Direction And Vision Of Primary Healthcare Discussion Paper

Task 1

Primary health care (PHC) can be described as a set of principles as well as an organising framework to assist health practitioners and nurses in facilitating equitable and just conditions for promoting good health (Clendon & Munns, 2018). This essay discusses the key direction and vision of the Primary Health Care Strategy (2001) (PHCS) and highlights the ways by which the Ala Mo’ui Pathways to Pacific Health and Wellbeing 2014-2018 strategy contributes to the recent development of primary health care in Aotearoa New Zealand. The identification of a modifiable risk factor (MRF) that is responsible for the progress of a particular health condition is provided, along with initiatives that are essential to address this MRF. The strategies that are associated with self-management should be maintained by Registered Nurses in primary healthcare to address the healthcare requirements of people affected by the identified health condition Direction And Vision Of Primary Healthcare Discussion Paper.

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The PHCS was established in 2001 to specify a clear direction regarding the future improvement of primary health care in New Zealand (Ministry of Health NZ, 2022b). The vision of the PHCS is to emphasise better health for all people and to lessen the health inequalities among various groups of the population. PHCS also provide support regarding the development of team environment which promote interdisciplinary teamwork. Those working in PHC help to respect and realise the responsibilities that should be displayed by every person involved, and to do this effectively, they need training and development (Clendon & Munns, 2018). To attain this vision, the PHCS supports a transformative healthcare system, which aims to improve the wellbeing of all individuals in New Zealand. PHC is widening the service range which is delivered to include multi-professional groups (Polin et al., 2021).

Primary healthcare services has six objectives that the strategy aim to fulfil and these are to promote: accessible healthcare, the use of appropriate technology, health, cultural safety, and sensitivity, community participation, and inter-sectorial collaboration (Clendon & Munns, 2018). These aims of the primary healthcare service delivery provide the basis of operations for many different health professions. Accessible healthcare as outlined with primary healthcare services aims to make various components of health care services such as diagnosis accessible to citizens within the country. Use of appropriate technology encompasses application of modern technology in healthcare service provision such as use of health information system. Cultural safety and sensitivity requires healthcare providers to uphold cultural competency at all time with observance of cultural needs of populations such as indigenous people. Community participation on the other hand is the involvement of community in health service provision. For instance, involvement of community in community health advocacy to promote good healthcare service. Inter-sectorial collaboration is the interaction of various sectors within the healthcare service as provided by the PHCS.

Ala Mo’ui Pathways To Pacific Health And Wellbeing 2014-2018

Ala Mo’ui is a strategy designed for the promotion of optimal standard health services to best serve the health needs of Pacific people. One of the health need for Pacific people is increasing the average life expectancy from 6.7 year less of Pacific male. This is based on the need to improve the health outcomes. In addition, Ala Mo’ui has clearly outlines health needs of Pacific people with specific actions needed for improving health. According to the Tair?whiti District Health Board (2020), since 2014 the strategy has helped to address the health care needs of Pacific individuals and developed stipulations regarding the activities. Ala Mo’ui has provided basis of improving health care through primary healthcare which in turn improves the standards of health care practices. This is achieved through clinical leadership, decision making, population health, and population performance which all contribute to the on-going development of the PHCS Direction And Vision Of Primary Healthcare Discussion Paper.

Based on population, the people of the Pacific region face reduced health outcomes in New Zealand (Ministry of Health NZ, 2022a). Clinical governance can be described as the framework via which the healthcare providers are responsible for constantly improving the standard of their services as well as safeguarding optimal standards of care. Through clinical governance, healthcare providers seek feedback from patients, as well as the public, with the objective of attaining insight on the care quality they have received and to mitigate any possible issues (Adams, Boyd, Carryer, Bareham & Tenbensel, 2020). Clinical governance provides help to the workforce and practitioners to serve secure and standard clinical care in the form of a holistic approach. Through the implementation of the concerned strategy, the clinicians became passionate regarding the safety and quality of the care that they deliver. These are the major drivers associated with the tasks that they perform and resonate with their vital professional values. Ryder et al. (2021) assert that the core focus of the health providers should be to optimise clinical governance. Improvement and development of the services throughout Hauora Tair?whiti are improved by clinical leadership via the committee of clinical governance that is represented on Te K?hui Whakahaere and District Health Boards (DHBS) potentially helps in decision development. The committee of clinical governance has a major responsibility to mitigate any clinical risks and to improve clinical facilities. Clinical governance includes PHC representations and the individuals who are the recipients of healthcare. Ala Mo’ui establishes the activities which will contribute to attaining the health objectives set out by the government. Appropriate technology is used to address the set directions of the PHCS equitably.  For instance, health information system improves the quality of the healthcare service delivery with flexibility (Ma et al., 2017)Direction And Vision Of Primary Healthcare Discussion Paper.

Clinical Governance

On a population basis, in New Zealand Pacific communities experience poorer health outcomes. For example, Pacific male life expectancy is 6.7 years less than for the total male population, and Pacific female life expectancy is 6.1 years less than the total female population. 4.3 Pacific people’s health status remains unequal with non-Pacific people across almost all chronic and infectious diseases. Subsequently, to facilitate the delivery of high-quality health services that meet the needs of Pacific peoples, Ala Mo’ui was developed. ‘Ala Mo’ui: Pathways to Pacific Health and Wellbeing 2014–2018’, builds on the successes of the former plan, ‘Ala Mo’ui 2010–2014’. It set out the strategic direction to address the health needs of Pacific peoples and stipulated new actions to be delivered from 2014 to 2018.

The Ala Mo’ui plan was established in collaboration with clinical and community leaders to make sure that the policy activities and objectives were in line with the desires of the community (Clendon & Munns, 2018). The Ministry of Health explored the issues facing DHBs especially the issue of life expectancy or quality of life that determines the life expectancy. Thus, it is expected that the DHBs will gain recognition with their Annual Plans for the most crucial activities that are desired to address challenges encountered by local people. This also contributes to the health promotion aspect of PHC.

From a professional viewpoint, knowledge gained regarding the risks that are modifiable, can be used to develop intervention plans to help in promoting and sustaining the health of the population (Clendon & Munns, 2018). Cardiovascular disease (CVD) is the leading cause of death globally and this is associated with an increased expenditure on health care (Nasarian et al., 2020). There are some modifiable risk factors that are associated with cardiovascular diseases. These include High BP, high blood cholesterol levels, smoking, diabetes, overweight or obesity, lack of physical activity, unhealthy diet and stress. The notion regarding CVD risk factors is the core aspect of modern medicine that has led to the development regarding improved treatment. There are several risk factors for CVD, some of which are controllable these are called MRFs, whereas the others are uncontrollable. A MRF for CVD is a high blood cholesterol level. Differences regarding the disease epidemiology occur due to the prevalence of MRFs (Pimpin et al., 2018). When there is an excessive amount of cholesterol in the blood, it ultimately accumulates in the artery walls; this leads to the development of heart disease as a narrowing of arteries ensues and the flow of  blood to the heart muscles reduces. This leads to cardiovascular diseases such as hypertension. The high level of cholesterol in the blood is a risk factor that can be modified by introducing changes to one’s lifestyle. Having a diet that is rich in trans and saturated fat, may contribute to increased cholesterol such as CVD. Not doing adequate physical activity can cause an individual to gain weight, and this can lead to an increase in cholesterol (Lockett, Lai, Tuason, Jury & Fergusson, 2018). Regular education regarding improved adherence towards maintaining a healthy blood pressure as well as about LDL cholesterol should be delivered by the nurses (Doggrell, 2019)Direction And Vision Of Primary Healthcare Discussion Paper.

Task 2

Certain contemporary initiatives are required to be taken by the nurses in the context of primary health care to address the identified MRF. The cornerstone that is associated with the treatment of hypercholesterolemia is having optimum weight, doing daily exercise, maintaining a healthy lifestyle, and not smoking (Adams, Boyd, Carryer, Bareham & Tenbensel, 2020). The diet should be low in trans as well as saturated fat content and should be enriched with fatty fish to provide omega-3 fat, vegetables, fruits, and fibre. The main role that should be played by PHC providers is regarding the delivery of effective health related outcomes (Obucina et al., 2018). High cholesterol can be considered as a physiological or behavioural factor that can be controlled (Obucina et al., 2018). Primary healthcare services have created an enabling environment where nursing practitioners can come up with care plan to assist patient with high blood cholesterol. The nurses must take the initiative to provide health education to patients and motivate them regarding positive behavioural transformations (Finlayson & Raymont, 2012). These actions will contribute to the improvement of their lipid profile. According to Pylypchuk et al. (2018), the advantages of treatments that lessen the risk associated with CVD are proportional to the potential risks pre-treatment.

The nursing care strategies have possibility of improving patient outcome especially those patients with high blood cholesterol through a combination of motivational interviewing under the Stages of Change Model. In this initiative, the nurses ask the patient the extent to which they are motivated to move on from their unhealthy behaviour. Sometimes, the nurses in an intuitive manner can make decisions regarding the current change stage of the patient. Motivation should be provided to the concerned patient by the nurse to deliver positive support regarding a potential change in their health. CVD imposes a significant burden on the worldwide population (Kurup et al., 2021). It is the commonest cause of death throughout the world, with a recorded increase in the incidence as well as the prevalence rates (Merone et al., 2020). Nurses must give the patient standardised health data about the disease from which he/she is suffering in written form, including about modifiable changes that can be made by them to manage their high blood cholesterol issue (a MRF) to stay healthy (Pylypchuk et al., 2018). Additionally, technologies within PHC can be used by the nurses to deliver patients educational data via a Smartphone. This enables development of patient knowledge on clinical outcome and services through nursing approach.  PHC has created an enabling environment that facilitates this technology enhanced patient relationship with nurses (Bharatan et al., 2021)Direction And Vision Of Primary Healthcare Discussion Paper.

Modifiable Risk Factors For Cardiovascular Disease

There are some contemporary health promotional initiatives that aim at reducing the impact of cardiovascular disease. Nursing professional practice for patient self-management should aim at assisting patient to manage their health conditions especially for those patients suffering from cardiovascular diseases. Nurses therefore, must provide education to the concerned patients on the aspects of life style management such as taking their prescribed statin medicines, becoming active physically, quitting smoking, suggesting that they monitor and control their blood pressure at home themselves and develop control over their blood sugar levels. The nurses should suggest that the patient has timely follow-ups with the clinicians, decreases their body weight, decreases their consumption of a fatty diet, and takes measure to reduce his/her stress level. PHC nurses are ideally placed to provide education to patients regarding lifestyle changes, resuming a healthy lifestyle, and having a healthy diet (Norman, Chepulis, Burrows & Lawrenson, 2021).

There are some strategies that registered nurse can use within the context of self-management to assist patient, family or community dealt with cardiovascular disease issue. CVD is a chronic illness that is highly prevalent and one that reduces quality of life, increases healthcare costs, and mortality rate. Self-management supports the inclusion of patient education to whanau members regarding their care or health conditions through encouraging them to manage their health optimally.

Patient collaboration is Registered Nurse strategy that focuses on patient engagement and involvement in self-management care for patient with CVD. Self-management is described as the practice in which the patient in collaboration with the RNs take the responsibility own healthcare decision making. This enable patient to undertake self-care especially for patients with the knowledge attained to manage their chronic health issue such as cardiovascular diseases. The strategies of self-management are identified as the core components used by the Registered Nurses (RNs) to help the patient address their chronic and acute illness. Research in New Zealand has emphasised the type of CVD care that should be provided to patients (Godinho et al., 2020)Direction And Vision Of Primary Healthcare Discussion Paper. It is the learning experience continuum in which an individual, family, and whanau, perform in care in collaboration with the healthcare professionals. According to Hyun et al. (2021), CVD is the leading cause of death globally and self-care is the best approach to the management of CVD.

Application of health system monitoring using telemonitoring system enhances self-management of patient health. The application of telemonitoring in the CVD management enable improvement in blood pressure monitoring which has positive effects on patient’s self-management. In 2019, CVD was responsible for 35% of the total deaths of women (Vogel et al., 2019) which make CVD a serious health concern that need proper management. Therefore, strategies that must be taken into account in self-management within the context of primary care. This will ensure that the care provided is patient-centred, proper training and staffing are provided. There are also protocols in place regarding the way staff members should be supported, and the collaboration during self-management. Given the prolonged ongoing collaboration between health professionals and the patients, the RNs  should be actively collaborate with patients to control of their blood pressure and decrease of lifestyle risk of CVD (Stephen et al., 2019). The self-care strategies can be implemented by the RNs to help CVD-affected patients through self-monitoring. This can be done in conjunction with assisting patients to administer right medicine dosage, pre-specified patient oriented plan developed and approved by the RN, health practitioner, as well as the patient. Primary health care teams should serve the patient with an array of self-management support functions (Harris et al., 2020). This may include physical activity advice and nutritional guidelines that help reduce the severity of the disease in the life of patient.

NZ nursing professional responsibility stipulate the need for patient education which help patient to manage their health effectively. Within the professional nursing framewok, the RNs need to assist patient change their care behaviour concerning CVD, their whanau, and family. Nursing practitioner should ensure a collaborative approach during care planning which is patient oriented with mutual respect and faith. The nursing practice framework provides the basis which the RN contributes to and help in the behavioural change of the CVD patient by providing data that can support him/her to make effective decisions and establish objectives for them to get rid of the disease. CVD is a major cause of premature death and disability globally (Zecchin et al., 2019). The RNs should motivate the concerned patients to participate in self-management by providing acknowledgement that they are the experts regarding their personal lives. The behavioural issues that are mainly found to be present in the CVD patient include having insufficient insight regarding CVD, ineffectively coping with CVD, non-adherence with medications, overuse of alcohol, smoking, being physically inactive, excess stress, fear emotions, and so on. It is essential to evaluate the self-management interventions among the CVD patients (Ruksakulpiwat & Zhou, 2021). The RNs must provide education to these patients so they can implement a healthy lifestyle. The patients should be advised to demonstrate positive behaviour which is aimed at therapeutic adherence and daily contact maintenance with the health employees. Motivation should be provided to the patient by RNs to develop a therapeutic alliance and thereby attain more autonomy to manage CVD Direction And Vision Of Primary Healthcare Discussion Paper.

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To conclude, a discussion regarding the major directions and vision of the PHCS is provided in this essay. The link between the Ala Mo’ui Pathway strategies to recent developments regarding the primary healthcare system in New Zealand is described. The MRF that is identified here is an increase in blood glucose level which, if left unchecked, can contribute to cardiac issues among patients. This enhancement in blood glucose level can be controlled through effective administration of lifestyle factors and physical exercise. Several healthcare initiatives which can be taken by the nurses in the aspect of primary care, so that the identified MRF can be effectively addressed have been discussed. Finally, it is found that self-management strategies and support are helpful for patients suffering from CVD to address the disease. The way that RNs in the settings of primary health care apply self-management strategies as well as provide support, are highlighted. These supports are found to be effective to address the healthcare requirements of community, whanau, as well as the individuals who are affected by CVD. The identified CVD and MRF are required to be addressed by the RNs by following the strategies and initiatives mentioned here Direction And Vision Of Primary Healthcare Discussion Paper