Primary Healthcare Initiative: Nurse Practitioner In Aged Care

Key Elements of the Community/Primary Health Care Initiative

Discuss about the Primary Healthcare Initiative.

The Nurse practitioner in aged care is a community/primary care initiative by the government which is based on supporting the general practices that improve clinical outcomes (Shi 2012). The health initiative is also based on promoting the chances of maintaining good health among individuals with complex conditions or chronic conditions. Additionally, it promotes access to healthcare through encouraging a culture of quality improvement in primary health care thus effective in addressing diverse healthcare problem faced by the population in the country. The community healthcare initiative is one of the programs in the country that helps in achieving a healthy nation as well as enhancing the citizen’s access to quality and reliable healthcare services irrespective of their position in the society. NP in aged care further enhances the government’s support which improves healthcare outcomes leading to improved ability of the country to manage chronic conditions. The program encourages collaboration between different stakeholders participating in general practice to enhance their ability to improve care and chronic disease prevention (Grol et al. 2013).

Nurse practitioner in aged care is based on five key elements which involves the program topics as the first element (Kitson et al. 2013). The element involves different topics of the collaborative program based on the aims, principles and ideas of change and measures of improvement (Stevens 2013). The element involves different topics such as chronic obstructive pulmonary disease, diabetes, heart disease and chronic disease prevention among other aspects involved in primary care (Zwar et al. 2017). The second key element of the program involves the learning workshops that are based on providing participants with key knowledge and opportunity to improve their care and practice systems. The element further exposes the primary care providers to ideas and experiences from different professionals which play a significant role in improving their practice as well as promoting positive outcomes. This serves as one of the major elements of the program since it provides the basis for achieving its key objectives of improving the clinical outcomes and maintaining good health among people with complex and chronic conditions.

The third key element of the NP in aged care program involves activity periods with local support which is done between and after the learning workshops in order to ensure the implementation of the improvement or new practices learned (Seymour et al. 2013). The element also introduces the aspect of local support for the healthcare practice activities in order to achieve positive outcomes. The element plays a significant role in achieving evidence-based practice; however, implementation is based on cycles of small changes to ensure positive outcomes. Besides, the local support activity promotes the chances of achieving the collaborative approach of the program by ensuring the community members are involved in healthcare services. The element further promotes the chances of effectively improving access to healthcare by promoting a culture of quality improvement in the delivery of primary healthcare. The fourth key element of the program involves providing data reports and feedback which helps in analysing the performance of the program. The element creates the need to among primary healthcare providers to deliver monthly data through an online reporting system which demonstrates the improvements within a given time. The last element of the NP in aged care involves spread and sustainability which incorporates participating in local groups that can help in spreading the knowledge on collaboration to general practices (Walsh et al. 2012).

Implications of the Initiative to Key Stakeholders in the Community

The five key elements of the Nurse practitioner in aged care program promote the chances of achieving the desired objectives as well as enhancing quality improvement in primary healthcare services (Stirman et al. 2012). The program has also been effective in promoting collaboration between different primary health care professionals based on sound understanding and application of appropriate care methods and skills. The program’s elements have been effective in achieving improved patient outcomes within the country, reducing the risk factors and helping in maintaining good health among individuals with complex conditions. Additionally, the program element have significantly influence the development of a culture that is based on quality improvement in primary health care within the country. Over the years NP in aged care program has encouraged different participants involved in healthcare to support healthcare delivery as well as share experiences and quality improvement skills (McCormack, Manley and Titchen 2013).

Nurse practitioner in aged care program has key implications to key stakeholders in the community since it’s based on improving the quality of care provided (Wilson, Whitaker and Whitford 2012).  The first key implication of the initiative involves improving the overall knowledge of the key stakeholders involved in primary healthcare which helps in delivering quality and effective healthcare services and positive outcomes. The health care initiative is based on collaboration between healthcare professionals, which promotes the chances sharing different experiences and evidence which addressing complex of chronic conditions. The aspect impacts both the primary healthcare providers and the patients in terms of positive outcomes while the healthcare providers enhance their knowledge through collaboration and workshop trainings.

The second key implication of the initiative to the key stakeholders in the community involves enhancing the chances of reducing the risk factors and better management of chronic and complex medical conditions such as obstructive pulmonary disease and coronary heart disease among others. The initiative is based on the adoption of measurable, systematic and sustainable improvements in the care to ensure the patients achieve positive outcomes. The initiative significantly impacts the patients with the conditions positively due to improved quality of life, reduced risks and better clinical outcomes (Osheroff 2012).

The role of nurse practitioners (NPs) were initially established to provide healthcare facilities to the populations that were underserved (Clark et al. 2013).  Surveys from Australia had indicated that the total number of general practitioners (GPs) visiting the facilities of residential age care were declining along with troubles in accessing the facilities (Abernethy et al. 2013).  With the increased challenges in providing the healthcare facilities to the aged population, increased the scope of the NPs in contributing care to the old-aged people (Davis et al. 2016). Research studies within this area had described the role undertaken by the NPs in caring the old aged people followed by the impact of their role in improving the patient outcomes through communication and engagement thereby attributing the model of nursing care that establish the NPs suitable in serving this population. These professional interventions along with the organisational interventions were found to facilitate structured and regular point of views from the patients in order to improve the nursing care process. Educating the patients and with enhanced nursing role in treating the patients with chronic conditions improved the outcomes of patient (Blackberry et al. 2013). It is estimated that in Australia, general practitioners of approximately 20,000 individuals provide care to 7200 practices. These practices get their support from the regions that are mainly funded by the government and are independent organisations known as general practice divisions. There is also a network of Aboriginal based medical groups who aims at focussing the Aboriginal community.

Role of Practitioners in Aged-Care

One of the nursing care initiative models can be explained through “the Nurse Practitioner – Aged Care Models of Practice” that assists in disclosing the roles of the nurse practitioners (NP) across Australia (Hungerford Prosser and Davey 2015).  The model explains the community based clinic practice that is located in a remote destination for the local populations and tourists without any general practitioner.  The medical services were provided to the local population and to several seasonal tourists passing that region by a NP. Among the tourists included old aged people suffering with chronic diseases such as diabetes, hypertension and cardiac arrest (Singh 2012). The NP practices compile with comprehensive assessments of health and deliver a series of interventions with coordinate care, prescribing or ceasing medicines, referring the patients to health professionals and ordering the investigations of the diagnostics (Mittler et al. 2013).  Apart from all these, another essential work of the NPs is the close relationship with the health practitioners, members of the health teams of multiple discipline and allied health professionals in order to ensure the optimised communication between the stakeholders (Nancarrow et al. 2013). The Australian government donated to establish an initiative of 4 year named the Nurse Practitioner – Aged Care Models of Practice Initiative (NP Initiative) in 2011 to address the different heath problems that increased in the ageing population of the nation (Oliver-Baxter Brown and Bywood 2013). The first goal of the initiative was to assist the effective development, economical and sustainable age care NP practice models throughout Australia. The second goal was to provide the growth of NP workforce for the old age caring and the third goal was to generate the access to the primary health nursing by the old aged people (Bardach and Rowles 2012). This initiative of NP implemented 29 NP practice models throughout the metropolitan, urban and rural locations in Australia (Woods and Murfet 2015). The NP evaluation aimed in comparing each and every aged-care models  by  assessment of the resource requirements, costs, effectiveness of the models and discovering the patients experience and the delivery of models providers thereby impacting the evaluation of the quality care and health outcomes (Grol et al. 2013).  Most of the applicants of the NP program advocated care models in which they actively promoted wellness rather than reacting to illness (Aysola et al. 2013).  Some of the applicants of the NP Program proposed to assist the required care through appropriate care culturally. Some of the successful models consists the proposal to implement care to specific linguistic or cultural group such as the people with specific community language or religious clients (Holland 2017). The NP applicant found the prevalence of chronic diseases causing inability among the Aboriginal and Torres Strait Islander people with age 45 and above (Stephens Cullen and Massey 2014). The applicant found out that the identified health disorders restricted the mobility, life quality and the active participation within the community (Bowling 2014). Within this model, the NP optimized the clients health outcomes by incorporating early intervention and strategies for prevention followed by management of chronic diseases and efficient monitoring and assessment at home (Markle?Rei Browne and Gafni 2013). The NP worked with the clients or patients who were at the verge of ending life and assisted them in transferring them in palliative care (Clark Parker and Davey 2014). The NP gave proposal for the case management and clinic establishment where the NPs would provide disease trajectories, advanced planning, management of the symptoms and preparing the clients and their families for a normal death within the preferred place (Gallant 2015). This provided person-centred palliative care for providing support in natural death and relief from suffering (Karlsson et al. 2014).  Another manifestation by the NPs was providing care at the exact time usually after 4p.m. to midnight hours. The group linked with a suburban hospital and made a mobile team to provide primary care to the old aged people at afterhours. All these role of the NPs in the collaborative care of the organisation helped in the primary care of the people suffering from various chronic diseases.

Three major problems were faced while conducting the nursing models by the NPs. First one was the NP model viability as it was challenged by ongoing issues of financial sustainability (Clark Parker and Davey 2014). NPs had restricted access to MBS of Australian Government for example, only 4 MBS (Medical Benefits Schedule) products were available to NPs in comparison to100 items available to GPs (Day et al. 2016). The NPs were paid less. The second problem faced by the NPs was the understanding of the health professionals and community members. The non profit organisation undertook promotional campaign in order to inform the stakeholders about the changes from RAN (Remote Area Nurse) to NP (Ray 2014). Afterwards the NP continuously provided promotional instructions to their working partners such as patients, community members and health professionals (Portillo et al. 2015). Still the stakeholders found problems in understanding the variation of the roles between NP and RAN. Thus, in order to solve this problem there warranted an ongoing urgency in educating the people about the NP roles along with the expanded practice scope of NP (Liebler and McConnell 2016). Associated with this challenge there was another issue in differentiating the NP as a person from their role. For an example when the patients expressed increased satisfaction rates due the service received from the NPs within the community based clinic, confusion aroused in how the consumers differentiated between the role of the NP and the individual. The clarification about the confusion can be cleared by articulating the key stakeholder models. Heath care system had better outcomes than the individual based services (Pillemer et al. 2015). Another problem faced in the NP model was staffing the members (Auerbach et al. 2013). There arouse a seasonal demand to add more staffs in order to support the ongoing operation of the clinic which made the recruitment difficult. Moreover the staff rates were elevated because of the salaries provided to the health professionals in the mining companies nearby. This kind of high turnover was usual in remote and rural locations throughout Australia (Kotey and Rolfe 2014). This made the state and the national governments for continued search in sustainable solutions. This issue lead to the foundation of different non profit organisations to support the NP model along with other organisations that agreed in building up the same type of NP practice models with a goal to allocate support to NPs during the peak season of holidays. This problem was solved by filling back the NP position providing them to take required holidays by assuring the needs of the healthcare of the local community would be addressed.

Although the general practices of Australia was well computerised in prescribing and entering clinical records but lacked the system to extract the outcome measures from the records. Disease registers, population management team, disease coding and team care were not accustomed to most of the practices. Thus, building a significant capacity was the essential part of the model. Thus to improve this problem, a general practice division that comprised of the existing expertise was allocated to develop a software that had the ability to search the clinical records electronically in order to extract the outcome measures.

Conclusion

From the above discussion it can be concluded that by implementing NP models in primary care can help improve the patients suffering through chronic illness in Australia. NPs proposed to improve the older people care by providing the right care at the right time in the right place. The model provided positive outcomes by improving the access and assisting the clients to prevent hospitalizations thereby preventing the deteriorating condition and supporting the patients to die with dignity. One of the main enabler of the community based localized clinics was the funds and sponsors provided by the non-profit organisations that gave pre-existing framework for the general management and clinical governance. Problems to the nursing model were the limited organisations capacity in order to back-fill the leaves of the NPs and other development entitlements in the profession and to procure recurrent funding in sustaining the model. Apart from all these challenges, the other main challenge was the organisation need to clearly describe the NP model and their role and to deliver understanding among the service key holders. The NP model was proposed to meet the needs of healthcare and the population preference within local community, old aged people with chronic illness that transferred the model to clinics locally located along with the principles that provided an example for the other organisations and NPs to amend in developing same innovative nursing models with response to change the service demand.

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