The values and philosophies of nursing and primary health care are related, and the field of nursing is essential in primary health care. Primary health care model is one of the fundamental models of primary health care in the field of nursing. The other three models are biomedical model, traditional model, and behavioural model. The primary health care model is concerned with understanding how organisations of individuals and groups affect illness and health (Chan, 2006). The model appreciates the role of the structural framework of the society in determining the health outcomes of individuals and groups. It addresses all physical, psychosocial, biological and nutritional factors that may affect illness and health. In other words, primary health care mobilises individual and society’s efforts to understand factors that are responsible for ill health, and how to prevent them from the community.
Therefore, primary health care approaches health from a holistic perspective. It focuses on health education, nutrition, sanitation, immunisation, epidemiology, treatment and disease prevention (Chan, 2006). The philosophy of primary health care revolves around accessible, affordable, acceptable and basic form health care. Nursing practices in Hong Kong and other countries in the world are concerned with promoting basic care for preserving life. Nursing care is also concerned with promoting curative strategies that are crucial in preventing illness from worsening.
Primary health care stands on the following three pillars: participation, intersectoral collaboration and equity (Chan, 2006). Primary health care participation requires involvement of the government, different bodies and organisations in promoting health care. Nursing practices play crucial roles in health promotion in the community by involving members of the society in understanding the factors involved in illness and health. Nurses do this mainly in health promotion programmes. In Hong Kong, intersectoral collaboration involves participation of many government agencies and other bodies in determining the factors that are essential in influencing health. Equity pillar in primary health care addresses imbalances in the distribution of health care. Research demonstrates that health care is distributed unequally in favour of the minority few at the expense of the majority poor (Chan, 2006).
Nursing practices adopt two forms of primary health care: comprehensive health care and selective health care (Cueto, 2004). Comprehensive primary health care empowers communities with the aim of controlling the factors that bring about ill health. It focuses on community-based approaches like health education, nutrition and housing. Provision of medication has little impact on these factors in the community (Magnussen, Ehiri & Jolly, 2004). In addition, nurses promoting comprehensive health care are concerned with understanding the basis of disease over a long period (Cueto, 2004).
On the other hand, selective primary health care perceives ill health as the absence of disease, and is concerned with promoting strategies of eradicating and preventing disease by health care personnel. It is also involved in provision of health care to individuals in the community at an affordable cost (Magnussen et al., 2004). Whereas comprehensive primary health care is concerned with finding long-term measures to address ill health in the community, selective primary health care focuses on short-term measures to reduce the occurrence of diseases in the community (Cueto, 2004).
The role of nurses in primary health care
Nursing practices are essential in effective provision of primary health care in the communities in Hong Kong (Cueto, 2004). In the context of primary health care, nurses do the following:
- Mobilising social will with the aim of promoting care by educating individuals.
- Sharing knowledge with their colleagues promoting primary health care.
- Appreciating the crucial roles played by other workers outside the mainstream health sector. For example, workers in the social sector.
- Promoting both curative and preventive health care.
- Identifying the needs of individuals with the aim of maintaining their health.
- Emphasising the adoption of technologies for preventing ill health, and treatment.
- Encouraging both individual and group participation in health promotion strategies.
- Integrating social, economical and political dimensions essential in promoting good health in the community.
In Hong Kong nursing takes place in the following settings:
- Hospital setting
- Community setting, and
- Environmental and green setting.
The hospital setting involves nurses providing primary health care to individuals in both ambulatory and inpatient settings in hospitals. Research demonstrates that hospital settings (ambulatory and inpatient settings) are excellent places where nurses could articulate their issues in primary health care and offer quality care.
The community setting involves sub-settings like the school health setting, child health setting, maternal health setting, occupational health setting and mental health setting. The community health setting aims at addressing a broad range of health issues in the community that are part of primary health care.
The environmental and green setting focuses on factors in the environment that influence health outcomes of individuals and groups in the community. These factors may be global warming and seasonal breeding of insects responsible for transmitting disease causing microbes, among others. Nurses who understand the environmental factors that influence disease outcomes are able to advise individuals and groups on disease prevention strategies (Blegen et al., 2001).
The nursing education offered to nursing students determines the quality of nursing care offered to individuals in the community. Research demonstrates that nursing education places more emphasis on curative measures than preventive measures in primary health care (Blegen, Vaughn & Goode, 2001). This approach to nursing education negatively impacts comprehensive primary health care which focuses on long-term measures on prevention of illnesses and diseases in the community. Meaningful contribution of nursing practices on primary health care could be realised by adopting education that focuses on disease prevention, enhancing perception of health by communities and health promotion among individuals and groups (Blegen et al., 2001).
Nurses have to be trained to comprehend the roles played social and economic dimensions in health (Xu et al., 2000). Nursing education should aim at equipping students with the right knowledge and skills so that they could play their roles in primary health care. This requires changing the nursing curricula to put more emphasis on primary health care strategies (Xu et al., 2000). It has also been proposed that nurses should be retrained so that they could comprehend and adopt issues in primary health care. Nursing education in Hong Kong should be carried out to enhance patient input and collaboration. This could be aimed at reducing tension between nurses and laypersons (Blegen et al., 2001).
Effective nursing leadership is required to realise the benefits of quality nursing in primary health care (Koulan, 2006). Nursing leaders should guide their teams in understanding the benefits of primary health care in the community (Tomey, 2009). They should motivate their teams to adopt long-term approaches to disease prevention and health promotion. It has been suggested that nursing leaders should comprehend all aspects of primary health care so that they could transmit the knowledge to their teams (Tomey, 2009). By understanding the issues, they could guide their teams on policy towards equity to help minimise health imbalances and socioeconomic imbalances among individuals and groups in the community. Effective nursing leaders identify strategies and guide their nursing teams to develop trust and confidence. Modern nursing leadership should aim expanding the traditional nursing roles and education programmes. This will help nurses to comprehend the philosophies and values encompassed in the comprehensive primary health care. Nursing practice has much to offer to primary health care. However, this could be realised by strong nursing leadership that understands and speaks for the nurses with the aim of promoting the roles of nursing practices in primary health care (Tomey, 2009).
Nursing services determine the quality of primary health care offered to individuals and groups in Hong Kong (Koulan, 2006). Primary health care nursing organisation should be done in a manner that promotes nurses’ oversight, support and supervision on care offered to individuals and groups in the community. Research demonstrates that primary care needs are on the increase in Hong Kong. Proper planning is required to ensure that nursing services meet the demands of the population.
The planning takes into consideration the fact that a good number of nurses should be trained annually to meet the demands of individuals and groups in the community. It will aim at motivating nurses to further their studies so that new nurses could be enticed to take up entry level nursing jobs. This calls for the provision of more resources in the primary health care sector and re-evaluating policies on nursing careers to enhance nursing services in the community (Tomey, 2009).
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Chan, Z. C. (2006). Primary health care in Hong Kong. Education For Health-Abingdon- Carfax Publishing Limited-, 19(2), 229.
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Koulan, H. (2006). Problems existed in development of community care in China and its countermeasures. Chinese Nursing Research, 7, 047.
Magnussen, L., Ehiri, J., & Jolly, P. (2004). Comprehensive versus selective primary health care: lessons for global health policy. Health affairs, 23(3), 167-176.
Tomey, A. (2009). Nursing leadership and management effects work environments. Journal of Nursing Management, 17(1), 15-25.
Xu, Y., Xu, Z., & Zhang, J. (2000). The nursing education system in the People’s Republic of China: evolution, structure and reform. International Nursing Review, 47(4), 207-217.