President's update: A vision of primary health care for RNs

[HEADNOTE]

A Vision of Primary Health Care for RNs

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FOR me, primary health care is more than a model of delivering health care services. It is an approach which, among other things, gives us an opportunity to use the knowledge, skills and education of registered nurses for the greatest benefit of patients and the health care system. More than that, it is an approach built on the foundations of the nursing profession.

I am going to trace the relationship between primary health care and the roots of nursing. Then, I will discuss the implications for registered nurses today. Finally, I will share my vision of primary health care as an opportunity to revitalize register nursing in Alberta.

In the 1980s, there was a popular movie titled "Back to the Future." I invite you to "go back to the future" with me because primary health care is really nursing principles in action. As British nurse Edith Cavell said, "If I speak concerning the past, it is because it is sometimes wise to look behind on the road we have traveled, and to take account of our errors as well as our progress." The future of nursing depends on our ability to recapture the vision of our founders.

Professional nursing began in mid-19th century England as a consequence of the industrial revolution. At that time, the relationship between poverty and ill health was evident, along with the need for social reform.

Florence Nightingale was convinced of the importance of preventive social policies and certainly saw that health depended on the whole environment, not just the state of the body.

In 1861, she wrote: "It is mere childishness to tell us that it is not important to know what houses people live in... the connection between health and the dwellings of the population is one of the most important that exists."

She clearly defined health as more than the absence of illness. In fact, her definition of health predated by over half a century that which emerged from the 1978 primary health care conference in Russia...although it was remarkably similar. In 1893, she wrote: "Health is not only to be well, but to be able to use well every power we have."

Although she clearly saw a difference between nursing and medicine, she made little distinction between nursing and health. In Notes on Nursing [what it is and what it is not], she said: "The same laws of health or of nursing, for they are in reality the same, obtain among the well as among the sick."

American nurse Lillian Wald shared Nightingale's belief that health was a community responsibility which warranted the same level of government support given to the care of the sick. Wald was a master at putting health on the agenda of policy makers. Like Florence Nightingale, her accomplishments were awesome and her influence extended well beyond the realm of nursing. Here are just a few of her achievements:

* Establishing the first municipal playground in New York City

* Introducing hot lunches for school children

* Improving attendance at school given that illiteracy was a major concern of hers

* Introducing special education for mentally handicapped children

* Abolishing physical abuse of children in institutions for the handicapped, and

* Working to develop legislation to prohibit labour abuse of children.

Nightingale and WaId shared a common understanding of the purpose of nursing. Nightingale defined nursing practice as "putting people in the best possible condition for nature to restore or to preserve health."

Nightingale's definition is once again very similar to the 1978 World Health Organization (WHO) definition of health promotion: "The process of enabling people to increase control over and improve their health." In other words, nursing and health promotion are one and the same thing!

The fundamental truth that there is more to health than health care is at the very core of the primary health care concept. The very words primary health care are often misused in today's health care debate. They encompass more than primary care which is generally understood to mean the first contact people have with the health care system in their community.

The AARN was very pleased by the recent federal provincial health accord, with its increased funding for primary health care initiatives. However, we need to make sure that funding allocated for primary health care reform is actually used for that purpose instead of being used solely to address primary care issues.

Primary health care will include the following elements:

* Inter-disciplinary teams which could include physicians, registered nurses, dietitians, home-care workers, physio-therapists, social workers, nurse practitioners, licensed practical nurses and many others. These teams of providers are assembled based on the needs of the individual, family or community.

* People can access health services through members of the team as appropriate. Although physicians continue to play a key role in service delivery, they need not be the first or only point of access to the health care system.