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Community and Primary Health Care Nursing

Introduction to Primary Healthcare in Nursing

Primary healthcare in nursing ensures continuous cure to the patients with increased accessibility to the care services to the community to promote health and prevent any medical delay (Barton, 2017). Nurses that work in primary care are employed at various roles with a critical role in health promotion and education, ensure treatment of the patients, and prevent illness. The primary healthcare services include accessibility, the participation of the community, health promotion, use of appropriate technology, and collaboration for inter-sectorial cooperation (Calma et al., 2019). Primary healthcare is crucial as it is associated with initial care provided to the patient and overall discourse of the management, treatment, and cure (Giard et al., 2017). This essay will focus on the particular case study of Mrs. Mary Tonkin and discuss the primary healthcare principles for case management. Further, it will also evaluate the role of community nurses in preventing hospital admissions concerning the same.

Case Background of Mrs. Tonkin

Mrs. Tonkin is a 79-year-old woman who lives alone after the death of her husband. The patient has reported that she feels fatigued often and has also been having episodes of forgetfulness. The patient is also reporting disorientation and difficulty in completion of everyday tasks. The patient was admitted due to dizziness and was diagnosed for atrial fibrillation. The medical history of the patient includes trans ischemic attack, right-sided cerebrovascular accident, diverticulosis, cholecystectomy, hypertension, atrial fibrillation, type two diabetes, Colles fracture, and humerus fracture. After the stroke, the patient has also suffered from left leg hemiparesis. The familial history includes COPD, pneumonia, Alzheimer’s dementia, abdominal aortic aneurysm, and pulmonary embolism. The patient has already stayed in the hospital for five days for the recovery of fatigue and shortness of breath experienced with an incidence of atrial fibrillation and cardioversion. The patient is now healthy and about to be discharged. The patient is also under medication Clopidegrol 75mg, Digoxin 125mcg, Warfarin 3mg, Microzide 25mg, and, Metformin 500mg.

Principles of Primary Health and Case Management

The World Health Organization identifies primary healthcare as a whole of society approach (Clendon& Munns, 2018). The seven principles of primary healthcare include accessibility to healthcare, enhanced public participation, promotion of health and beneficence of the community, use of appropriate technology for case management, and intersectoral cooperation through a multidisciplinary approach for desired outcomes (Barton, 2017). In the given case scenario of Mrs. Tonkin, these principles applied can help in the improvement of the health condition of the patient by ensuring necessary assistance and care as the patient lives alone and requires effective care with age-related complexities arising. The first principle that can be applied in the case is through intersectoral cooperation. Mrs. Tonkins requires comprehensive care with her age-related complexities like forgetfulness and orientation to effectively work and get the daily activities streamlined. Therefore, cooperation is needed for elderly care centres for around the clock care service provision (Campens et al., 2017).

Further, the patient also suffers from severe cardiovascular problems like hypertension, atrial fibrillation, and has also undergone a stroke, therefore, cooperation from cardiovascular health professionals is also needed to monitor the well being of the patient. The hemiparalysis of the left leg after the stroke and multiple fractures must be taken care of by the orthopedics and the physiotherapists to ensure effective movement of the patient for completion of the everyday tasks. Therefore, intersectoral cooperation through primary healthcare can significantly help in case management of Mrs. Tonkins. Collaboration and care from multiple teams for the management of the condition of Mrs. Tonkins will ensure that she receives holistic care and overall management of her health (Walters et al., 2019). This will also result in the improvement of her health outcomes and assure a better quality of care received (Klode et al., 2020). The second primary principle that can be applied for the care and management of the case of Mrs. Tonkins is the use of appropriate technology. Since the patient has been experiencing incidences of forgetfulness and confusion, the use of technology for setting up reminders can be used for the case management.

Dementia is a neurodegenerative condition that is often associated with the elderly and results in forgetfulness (Tokunga et al., 2016), loss of orientation, and difficulty in completion of everyday tasks, Reminder systems for the daily activities and to encourage physical movement is therefore found to be helpful. The reminder system should also be used for the consumption of the medications for the patient to ensure timely management of the health condition and prevention of secondary complications (Tokunga et al., 2016). A reminder device is often used that is wearable and comfortable and therefore can be of essential assistance to the patient (Ramos et al., 2020).

Since the patient lives alone, the reminder device can be helpful for the patient and encourage self-management and care. The technological assistance can also be used by fixing the reminders into the mobile system of the patient. Reminder systems have been found to be helpful in the management of patients with diseases and health conditions like dementia, especially in the elderly to be highly efficient and promote wellbeing (Ramos et al., 2020). Therefore, for the case of Mrs. Tonkins, use of technologically advanced reminder tools, and inter-sectorial collaboration are the two primary health principles that can be beneficial and have a positive impact on the management of the health condition. 

Role of Community Nurses for Hospital Avoidance for The Patient

The nurses’ function in community primary care programs to promote the health and wellbeing of the patients, prevent illness and manage the health condition of patients with complex care needs. The Nursing and Midwifery Board of Australia has established a code of conduct for nursing that asserts that the promotion of health and ensuring beneficence of the patients is the essential responsibility of the healthcare professionals (Cowin et al., 2019). Hospital avoidance and care are defined as the services that are aimed for reducing unplanned presentations, readmissions or admissions in the acute care facilities (Lewis et al., 2017). In the case of Mrs. Tonkins, the admission to hospital can be avoided by ensuring person-centred care and incorporation of the family carers for care facilitation and support for the patient through sharing knowledge and explaining the need of collaboration (Colla et al., 2017). Person-centred care is an essential component of care for the elderly like Mrs. Tonkins. The patient is suffering from a variety of health conditions and age-related complexities that can affect the quality of life and longevity of the patient.

Therefore, a person-centred care regime is required. The patient must get a primary care nurse for assistance in the completion of daily activities in conjunction with the reminder alarms and medical facilities. This is required as the patient is old, has hindered mobility with left leg hemiparalysis after stroke, and with incidences of confusion. The patient is also at high risks of falls due to her age and left leg hemiparalysis and therefore, the assistance of a primary carer will minimize the risks of hospital readmissions through constant support, comprehensive care, and reduced risks of falls (Girard et al., 2017). The patient lives alone with a pet and has lost her husband ten years ago. Therefore, emotional and psychological support is required, the family of the patient must be informed and involved in the care for mental support and assistance for the patient. The Nursing and Midwifery Board of Australia also asserts the importance of effective communication and sharing knowledge with the patient for informed decision making (Cowin et al., 2019). The patient has three children, and Sam, the youngest of all, lives only 20 minutes away. Therefore, it is advised that Sam is also involved in the care and wellness of his mother.

This will provide reassurance, psychological support, and comfort to the patient and help in the management of the health conditions. Further, the inclusion of family will help in understanding the needs of Mrs. Tonkins more effectively and thereby help in improved care facilitated (Girard et al., 2017). The patient requires comprehensive care and 24-hour support to ensure beneficence and avoid hospital admissions. This can be communicated with Sam and Mrs. Tonkins through effective communication and patient education. In the given case scenario, if the collaboration of Sam is achieved through effective communication and knowledge about patient condition, a better quality of care can be provided to the patient and incidences of hospital admission can be avoided.

Conclusion on Community and Primary Health Care Nursing

The given essay provides an elaborate discussion about the importance of primary healthcare for case management concerning the case of Mrs. Tonkins. Mrs. Tonkins is an elderly woman who has a history of several cardiovascular problems like atrial fibrillation and familial history of Alzheimer’s dementia. Recently, the patient has noted that she has been feeling disoriented and fatigued, The patient has been treated for atrial fibrillation and is ready for discharge. This essay focuses on the application of primary healthcare principles, intersectoral collaboration and participation and use of appropriate technology to assist the patient in the management of the health condition. Further, this essay also highlights the role of community nurses in preventing hospital readmissions. In case of Mrs. Tonkins, comprehensive care through person-centred orientation has been proposed as an effective measure to minimize the hospital admissions along with family intervention and care by her son, Sam, who lives in proximity to ensure delivery of highest quality care and around the clock service to minimize falls, manage the health condition of the patient.

References for Community and Primary Health Care Nursing

Barton, A. J. (2017). Role of the RN in primary care: Implications for nursing education. Journal of Nursing Education, 56(3), 127-128.

Calma, K. R. B., Halcomb, E., & Stephens, M. (2019). The impact of curriculum on nursing students’ attitudes, perceptions and preparedness to work in primary health care: An integrative review. Nurse Education in Practice, 39, 1-10.

Campens, J., Schiettecat, T., Vervliet, M., Van Heck, L., Lesseliers, J., Goethals, I., & De Witte, N. (2017). Cooperation between nursing homes and intellectual disability care services: State of affairs in Flanders. TijdschriftVoorGerontologieEnGeriatrie, 48(5), 203.

Clendon, J., & Munns, A. (2018). Community Health and Wellness: Principles of primary health care. USA: Elsevier Health Sciences.

Colla, C. H., Mainor, A. J., Hargreaves, C., Sequist, T., &Morden, N. (2017). Interventions aimed at reducing use of low-value health services: A systematic review. Medical Care Research and Review, 74(5), 507-550.

Cowin, L. S., Riley, T. K., Heiler, J., & Gregory, L. R. (2019). The relevance of nurses and midwives code of conduct in Australia. International Nursing Review, 66(3), 320-328.

Girard, A., Hudon, C., Poitras, M. E., Roberge, P., & Chouinard, M. C. (2017). Primary care nursing activities with patients affected by physical chronic disease and common mental disorders: a qualitative descriptive study. Journal of Clinical Nursing, 26(9-10), 1385-1394.

Klode, K., Ringer, A., &Hølge-Hazelton, B. (2020). Interprofessional and intersectoral collaboration in the care of vulnerable pregnant women: An interpretive study. Journal of Interprofessional Care, 1-10.

Lewis, C., Moore, Z., Doyle, F., Martin, A., Patton, D., & Nugent, L. E. (2017). A community virtual ward model to support older persons with complex health care and social care needs. Clinical Interventions in Aging, 12, 985.

Ramos, L., Miller, L., & van den Hoven, E. (2020). Prospective memory failure in dementia: Understanding and designing to support. In HCI and Design in the Context of Dementia (pp. 131-146). United Kingdom: Springer, Cham.

Tokunaga, S., Horiuchi, H., Takatsuka, H., Saiki, S., Matsumoto, S., Nakamura, M., & Yasuda, K. (2016). Implementation and evaluation of interactive memory-aid agent service for people with dementia. In International Conference on Digital Human Modeling and Applications in Health, Safety, Ergonomics and Risk Management (pp. 357-368). USA: Springer, Cham.

Walter, U., Röding, D., Kruse, S., Heinze, N., Rana, V., Komainda, N., ... & Quilling, E. (2019). Models and evidence of intersectoral cooperation in prevention and health promotion. European Journal of Public Health, 29(4),185-610.

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