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The primary problem

A new study indicates nursing curricula needs to be more in tune with the evolving health care agenda in Australia. Annie May reports.

Shifting focus from hospital-based care to the promotion of health and prevention, the government is placing increasing emphasis on primary care, and the role nurses can play, as the linchpin of its health reforms.

But will the next generation of nurses be properly prepared to work in a strengthened and expanded primary health system?

This is the question asked by the authors of a recent study looking at how well Australian nursing courses perform in achieving this.

The answer: not as good as they need to be.

The findings indicate that undergraduate student preparation for practice in primary health and community settings is patchy and not keeping pace with reform agendas, say the authors Helen Keleher, Rhian Parker and Karen Francis.

The first of the two-stage study was an audit of all undergraduate nursing curricula in Australia to understand how well it integrates the principles and practices of primary health care, health promotion and primary health care and teaches competencies for careers outside acute care settings.

Reporting on the findings in the recent Australian Journal of Primary Health, Keleher says the attention given to primary health care, prevention and health promotion is “patchy, rather than systematic”.

Nursing roles are not confined to the acute sector but are increasingly required in communities and community-based services where the new primary health care and prevention agendas will be implemented.

“In Australia, nurses with bachelor-level university education are in an ideal position to play a key role in these new health reforms. But they must be adequately prepared,” she says.

“Such preparation needs to be facilitated through partnerships that develop appropriate education for a workforce focussed on prevention. Nursing curricula needs to be much more in tune with the evolving health care agenda in Australia.”

There are 38 pre-registration undergraduate bachelor-level nursing courses in Australia, with the authors examining the curriculum of all them for 2007-09

Overall, most courses followed a similar model. First year is inclusive of fundamental skills and knowledge and often around a theme of wellness; second year is focused on acute medical and surgical nursing and also usually covers mental health; and third year is generally focussed on higher level acuity in illness, tertiary level care such as rehabilitation and management of chronic illness, and transition to practice.

“A handful of universities reflect a course philosophy of primary health care across their nursing curriculum. However, the majority of courses simply cover primary health care and the promotion of health and well-being as a topic within the curriculum,” say the authors.

“A single unit specifically looking at community health or health sociology is the closest that most nursing programs get to a primary health care focus.”

It was also found that just one-quarter of courses provided a unit in indigenous health and only a small number of universities offer units of health inequalities and social determinants of health. The authors admit that is difficult to quantify because content on these topics may be embedded in the curriculum content of units that is not necessarily obvious for handbook entries.

A handful of courses specifically covered global health in either a second or third year unit.

“This audit indicates that undergraduate nursing programs are yet to respond to the expectations of increased participation of nurses in primary care, primary health care, or to the increasing importance of health promotion and prevention interventions.

“Most courses introduce learning about primary health care in the first year with some reinforcing the learning at third year, but such an approach is not consistent.

As a result of the government’s reforms there will be an increase in opportunities for nurses to work in these areas from beginning through to advanced practice levels.

Appropriate education that prepares nurses for work in the primary and community sectors would encourage more nurses to develop a career in primary health care and give them a good foundation for postgraduate education and training

“From our data we consider that nursing curricula in Australia have yet to be constructed in a manner that recognises the central role primary health care and health promotion plays in the health and well-being of the population and the central roles for nurses that are being mapped out as the reform agendas for hospitals, primary health care and prevention, unfold.”

But, the authors state, there are wider international reasons why Australian nursing needs to do more in relation to nursing education relative to primary health care.

“The International Council of Nurses has, for several years, been arguing strongly that nurses have leadership roles in primary health care reforms.

“If Australia is to be in step with international developments in nursing and nursing education and with the greater emphasis on primary health care, nurses need adequate preparation to make an effective contribution and to assume leadership roles.”

To meet the challenge of accessible and holistic care for all and address significant workforce shortages in some areas, nursing curricula in Australia need to prepare the next generation of nurses for a breadth of careers outside the acute care sector.

“The implications for nursing curricula are that they may need to be much less focussed on the workforce needs of the acute sector. Modernising nursing curricula to provide more choice may also be a way of supporting nursing careers in primary care and primary health care.

National health system reforms will be looking for a health workforce that is versatile and able to take up the challenged presented by prevention and health promotion, primary care and primary health care.

“Nursing as a profession has opportunities to take up these challenges as they are, perhaps, the most versatile workforce group, but only if the competencies and curricula for undergraduate preparation is indeed a preparation for the new health system realities and emerging health system reforms.”


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