primary health care and its underlying principles are a natural extension of nursing practice, nurses play a vital role in their implementation by fostering:

^{(1) Primary health care should not be confused with "primary care" or "primary nursing." Primary care "is a medical concept referring to a situation where the physician provides diagnosis, treatment, and follow-up for a specific disease or problem." Primary nursing is a system of delivering nursing services whereby a nurse is responsible for planning the 24 hour care of a specific patient. Both of these concepts are illness-oriented concepts. (Registered Nurses Association of British Columbia, Primary Health Care: A Discussion Paper. May 1990, RNABC: Vancouver, p. 2.)}

Accessibility

All Canadians should have reasonable access to essential health services with no financial barriers. Nurses provide more options for accessing health services by:

• acting as an entry point for clients into the health care system;
• providing nursing care and treatment for health problems;
• helping clients to identify and use health resources, both formal and informal; and,
• acting as a source of health information for clients.

Public Participation

Clients should be encouraged to participate in planning and making decisions about their own health care. Nurses increase public participation in health care by:

• involving clients in decisions about their own health;
• encouraging clients to take action for their own health;
• involving clients in identifying their health care needs;
• involving clients in planning, using and evaluating their own health care services; and,
• encouraging and utilizing community development approaches.

Health Promotion

Health systems should focus on helping clients stay well, instead of treating them when they are ill. Nurses are able to play a leadership role in health promotion.⁽²⁾ They are effective at initiating health education and other activities that assist, promote and support clients as they strive to achieve the highest possible level of health.

^{(2) Canadian Nurses Association, Policy Statement on Health Promotion. CNA: March, 1992.}

Appropriate Technology

Technology and modes of care should be based on health needs, and appropriately adapted to the community's social, economic and cultural development. There is a need to develop alternatives to high cost, high-tech health care services and make better use of other lower-cost, highly qualified health care providers and services. Nurses provide cost-effective care that is based on client needs, research evidence, and measurable health outcomes. They should be involved in developing, implementing, and evaluating technology and modes of care to ensure their appropriateness and cost-effectiveness.

Intersectoral Cooperation

Health activities must be undertaken concurrently with measures aimed at improving economic and social development. Professionals from all disciplines should cooperate with each other, with clients, with professionals from other sectors and with governments. Nurses coordinate client care and strive to integrate health services. Nurses also participate with clients in designing healthy public policies and will continue to do so to achieve health for all.

Nurses will continue to work with clients and other health providers to implement the principles of primary health care. The Canadian Nurses Association will support them in this endeavour and will monitor the progress of primary health care in Canada.

April 1995

References

CNA Today, Vol. 2, No. 3. Nov./Dec. 1992

Innes, Jean. Primary Health Care in Perspective. The Canadian Nurse/L'infirmière canadienne, September 1987.

International Council of Nurses. Nursing and Primary Health Care: A Unified Force. Geneva: ICN, 1988.

Registered Nurses Association of British Columbia. Primary Health Care: A Discussion Paper. May 1990, RNABC: Vancouver, p.2

World Health Organization, Division of Health Manpower Development. Report of a meeting on "Nursing in support of the goal Health for All by the Year 2000", 16-20 November, 1981. Geneva: WHO, 1982.

World Health Organization. Primary Health Care: Report of the International Conference on Primary Health Care. Alma Ata, USSR, Geneva: WHO, 1987.