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Increasing Research in Primary Care
Critical for consolidating nurses’ position in the primary health care team
Kathleen Dracup
Dean and Professor, University of California, San Francisco CA, United States of America (on behalf of the DISCOVER Investigators)
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.
References
Halcomb E, Davidson PM, Daly J, Yallop J and Tofler G (2004) The role of practice nurses in chronic heart failure: A review of the literature. European Journal of Cardiovascular Nursing 3(2): 135-147.
Hanucharurnkul S (2007) Nurses in primary care and the nurse practitioner role in Thailand. Contemporary Nurse 26(1): 83-93.
International Council of Nursing (nd) The ICN Definition of Nursing. Accessed on 5 June 2007 at http://www.icn.ch/.
Saxe JM, Janson SL, Dennehy PM, Stringari-Murray S, Hirsch JE and Waters CM (2007) Meeting a primary care challenge in the United States: Chronic illness care. Contemporary Nurse 26(1): 94-103.
World Health Organization (1978) Declaration of Alma-Ata. Accessed on 5 June 2007 at www.who.int/hpr/NPH/docs/declaration_almaata.pdf.
World Health Organisation (2003) The World Health Report 2003 - shaping the future. Accessed on 5 June 2007 at www.who.int/whr/2003/en/.
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