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The concept and practice of community nursing in Ireland within the context of current primary health care reforms

The concept and practice of community nursing in Ireland within the context of current primary health care reforms

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An essay for the 2011 Undergraduate Awards (Lecturer Nomination) Competition by Ursula Martin . It is nominated by Lecturer Siobhan O' Neill of St Angela's College, Sligo in the category of Nursing & Midwifery
An essay for the 2011 Undergraduate Awards (Lecturer Nomination) Competition by Ursula Martin . It is nominated by Lecturer Siobhan O' Neill of St Angela's College, Sligo in the category of Nursing & Midwifery

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Published by: Undergraduate Awards on Sep 01, 2012
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10/27/2013

 
Module Title:
Community Nursing
Essay Title:
Discuss the concept and practice of community nursing in Ireland within the contextof current primary care health reforms
Student Name:
Ursula Martin
Student Number:
08451796
Course:
BNSc General
Introduction
Community nursing is a specialist field of nursing practice characterised by specialisedknowledge and skills, inter-professional collaboration, client responsibility and self caresupport with emphasis on prevention, health promotion and wellness, It combines publichealth nursing with nursing in order to formulate a community based, population focusedpractice (Allender & Spradley, 2005). Community Nursing in Ireland has being in
 
development over a number of years however, with much more emphasis placed on thecommunity in recent years, it is finally making progress in relation to Intellectual Disability,Psychiatric, Public Health, General and Specialist Nursing in integrating secondary servicesinto the community. In order to describe the concept of community nursing in Ireland, thisassignment will take account of the following three themes, primary care, community nursingboth present and future and team working in the community.
 Main Body
Primary Care:
Primary Care is not a new concept but, one that has being developing over thelast 30 years however, it has only recently begun to be strongly reaffirmed in Ireland. Froman international perspective, primary care is driven by the World Health Organisation (WHO)since it evolved at the Alma Ata conference 1978, where a declaration was proposed (WHO,1978) (Appendix 1). The declaration however, has been rejuvenated in recent times by theWHO Report (2008) which state
s primary care “now more than ever”. The WHO believed
that primary care was the most effective way to deliver care in the community and proceededto ask governments to establish primary care teams (PCTs) within their countries in order tofacilitate their proposed move towards the delivery of primary care outside of the hospitalservice. Today, countries such as UK, Spain, Netherlands, Denmark and Norway have welldeveloped primary health care systems where clients can only access secondary healthservices through GP referral which significantly reduces health care expenditure. On theother hand, Poland, Bulgaria and Africa are recognised to have under developed health caresystems with little focus on primary care.From a National perspective, the government in Ireland attempted to implement the PrimaryHealth Care Strategy in 2001 (DOH&C, 2001a) which focused on Quality and Fairness(DOH&C, 2001b). The proposed model of primary care was based on a team approach. Thestrategy put forward the need for an empowering primary health system which would provide
 
24 hour services, treat everybody equally and provide high quality services whileencouraging clients to manage their own health. The Irish government provided a rationalefor change by identifying weaknesses in the current healthcare system. They outlined 20action points in the primary care strategy and an implementation plan and looked at evidenceinternationally and from other lay experts. The Government also placed corporateresponsibility on the HSE to take reform who responded by undergoing primary care reforms.They developed the HSE transformation programme agenda 2007-2010 (HSE, 2007) whichfocused on integrating hospital and community services to manage the health needs of clientsin the community.In Ireland in 2009 there were 195 PCTs in position with 115 being developed, it is estimatedthat there will be 530 PCTs developed by October 2011(Murphy, 2010). Although there arefew PCTs established locally in Sligo, Leitrim, West Cavan, there are 10 proposed PCTs forthese areas (HSE West, 2007) (Appendix 2)
. A limitation in the author’s opinion as a student
nurse was the lack of primary care teams during the community experience and the inabilityto identify the impact that Primary Care has on clients however, there was evidence of informal team working between PHNs, social workers and OTs despite this deficit.The most important aspect of this primary care development is to ensure that it isunderpinned by policy and legislation in order to ensure a consistent, strategic service(Barker, 1996). Examples of necessary legislation in primary care include the code of conduct (An Bord Altranais, 2000), scope of practice (An Bord Altranais, 2000), the healthpromotion strategy 2000-2005 (DOH&C, 2000) and many others.The key features of primary care as a health system include first contact, comprehensive, coordination and continuity of care according to Starfield (1998). In the authors opinion,Primary care should be of great advantage in that it is cost effective providing evidencebased, person centered care with many health gains for service users (DOH&C, 2001a). It is

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