Primary health care —community nursing
Primary Health Care (PHC) principles are most important when it comes to health status of any community. Primary Health Care became an important health care policy with the Alma Ata Declaration of World Health Organization in 1978. These principles provide guidelines for all healthcare systems in all countries. They also provide a basis of communitynursing. Therefore, these principles are used in the analysis of the clinical scenario. They provide the back bone for health systems and are used when determining development of the health sector in all countries.
The clinical scenario in this report is an assessment of a patient, Mrs Azizi, in an effort to help her recover her health through community based nursing. An analysis of Mrs Azizi’s home, culture, present autonomy and environment is important in order to pinpoint health and safety risks that are a danger to her recovery and to the community nurses that will provide secondary care to her. Primary health care principles as outlined by the World Health Organisation that relate to this scenario are discussed in detail. Factors that relate to safety of the patient in the home.
Primary Health Care
Community nursing involves nursing care that takes place outside the health centre or a health institution. As explained by Gaargioni (2009), community nursing has two main branches; community based nursing and community health nursing. Community based nursing is focussed on the health of individuals and families while community health nursing focusses on the health of the entire community, a group of people or a specified population. This clinical study is a community based nursing for Mrs Azizi who has just undergone a surgery and is in her recovery process. The family of the patient will also be part of the community based nursing (Zotti et al, 1996).
Primary health care in Australia involves personal care, prevention of diseases, and development of a community and health promotion. The principles that relate to the clinical study are: provision of primary health care should be equal and fair without depending on the financial position of the patient, health centres should be easily accessible for all people and prevention and management of a disease are core factors in primary health care. According to John et al (2007), primary factors that affect the health of a community include access to clean water, adequate nutrition, sanitation, adequate housing, safety support, social support, cultural factors and access to primary health care (PHS, 2011).
Risk management is defined as the process in which vulnerable things are identified and adequate changes are put in place in order to minimise consequences that such risks may cause. The process of eradicating vulnerabilities ensures safety and aims at avoiding harmful accidents. Some risk management practices are risk avoidance, training on procedures during movement and handling and risk acceptance. Safety and clinical hygiene during the post operation care provided must be practised. Mrs Azizi may have safety related risks that will impact her recovery and health (Kralik, 2011).
According to Reynolds (2009, p. 26), the first visit may not be effective in pointing all hazards that a patient and the family are facing. It is important that subsequent visits are planned for effective risk assessment. The risk assessment tool developed by National Patient Safety Agency depends on two factors: the likelihood of the risky incident occurring and the consequence that the risk will have. The consequence is then classified as insignificant, minor, major or catastrophic. Once the hazards have been classified, the community nurse has to come up with appropriate control measures that must be taken in order to minimise the extent of the risk(Hunt, 2009).
Analysis on Primary Health Care and Risk management
Mrs Azizi has several potential risks. First and foremost, Mrs Azizi cultural background presents a problem. As explained in the clinical scenario, the lady has lived in Australia for 5 years and has not learnt to speak well. Culturally, according to Greco (2013), the Afghanistan woman is responsible for taking care of the household and domestic chores. In some areas, women are prohibited from driving and bike riding. She lives in a big household and does all the work on her own including vacuuming and moving furniture. This overworking will affect her post surgery recovery and the wounds. She is also likely to fall during the house chores because she doesn’t wear shoes.
Secondly, the house Mrs Azizi lives in is constructed with stairs at the front and has stilts. The toilets are quite far from the house which requires more movement. Thirdly, she lives in a rural setting that is a long way from town. The farm house is big without any neighbouring households. This denotes that she has an unsocial life. In addition to that, she has been taking herbal medicines at the same time that she is using post-surgery medication. These medicine may work in corporation or in contrast to the medicines that have been prescribed. They are therefore a risk to her recovery.
In terms of principles of primary care, Mrs Azizi lives far away from town and hence has little access to primary health care. It can be assumed that she opts to use herbal medicine due to the long distance between the farm and the primary health care centre. She does not drive which denotes that she has to rely on public transport to get to the health centre. Secondly, Mrs Azizi has no toilet in her house and her access to sanitation is strenuous. Walking for fifteen minutes in order to access the toilet is a risk to the post-surgery wounds.
According to the primary principle of equity, each patient should be treated without regard of their financial status. In the scenario, the community nurses that visit are catered for by the discharging hospital but the patient is required to buy dressing supplies. This may be a problem for Mrs Azizi who relies on her husband and children for money. According to the report, a man hands the community nurse 50 dollars when she is about to leave the house which means that they are able to pay the additional cost(Tham et al, 2011).
The workplace of the community nurses should be free from health and safety hazards. This workplace is the community they serve. As explained by Guzys (2013, p. 173), common hazards for community nurses are falls, slips, trips, aggression, stress and musculoskeletal injuries. These nurses may be injured when moving in the house or as they travel from town to Mrs Azizi’s house. It is important that the needs of these nurses are provided. Major stressing factors for community nurses are overworking, unrealistic work demands, inadequate staff, insufficient staff, poorly qualified staff and dealing with death cases, abusive patients, aggressive patients or relatives and working on weekends or shifts( Johnson, 2006).
The community health worker may also present a risk to the patient. This may be caused by poor working behaviour and may include poor communication, lateness, missed appointments, poor risk assessment, bad record keeping, poor assessment of the patient’s health condition and poor delivery of primary care for example dressing wounds carelessly or in a haste. The health worker must be well trained to handle diverse personalities when serving the community. An additional solution to this is the proper organisational policy and procedures and strict enforcement of the policies and procedures (Leyshon, 2005).
Recommendations on primary health care and risk management
The first control measure is to highlight the role of the family in providing tertiary and secondary care. The family should overlook the culture of women running the household and look for an alternative such as a house help until her post surgery wounds and associated side effects have healed. It should play the first role in helping Mrs Azizi to heal. They should also spend time with her instead of leaving her alone. This will ensure that someone is around to help her in case of a fall. Secondly, Mrs Azizi must be encouraged stop taking herbal medicine because they may conflict the medications that were prescribed.
Thirdly, Mrs Azizi has to be encouraged to have a social life. She should be allowed to have her autonomy. It is important that the family will look for ways of interacting with neighbours and other people in the community who may be of the same origin. This will encourage her to interact with others. Fourthly, Mrs Azizi’s family can reduce the risk of falling and post-surgery complications by buying an equipment she can use in moving such as a wheel chair. The family should be encouraged to have toilets in the house which will reduce the movements that the patient has to take.
Lastly, Mrs Azizi should be encouraged to join a support group or a neighbourhood group in order to enhance community development. It can be assumed that she speaks limited English because she does not interact with the neighbours. Interaction with others will improve her communication skills and enhance her social life. The family should also be trained on dressing of wounds so that they are able to help Mrs Azizi when the healthcare nurses are delayed. They should also be informed about the prescribed medications that the patient takes so that they remind her and help her in stopping the use of herbal medicines.
The home visit
Community nursing is part of tertiary and secondary care that is provided for patients that have been discharged from primary care. The main advantage of home visiting is that it allows community nurses to understand other factors that may affect the patient that were not clear when the patient was in hospital. It is also a way of follow up especially for patients that are at risk and require specialised care. This may involve the aged and the disadvantaged. It also helps in providing care for people that are too sick to go to the health centre.
Before the visit, it is important to plan. Several things have to be done. First, the community nurse must communicate with Mrs Azizi family on the exact time and place they will come so as not to miss someone at home. They will also need to come up with a schedule on subsequent visits since it is a continuous process. They should go over the case notes that relate to Mrs Azizi’s health status to avoid wastage of time and resources. The nurse should also understand what she is going to do and this includes dressing up wounds as well as post-surgical care provision. They must therefore carry appropriate equipment such as dressing supplies.
The community nurse should have knowledge of the culture and habits of the community they will visit. In this case, Mrs Azizi speaks very little English and the nurse might have to come with a translator or confirm if a person in the family will help with the translation. They must also set an aim that they plan to achieve with the patent. In cases where the patient has been treated by more than one physician, the nurse must consult the different health teams. This will help in coming up with the best post-operative care based on the advice of the doctors and the nurse will understand what examinations she will take during the visit.
After the visit is completed, the important factors should be discussed with the family. Future visits can be scheduled at this time. The family should also be trained and informed on wound dressing and post-surgery care. Mrs Azizi should also be referred to specialists that will look at her wounds and the cancer treatment. A full risk assessment should be carried out and the family informed about those risks in order to involve them in risk avoidance. The last thing to be done is finalizing all documents. These may include case notes and health status reports that are forwarded to the specialists and the nurse can use for reference.
After the risk assessment, it is important for the community nurse to record the risk assessment that has been carried out and control measures that were identified. This information has to be relayed to other health workers that attend to the patient and the patient. Communication is very important in risk management. Miscommunication between the nurse and the patient or the nurse and the colleagues will lead to misunderstanding. On the other hand, good communication will protect health workers from the risks that are identified. The documented risk assessment should be reviewed and control measures can be revised. This process will help in maintaining quality patient care (Guzys, 2013).
Community based nursing is a very important sector in community nursing. In Mrs Azizi’s case, it is aimed at providing g care as she goes through the recovery. It is also aimed at reducing cases of post-surgery complications. The risk assessment analysis will help in reducing risks that may delay the recovery of the patient. For effective community nursing, the family must be involved in her recovery process and safety of the community nurses, the patient and her family must be ensured. This includes clinical safety and the physical safety of the nurses as they attend to Mrs, Azizi.
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