Primary Health Care

I am all for the emancipation and empowerment of Nursing, make no mistake about that. There is a historical context that persists to this day, that is a major social justice issue, and should bring shame to citizens who are proud of there being a “Charter of Rights and Freedoms”. The movement toward, enacting change, where Nursing comes into its own, (and out from the shadow of “medical authority”), is long over due. The history has been the “men of medicine” dominating the “women of nursing”. Such oppression stands as the ultimate metaphor for the gender based inequities of Canadian society.
So we wish to be a more socially just society? This is a beginning, and hopefully a reflection of a commitment of government to start addressing the disparities in our society and in and throughout Health Care and the Health Care Professions. A shift of authority for pharmacist to take a more active role in “educating patients” about their prescriptions. Clearly the next step is to empower Pharmacist to renew prescriptions…or change to more cost effective alternatives in the populations affected by chronic disease.So, back to the “Nurse led” context. Historically the mandate of nursing has been “patient or client-centred care”. It has also been a mandate of nursing to integrate the Principles of Primary Health Care(PHC)…and for that matter the Principles of Community Development (CD) into their public offerings. (all Health Professionals are after all …public servants…whether payment comes from the government (the tax base) or “out-of-pocket”…they are the consumer/customer if approached from that context.There should be a “trans-disciplinary” focus…(visit the principles of PHC & CD, they both address collaboration). I do use the term Trans-disciplinary for the very good reason, that in “multi-disciplinary settings and applications”, someone needs to be the “over-seer” of all the levels of care and therapeutics that are supported by “best-practice guidelines”, the Nurse is the only practitioner, that crosses over (through their basic and specialized training, and Advanced Practice) to diagnose and prescribe within such a broad scope of practice. The can provide basic care…all the way through the continuum of health and all through the lifespan. Any additional “medical” or surgical treatment can be facilitated through the collaborative consultation with a Physician. The expanding scope of practice, known as Advanced practice Nursing…liberates the Physician to be a specialist as they were meant to be. So in a sense, this social justice issue will be the “emancipation” of manner. Patients/clients, through choice will be liberated to partner with which ever Primary Health Care partner(s) they choose. It is all about the empowerment to choice. Choice is but one the ethical mandates defined by the Canadian Nurse Association (CNA).

Now, again, ultimately this is a very good development…and is long overdue…a sign that a Just Canada, is emerging. Meanwhile…to continue the application of ethical mandates, I think it undermines the context in which Nursing (inclusive of Advanced Nursing Practice)…if such approaches are “labeled” and interpreted as “nurse-led” clinics. I resist the term clinic, to start with as I feel that nursing should continue (in a very ethical sense) to focus on the “health and well-being”…the “wellness” of the individual…and not conceptualize them as patient…always there for “clinical” interventions. Yes, it is reasonable that Diagnosis and “Prescription” should be facilitated (as we have come to know some presentations require some Pharmaceutics to attain quality of life, or even in the context of Health Promotion and Illness and Injury Prevention (ANOTHER POWERFUL PRINCIPLE OF PRIMARY HEALTH CARE…AND THE PRIMARY MANDATE OF NURSING).

So what am I saying…not saying do not extend the social justice resolutions of empowering nursing to full scope of practice…I am saying let us bring the focus to: Patient?/ client, their definition of Quality of Life…and base this “Centre” (this Wellness Centre) on the Principles of Primary Health Care and the Principles of Community Development.

“Community Wellness Centre”, “Family Health and Wellness Centre”, “Centre for Primary Health Care” all allow for a “collaborative spirit” between the other Health Care Professionals, that would of course practice there also. To gather more information or “an expansion” of your consciousness to these concepts which I call the “Social Integration Model” visit here

For more on Primary Health Care visit here

For more on Community Development (Healthy Living, Healthy Families, Healthy Communities), visit here.

BE compassionate, BE person-centred,

Dave