EDITORIAL
Vol. 21 No. 1 March 2005
Crafting Future Primary Health Care Nursing
During 2002/3 in the process of implementing the Primary Health Care Strategy (Ministry of Health, 2001) the Ministry of Health purchased 11 primary health care innovations. These were selected from a pool of 149 proposals submitted by nurses all directed at improving the health of the population through better access to services, reducing health inequalities, and exploration of new ways to provide primary health care nursing for communities. The number of proposals attests to Registered Nurses’ long-term commitment and drive towards ensuring that primary health care nurses make the best possible contribution to the health of all New Zealanders. The profession’s response is something about which all nurses can feel proud. The opportunities provided by this targeted money are something to celebrate.
These funded nursing innovations vary with respect to focus within their differently evolving health organisations, and in relation to unique communities and populations. For instance innovations in Counties Manakau, MidCentral and Wairarapa are District Health Board wide. Northland and Auckland innovations span one and six Primary Health Organisations respectively. Those of Tairawhiti, Hutt Valley, Reporoa and Tuwharetoa (which is exploring nursing practice) are based in Non-Governmental Organisations and work with specific populations. The direction of Reefton and Taranaki innovations is towards developing integrated nursing models to close service gaps.
The Ministry has funded an independent evaluation of the intitiatives led by Waikato Institute of Technology. Part of the method is an annual two day workshop where representatives of the innovations meet with evaluators and the Ministry of Health. During the second two-day evaluation workshop held in the Waikato, February 2005, the accomplishments and growing confidence of the nurses involved with these innovations were evident to the Ministry of Health appointed evaluation team* (see below for details of membership). Innovation at this level involves developing new relationships, creating structures and transforming processes and practice. These challenges have required nurses to work with uncertainty, take risks and trial new and different ways of working to improve health. They have needed to learn to trust themselves, and to forge robust and effective relationships with communities within the population in which they work, and with other professional groups. These efforts have been critical for the innovations to take root, gather support, set directions and maintain momentum. There are complex differences within the cluster of innovations being established. Hence they are developing at different paces and not all have achieved the speed or degree of success to which they aspired initially. However, the combined progress and learning provides important insights into what needs to happen to enable nursing’s contribution to primary health care to reach its full potential.
Identification of factors that have enhanced and those that have hindered these innovations is part of the evaluation. Keys to successfully setting up and
sustaining the new approaches include access and control of adequate sustainable funding and resources, timely stable employment of sufficient nurses (including relievers) and support for nurses to attain advanced education. Also critical to success are involvement and teamwork at governance, management and operational levels of organisations, as well as productive working relationships with communities, other nurses and health professionals and effective interaction with Primary Health Organisations and District Health Boards. A community profile or other means to establish community priorities is fundamental. The committed expertise and time that communities, nurses, nurse leaders and others have gifted in order to obtain resources, develop teamwork and define community priorities has been invaluable. Paradoxically, sometimes what has helped one innovation grow appears to have worked against another. Similarly dynamics which are fruitful in one project may not be so in another. Such internal differences were not part of this evaluation.
The nurses working in the 11 funded innovations demonstrate an openness to engage with new and creative approaches, to go the extra mile, extend their practice, support others to advance their knowledge and skills, and to lobby and advocate. It is through this work that the projects are now demonstrating how nursing can create and craft future primary health care nursing practice which maximum benefit to the health of New Zealanders.
Trish Wright, Waikato Institute of Technology
Kathy Nelson, Victoria University Wellington
Margaret Connor, Independent Consultant
Janice McDrury, Otago Polytechnic
Jan Pearson, Royal New Zealand Plunket Society
Kelly Gibson, Waikato Institute of Technology
Sandra Thompson, Waikato Institute of Technology
Evaluation team for the Ministry of Health funded Evaluation of Eleven Primary Health Care Nursing Innovations.
* In the spirit of collaboration fundamental to primary health care, the evaluation team draws national Primary Health Care Nursing research expertise together under the umbrella of the Centre for Applied Health and Human Services Research at Waikato Institute of Technology.
Reference Ministry of Health. (2001). The primary health care strategy. Wellington: Author
