Increasing Research in Primary Care: Critical for consolidating nurses’ position in the primary health care team

Kathleen Dracup
University of California, San Francisco CA, United States of America (on behalf of the DISCOVER Investigators)

PP: 3 - 4

Article Text

Escalating rates of chronic conditions, health inequities and workforce shortages challenge health care systems globally (World Health Organization [WHO] 2003). Nurses work in both autonomous and collaborative care practice settings (International Council of Nursing nd). Across the life span and a range of conditions nurses intervene to improve health outcomes for individuals, families and communities.

Since the World Health Organization's Declaration of Alma-Ata in 1978 (WHO 1978), health care systems have looked to the primary care setting for driving health care reforms. Primary care refers to health care, based on the best available evidence and culturally appropriate methods, which is readily accessible to people in their communities (WHO 2003). Promoting community development; health promotion; illness prevention; and care of people who are unwell are key initiatives of nurses internationally and are increasing in importance.

In developed societies, the general practice setting is a focus of primary care nursing interventions. In general practice, nurses play a critical role in working with health professionals and community health workers to improve the health outcomes of individuals, families and communities. Advances in General Practice Nursing (ISBN 978-0-975771-03-7)provides a thought provoking comment on nurses working in an evolving sphere of nursing practice. Although nurses have worked in the primary care setting for many years, the role and scope of practice is not as well described as other areas of nursing practice, primarily due to the limited research and scholarship compared with their acute and critical care colleagues.

In 'Meeting a Primary Care Challenge in the United States: Chronic Illness Care', Saxe, a nurse practitioner, describes how advance practice nursing can improve outcomes for chronic illness in the community. Somchit Hanucharurnkul provides an insight into the nurse practitioner model in Thailand and how this model is culturally acceptable and appropriate. Descriptions of nurses working in collaborative models in Advances in General Practice Nursing, demonstrate that nurses share common challenges in scoping their practice and achieving a harmonious working relationship with their medical colleagues. Reports from Australia, New Zealand and the United Kingdom in this issue show that interprofessional dynamics, a limited evidence base for practice, and funding models are common issues. Increasing research in primary care will be important in systematically addressing these challenges and identifying enabling factors.

Clinical research appropriate to the primary care setting is critical in informing policy development and demonstrating nurses' contribution to health outcomes. Nurse-led research has resulted in developing innovative models of care to improve health outcomes across a range of settings, yet the evidence base in the primary care setting is less evident (Halcomb et al 2004). Limited resources for research in the primary care setting and opportunities for mentorship contribute to this limited evidence base. Yallop and McAvoy and Parker provide suggestions for strategies for building capacity in the general practice setting to promote nursing research.

Collaborative and interdisciplinary interventions are required for promoting highly skilled nurses and health policy leaders who are strategically positioned to promote the health and well-being of individuals and communities in the primary care setting. The increasing importance of primary and community based care demands a nursing workforce that is well prepared to work in this challenging, yet rewarding environment. This is a challenge for the nursing academy to prepare nurses with skills to enable and promote the health of communities. Nursing professional, educational and policy bodies need to collaborate to provide leadership and advocacy to support nurses not only in their professional preparation but also in consolidating their place within the primary health care team. Teaching, practice and research initiatives promoting the nursing role in primary care are essential in meeting the challenges facing health care systems.

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