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Breaking down the silos

An education project has been designed to bridge the gap between primary and acute healthcare. By Linda Belardi.

Rural acute care nurses will be targeted in an education program designed to help drive down avoidable readmissions in NSW hospitals.

From February, nurses in the Murrumbidgee Local Health District will have access to learning resources to improve their understanding of primary healthcare and its relevance to the hospital setting.

The project leader, Associate Professor Yun-Hee Jeon from Sydney Nursing School, said a primary healthcare approach would help focus the attention of acute care nurses on continuous, comprehensive care.

“The effective management of chronic conditions such as diabetes and heart disease requires long-term management. If nurses don’t think beyond the hospital door, it’s very likely that patients will be readmitted because their care is not continuously managed.”

She said acute care nurses, especially rural nurses, were well placed to play an active role in health promotion and preventative health.

“Nurses in small rural communities are highly valued and well respected members of the community. Through this position of trust, acute care nurses can provide important advice to patients about managing their ongoing health.”

Researchers from the University of Sydney and the Centre for Primary Health Care and Equity at the University of NSW developed the education tools in consultation with local nurses and managers from the rural towns of Narrandera, Holbrook and Cootamundra.

The education resource, Primary Health Care Principles for Practice, which includes a workbook and DVD, follows a group learning format to motivate nurses to apply the key concepts to their workplace. The three modules include rural case studies with a focus on patients with multiple chronic conditions.

Nurse champions within selected multi-purpose services and rural hospitals will be identified to encourage nursing teams to use the professional development resource. Jeon said the workbook could contribute towards the mandatory 20 hours of continuing professional development to meet annual registration requirements.

She said primary healthcare was not well understood by acute care health professionals and communication between the settings needed to improve.

“Often in the hospital setting, nurses tend to focus on the immediate medical tasks of providing care such as medication and dressing. A primary healthcare philosophy encourages more holistic thinking about how nurses can provide care that will benefit beyond the hospital treatment.

“It is important that nurses understand the patient not just in the context of the hospital but also in their home and community context. Nurses also need to be aware of the resources that are available to patients when they are discharged.”

Jeon said the recent development of new technologies and the increasing specialisation of nursing risked narrowing the focus of nurses.

“It’s very important that nurses are able to see the link between the acute, sub acute and community care settings and the role of GPs. We’re not telling acute care nurses that they need to do everything for everyone but the hospital is a prime opportunity for nurses to talk about other preventative health issues.”

The program is also in line with the national healthcare reform agenda that includes a renewed emphasis on primary healthcare.

Jeon and her team intend to evaluate the effect of the project on the behaviour and practice of nurses before expanding it. “The project is geared to what nurses can use in their everyday practice. We are confident that that information will be useful, but our next step is to ensure the program is implemented and sustained so more nurses can benefit.”

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