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March 6th , 2007
Palmerston North
It was an exciting experience to participate in a workshop that brought together the College of Nurses Aotearoa and the New Zealand Nurses Organisation. This workshop carried on the work from the October 2006 workshop composed of those parties who raised their hands to work toward reframing Care Plus as well as examining the bigger picture of the Primary Health Care Strategy. The purpose of the workshop was to come together to formulate a strategic plan. Jenny Carryer, Executive Director of the College and Chiquita Hansen, Chairperson PHC Nurses Council NZNO co-facilitated this workshop. The MOH was represented and have demonstrated commitment to this work.
Below is a summary of this workshop.
The workshop consisted of:
A review of the Primary Health Care Strategy by Jenny Carryer
- This Strategy is seen as a blueprint for survival; a drive to reduce disparities.
- By involving communities and utilizing nurses properly the concept of prevention is moved into a priority position. Has this happened?
- Primary health care nurses must look at his or her practice environment to see if there has been a “hijacking” by primary care. Are nurses nursing the practice or the individual coming in to the practice? What is the vision of the practice? Is this congruent and supported by the practice organization and daily operations?
- Nurses are well-recognised as boundary spanners. Focusing on individual/whanau-centred care requires nurses to wear many hats, overlapping other professional roles as individual/whanau care is facilitated. Are the current funding streams such as Care Plus and Services to Increase Access supporting this broad stroke of nursing capabilities or limiting care by forcing nurses into artificial disease-organised reactive health care?
- What observations and questions have arisen since the launch of this Strategy?
- Significant regional variations regarding incorporating the Strategy noted. There are only three DHBs that have formalized PHC nursing leadership at the DHB level.
- It was expected that in order to accomplish the goals of the Strategy a behaviour change to incorporate a more collaborative framework would be necessary. This has moved forth in pockets but not on a country-wide level. The medicalisation of health care still exists with a focus on pharmacotherapeutical and technical answers as opposed to population and primary prevention.
- What framework supports the professional nurse to be able to practice fully? Will this framework provide professional development without seeming self-serving?
- Allowing DHB increased control over PHC and aged-care and challenging private control will enable the goals of the Primary Health Care Strategy to proceed.
- Infrastructure of PHC can be developed more fully
- Person-centred as opposed to practice-centred care can be the focus
- Enhanced relationships can be developed between nursing and individuals/whanau seeking care. Improved self-efficacy on both parts leads to improved self-management – a key component in reducing the morbidity of chronic disease.
- Silos of care would be reduced due to the enhanced DHB PHC nursing infrastructure. Under this framework primary health care nurses would fall under the DHB who would support the educational-professional development pathways. Nurses would answer to nursing.
- Investing in Health: Whakatohutia te Oranga Tangata. This comprehensive, visionary framework deserves a fresh look with the current dynamics in mind. The concepts and elements of this document support the observations above and have already answered many of the questions that have been identified as barriers for nurses to do what they do best – promote, improve, maintain, and restore health.
An update from Saskia Patton regarding current MOH action
- Recognition that a culture change is required to support a change in how New Zealand is currently addressing chronic disease management.
- Best practice DHBs have been recognized. These innovations need to be highlighted across New Zealand due to significant progress from particular pockets.
- DHB support required for input. A sector Advisory Group, Primary Health Care Advisory Group needs to be signaled for ongoing support of primary health care goals.
A summary of practice nurses experience of providing Care Plus by Michal Boyd, NP
- Positive benefits include improving nursing satisfaction, collaboration, and coordination
- Access to health information difficult across all settings suggesting that sharing of information from ‘private' practices should be mandated to allow nurses to carry on with work
- More automation needed to identify eligible patients
- Multiple care plans can be confusing to patients and providers which may reflect fall-out of working in silos
- There is a need for non-interrupted client-time and space (boundary-setting) for nurse and client
- Nurses were taking on additional responsibilities and frameworks in ‘an old framework model.” Remuneration was going into the practice and not visible to nurses involved.
- Information technology design and support required for seamless support and collaboration
- Developing a national network of Care Plus coordinators would enhance mission, consistency, and support of project
- Support of nurses involved with Care Plus includes availability of modularized nursing educational units in an accessible, asynchronised, distance learning venue.
- A comprehensive data base of resources would assist in efficient delivery
- Current funding streams emphasize silo-model of care
- Developing a nationally-supported media blitz such as that seen with the MenzB programme would enhance public understanding and access of Care Plus.
- Developing clinical outcomes for individuals, beyond practice outcomes of increased enrollment would keep Care Plus focused.
Workshops examining alignment potentials of several documents/frameworks:
- Investing in Health Recommendations
- MOH Care Plus Recommendations
- CON (NZ) NZNO Recommendations
- Wagner's Pillars of Chronic Disease Management
- To learn more about this framework, watch this video. Wagner presenting at a conference describing framework.
- Go to www.ihi.org/ihi
- Scroll down left column; link to “topics'
- Link to ‘chronic conditions
- Link to ‘chronic care model audio presention
- Thanks Julia Ebbett for sharing!
Development of a document Expert Advisory Group on Primary Health Care Nursing. This framework strategically positions nursing as a robust primary health care team member.
Mary Jane Gilmer, Nurse Practitioner Primary Health Care
mgilmer@eit.ac.nz
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