Primary healthcare (PHC) is essential healthcare which is based on sound scientific and socially suitable processes and technology. These factors are formulated in a way that makes healthcare acceptable to all communities, families and individuals. PHC therefore is the approach to healthcare that focuses much on health equity in socially acceptable ways. This is considered as the cornerstone of general health systems (Barnett et al., 2012). The following are principles of primary healthcare and their application in the setting of a rural nurse (role).
Rural nurses give healthcare services in remote areas (isolated) where the patients suffer limited access to Medicare facilities. Typically, they work in labor and delivery, trauma, critical care nursing units and they also carry out usual nursing duties e.g. caring for inured and sick patients. In some cases the rural nurses could be primary care providers to the whole community. This might turn out to be rewarding in the sense that most times the patients will be family members, neighbors, close friends and generally familiar people. The rural nurses therefore will treat patients ailing common acute illnesses, those with chronic conditions and educate the rural community on health and wellness (Mason, 2012).
Rural nurses go through the hardship of balancing between cost and quality, conflicting agendas presentation dealing with many stake holders and dealing with everyday pressure and stress (Nsemo et al., 2013). On top of all this they need to ensure that the most effective and efficient individualized compassionate care is given to clients who comprise of family and friends all the time. There are keys to succeeding as a rural nurse includes: a comprehensive success system; a success toolkit; complete comprehension of the rural nurses’ roles and application of best practices.
Their top goal is to deliver high quality nursing care, coordinate and supervise the healthcare environment in the rural areas (Barnette et al., 2012). The rural nurse role is applied in relation to the principles of primary healthcare elaborated as follows.
It is concerned with making sure that care services (primary) are affordable, available and equally provided to all individuals not regardless of the location, ethnic group, age or gender (Bramble et al., 2013). Compassionate and comprehensive community centered care should be accessible to all individuals. The rural nurse should be conversant with the community surrounding their Medicare facility to be able to know their social economic needs. This determines the patients’ access to healthcare facilities either influenced by transportation or healthcare costs. By doing this the rural nurse will be able to subsidize healthcare through government interventions or even provide patients means of transport e.g. Ambulances.
The rural nurse also takes into account the community’s culture to ensure delivery of culture appropriate care so as not to push away patients with cultural differences and believes (Mason, 2012). They ensure the staff shuns away from tribalism and treats all their patients with equality.
Maybe done through helping people through strengthening of their social economic conditions that contributes to good health. The prerequisites of good health are food, education, shelter, income, peace, social justice and sustainable resources. Therefore it’s a believe that treating a person involves considering where and how they live and the challenges they face in their everyday life (Easom et al., 2012).
Health promotion can be in terms of orientation that includes individual perspective where people are helped to make health decisions, holistic orientation, engage in health promotion activities and health care that is client focused (Abdulraheem et al., 2012). The rural nurses provide psychological support, collaboration with patients, enabling participation of patients and nurse patient communication. They do this through carrying out voluntary work in the community and collaboration with professionals in the community. They do this through churches, visits to schools and organize door to door campaigns in rural areas. Mostly vaccinations are done door to door with the help of community’s governance e.g. Chiefs along with clan elders.
It also involves public health orientation that deals with disease prevention; focus is put on diagnosis and physical health and helping chronic disease patients. It also deals with authoritative approach that is, traditional health education, giving patients information and changing individual’s behavior.
The rural nurse organizes and oversees all these activities (Easom et al, 2012). Communication is the most important skill; it involves maintaining interaction with patients and having good relationship skills. In addition they should be aware of existing cultural aspects of health and how economics influences people’s health.
This includes using affordable, culturally acceptable and feasible medical technologies to community and individuals. It required integration of modern technology to ensure efficient and effective service delivery. While majority of the people believe that technological improvements will increase the safety, quality and efficiency of healthcare at low costs, some people consider some technologies as the result of errors and adverse effects in Medicare (Phillips et al., 2012). As much as technology holds much promise to improved Medicare, a few problems, practitioner or device related are inevitable. Therefore in the delivery of care and use of technology, rural nurses should be able to put in place systems to eliminate these errors, teach the stuff about patient safety at all times and help to avoid adverse events. Technology has been often described as both part of the solution and also part of the problem. Problems emerging from sheer volume of new introduction of devices should be the rural nurses’ responsibility. The nurse should pay attention to new technology implementation and monitor its integration in the healthcare environment in rural areas. Technology in its broadness also involves some paper based tool and clinical protocols in addition to devices such as syringes and catheters (Pimmer et al., 2014).
The rural nurse thus moderates and mediates factors that affect technology use to patients and other practitioners in rural areas. The nurse can also capitalize on technology to make mobile healthcare services a one stop healthcare service delivery system to access the very deep interior areas.
This involves addressing problems (health) from the roots (rural areas) by using all community resources. This helps the community to take ownership in its people’s health and wellness. Rural nurses play a big role in promotion of public health. Traditionally nurses focused on changing individual’s behavior in relation to their health and disease prevention (Muth et al., 2014). Nurses’ experience and multidisciplinary knowledge has made their role as promoters’ complex. Health promotions lead to numerous positive outcomes such as patients’ knowledge about their illnesses, improved quality of life and self management (Esther Thatcher & Eunhee Park, 2012).
Rural nurses ensure public participation through involving the rural people in deciding how to carry out vaccinations, days and time when they are comfortable to receive vaccinations so that people are not left out. And in so doing they feel that they are part of the program thus supporting it. The rural nurses can also organize health camps where people come and receive free medical advice and care. This could help to reach many people (Nsemo et al., 2013).
However, nurses have not been influenced by practical practices of health promotion due to adaptation of individualistic approach and behavior changing perspective (Nancarrow et al., 2013). Rural nurses therefore should be focused to ways of redirecting nurse education towards health promotion principles away from being only disease oriented. Integration of the challenges of delivering healthcare in rural areas should be studied in school to prepare nursing students for that kind of experience.
It should be recognized that well being of people’s health is not solely dependent on healthcare services that are effective. Other organizations, businesses and governments are of equal importance in promoting a people’s health and self dependence (Newhouse et al., 2013). The definition of health according to the World Health Organization is a state of complete mental, physical and social wellbeing. There are broad aspects of wellbeing that a single sector (health) can handle alone. This calls for a variety of inputs from many sectors. Taking an example, the education sector improves literacy, technology and industrial sectors develop appropriate technology and poverty reduction is an initiative of economic and strategic planning sectors (Visagie & Schneider, 2014). School health programs improve children’s well being, therefore reducing absenteeism and improving learning in the long run.
Rural nurses collaborate with school administrations to create time for the nurses to visit schools and give students lectures about health living, importance of healthcare and also use this opportunities to announce vaccination dates so that many people can become aware. They also visit women organizations and enlighten them about health issues facing women e.g., home deliveries risks and importance of immunizing their newborns.
Collaboration between all sectors is healthy for the improvement of the patients and societies well being. The rural nurse should facilitate the collaboration where required (Abdulraheem et al., 2012).
In sum, primary healthcare acknowledges that healthcare is not short term intervention but a continuous process of improving the lives of people especially in grass root areas. This also includes alleviating their social economic conditions that result to poor health. With all this interventions and rural nurse practice, excellent healthcare service delivery will be achieved.
Abdulraheem, B. I., Olapipo, A. R., & Amodu, M. O. (2012). Primary health care services in Nigeria: Critical issues and strategies for enhancing the use by the rural communities. Journal of Public Health and Epidemiology, 4(1), 5-13.
Barnett, K., Mercer, S. W., Norbury, M., Watt, G., Wyke, S., & Guthrie, B. (2012). Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study. The Lancet, 380(9836), 37-43.
Bramble, J. D., Abbott, A. A., Fuji, K. T., Paschal, K. A., Siracuse, M. V., & Galt, K. (2013). Patient Safety Perspectives of Providers and Nurses: The Experience of a Rural Ambulatory Care Practice Using an EHR With E?prescribing. The Journal of Rural Health, 29(4), 383-391.
Easom, L. R., & Quinn, M. E. (2012). Rural elderly caregivers: Exploring folk home remedy use and health promotion activities. Online Journal of Rural Nursing and Health Care, 6(1), 32-46.
Esther Thatcher MSN, R. N., & Eunhee Park BSN, R. N. (2012). Evolving public health nursing roles: focus on community participatory health promotion and prevention. Online journal of issues in nursing, 17(2), B1.
Mason, W. A. (2012). Oregon's economic crisis and the national nursing shortage: a transformational opportunity for rural areas. Online Journal of Rural Nursing and Health Care, 4(1), 64-74.
Muth, C., van den Akker, M., Blom, J. W., Mallen, C. D., Rochon, J., Schellevis, F. G., ... & Perera, R. (2014). The Ariadne principles: how to handle multimorbidity in primary care consultations. BMC medicine, 12(1), 223.
Nancarrow, S. A., Booth, A., Ariss, S., Smith, T., Enderby, P., & Roots, A. (2013). Ten principles of good interdisciplinary team work. Human resources for Health, 11(1), 19.
Newhouse, R. P., Himmelfarb, C. D., Morlock, L., Frick, K. D., Pronovost, P., & Liang, Y. (2013). A phased cluster-randomized trial of rural hospitals testing a quality collaborative to improve heart failure care: organizational context matters. Medical care, 51(5), 396-403.
Phillips, J. L., Piza, M., & Ingham, J. (2012). Continuing professional development programmes for rural nurses involved in palliative care delivery: an integrative review. Nurse education today, 32(4), 385-392.
Pimmer, C., Brysiewicz, P., Linxen, S., Walters, F., Chipps, J., & Gröhbiel, U. (2014). Informal mobile learning in nurse education and practice in remote areas—A case study from rural South Africa. Nurse education today, 34(11), 1398-1404.
Visagie, S., & Schneider, M. (2014). Implementation of the principles of primary health care in a rural area of South Africa. African journal of primary health care & family medicine, 6(1), 1-10.
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