How the Institutional and Policy Context Shapes the Establishment of Nurse Practitioner Roles and Practice in New Zealand’s Primary Health Care Sector

2020 ◽  
pp. 152715442096553
Author(s):  
Sue Adams ◽  
Jenny Carryer
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Primary Health Care ◽  
New Zealand ◽  
Nurse Practitioner ◽  
Central Government ◽  
Health Sector ◽  
District Health ◽  
Policy Context ◽  
Primary Health

The implementation of the nurse practitioner (NP) workforce in primary health care (PHC) in New Zealand has been slow, despite ongoing concerns over persisting health inequalities and a crisis in the primary care physician workforce. This article, as part of a wider institutional ethnography, draws on the experiences of one NP and two NP candidates, as they struggle to establish and deliver PHC services in areas of high need, rural, and Indigenous Māori communities in New Zealand. Using information gathered initially by interview, we develop an analysis of how the institutional and policy context is shaping their experiences and limiting opportunities for the informants to provide meaningful comprehensive PHC. Their work (time and effort), with various health organizations, was halted with little rationale, and seemingly contrary to New Zealand’s strategic direction for PHC stipulated in the Primary Health Care Strategy 2001. The tension between the extant biomedical model, known as primary care, and the broader principles of PHC was evident. Our analysis explored how the perpetuation of the neoliberal health policy environment through a “hands-off” approach from central government and district health boards resulted in a highly fragmented and complex health sector. Ongoing policy and sector perseverance to support privately owned physician-led general practice; a competitive contractual environment; and significant structural health sector changes, all restricted the establishment of NP services. Instead, commitment across the health sector is needed to ensure implementation of the NP workforce as autonomous mainstream providers of comprehensive PHC services.

scholarly journals The health promotion shift into Primary Health Organisations: Implications for the health promotion workforce

2011 ◽  
Vol 3 (1) ◽  
pp. 41 ◽  
Author(s):  
Sarah Lovell ◽  
Pat Neuwelt
Keyword(s):  
Public Health ◽  
Primary Care ◽  
Health Care ◽  
Health Promotion ◽  
Primary Health Care ◽  
New Zealand ◽  
Health Sector ◽  
Primary Health ◽  
Primary Care Sector ◽  
Care Health

INTRODUCTION: Reconciling the primary care sector’s traditional concern for individual health outcomes with a population health approach is integral to the implementation of New Zealand’s Primary Health Care Strategy, and a key challenge for health promotion in New Zealand. The purpose of this study was to examine the views of health promoters, their funders and managers toward the implementation of the Primary Health Care Strategy’s health promotion agenda. METHODS: Focus groups and interviews were carried out with 64 health promoters and 21 health sector managers and planners and funders over the 12 months beginning March 2008. Interview and focus group transcripts were analysed thematically. FINDINGS: Primary Health Organisations (PHOs) have been perceived as both an opportunity and a threat to health promotion. The opportunity was seen to lie in the development of health promotion responsive to the needs of communities. Yet the numerous PHOs that emerged spread funding and capacity for health promotion thin, particularly amongst smaller PHOs. CONCLUSION: The failure of the Ministry of Health to engage the health promotion workforce in the development and implementation of the Primary Health Care Strategy has led to a clear sense of vulnerability among health promoters. Ideological divisions between primary care and public health have been exacerbated by the restructuring of health promotion funding and delivery. Within non-governmental organisations and public health units concern continues to surround the legitimacy of health promotion approaches undertaken within the primary health care sector. KEYWORDS: Health promotion; primary health care; health policy; Primary Health Organisations; New Zealand; restructuring

scholarly journals The Pacific primary health care workforce in New Zealand: What are the needs?

2009 ◽  
Vol 1 (2) ◽  
pp. 126 ◽  
Author(s):  
Luisa Ape-Esera ◽  
Vili Nosa ◽  
Felicity Goodyear-Smith
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Primary Health Care ◽  
New Zealand ◽  
Health Care Workforce ◽  
Pacific People ◽  
Advantages And Disadvantages ◽  
Pacific Population ◽  
Primary Health ◽  
The Impact

AIM: To scope future needs of the NZ Pacific primary care workforce. METHOD: Semi-structured interviews with key informants including Pacific primary care workers in both Pacific and mainstream primary health care organisations and managers at funding, policy and strategy levels. Qualitative thematic analysis using general inductive approach. RESULTS: Thirteen stakeholders interviewed (four males, nine females) in 2006. Included both NZ- and Island-born people of Samoan, Tongan, Niuean, Fijian and NZ European ethnicities; age 20–65 years. Occupations included general practitioner, practice nurse, community worker, Ministry of Health official and manager representing mainstream and Pacific-specific organisations. Key themes were significant differences in attributes, needs and values between ‘traditional’ and contemporary Pacific people; issues regarding recruitment and retention of Pacific people into the primary health care workforce; importance of cultural appropriateness for Pacific populations utilising mainstream and Pacific-specific primary care services and both advantages and disadvantages of ‘Pacific for Pacific’ services. CONCLUSION: Interviews demonstrated heterogeneity of Pacific population regarding ethnicity, age, duration of NZ residence and degree of immersion in their culture and language. Higher rates of mental disorder amongst NZ-born Pacific signpost urgent need to address the impact of Western values on NZ-born Pacific youth. Pacific population growth means increasing demands on health services with Pacific worker shortages across all primary health care occupations. However it is not possible for all Pacific people to be treated by Pacific organisations and/or by Pacific health workers and services should be culturally competent regardless of ethnicity of providers. KEYWORDS: Pacific Islands, New Zealand, manpower, ethnic groups, Oceanic Ancestry Group, primary health care

New Zealand primary health care policy and the role of a non-government organisation

2004 ◽  
Vol 10 (3) ◽  
pp. 76 ◽  
Author(s):  
Peter Glensor
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
New Zealand ◽  
Health Care Policy ◽  
National Level ◽  
District Health ◽  
Leading Role ◽  
Primary Health ◽  
Government Organisation ◽  
Intersectoral Linkages

I was asked to make the presentation this paper is based on1 following the collaboration between La Trobe University and Health Care Aotearoa over several years. La Trobe is the home of the Quality Improvement Council, of which Health Care Aotearoa is a member. That Council has been one of the international partners who have given validation and inspiration for us in Aotearoa/New Zealand in the field of community-based primary health care. My own background, as a Methodist minister for 20 years, followed a life-transforming year as an 18-year-old volunteer in Sarawak in 1969, and exposure internationally to struggles for social justice. In recent years I have become more directly involved in political engagement, at both the local body and national level, as an expression of my understanding of community development and health. I am Chairman of one of New Zealand?s 21 District Health Boards and am relishing the opportunity to lead a regional health organisation as it builds intersectoral linkages, embraces excellence in the delivery of health services, and addresses issues of disparities in health outcomes. I continue to be involved in national leadership of a number of non-government organisations (NGOs), and am taking a leading role in building a new national entity that can encompass the whole non-government organisation sector in New Zealand. All this work arises directly from the experiences and insights described in this paper.

scholarly journals Characteristics of nurses providing diabetes community and outpatient care in Auckland

2013 ◽  
Vol 5 (1) ◽  
pp. 19 ◽  
Author(s):  
Barbara Daly ◽  
Bruce Arroll ◽  
Nicolette Sheridan ◽  
Timothy Kenealy ◽  
Robert Scragg
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Primary Health Care ◽  
New Zealand ◽  
Diabetes Management ◽  
Practice Nurses ◽  
Primary Health ◽  
District Nurses ◽  
Primary Care Nurses ◽  
Specialist Nurses

INTRODUCTION: There is a worldwide trend for diabetes care to be undertaken in primary care. Nurses are expected to take a leading role in diabetes management, but their roles in primary care are unclear in New Zealand, as are the systems of care they work in as well as their training. AIM: To describe and compare demographic details, education and diabetes experience, practice setting and facilities available for the three main groups of primary health care nurses working in the largest urban area in New Zealand. METHOD: Of the total number of practice nurses, district nurses and specialist nurses working in Auckland (n=1091), 31% were randomly selected to undertake a self-administered questionnaire and telephone interview in 2006–2008. RESULTS: Overall response was 86% (n=284 self-administered questionnaires, n=287 telephone interviews). Almost half (43%) of primary care nurses were aged over 50 years. A greater proportion of specialist nurses (89%) and practice nurses (84%) had post-registration diabetes education compared with district nurses (65%, p=0.005), from a range of educational settings including workshops, workplaces, conferences and tertiary institutions. More district nurses (35%) and practice nurses (32%) had worked in their current workplace for >10 years compared with specialist nurses (14%, p=0.004). Over 20% of practice nurses and district nurses lacked access to the internet, and the latter group had the least administrative facilities and felt least valued. DISCUSSION: These findings highlight an ageing primary health care nursing workforce, lack of a national primary health care post-registration qualification and a lack of internet access. KEYWORDS: Community health nursing; diabetes mellitus; internet; nurses; primary health care

scholarly journals Editorial

1995 ◽  
Vol 1 (1) ◽  
pp. 2
Author(s):  
Heather Gardner
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Primary Health Care ◽  
Continuity Of Care ◽  
Health Sector ◽  
Community Health Services ◽  
Continuing Care ◽  
Australian Health ◽  
Primary Health

The advent of the Australian Journal of Primary Health - Interchange reflects the changes which are taking place in the Australian health sector and the increased and increasing importance of primary health care and community health services. The significant role of primary care in maintaining health and enhancing wellbeing is at last being recognised, and the relationships between primary care, continuing care, and acute care are being redefined and the connections made, so that improvement in continuity of care can be achieved.

scholarly journals The use of Artificial Neural Networks in the diagnosis of manageable factors on Brazilian Primary Health Care

2021 ◽  
Vol 10 (1) ◽  
pp. e31010111740
Author(s):  
Kerla Fabiana Dias Cabral ◽  
Fábio Ribeiro Cerqueira ◽  
Rodrigo Siqueira-Batista ◽  
Marco Aurélio Marques Ferreira ◽  
Bruna Rodrigues de Freitas
Keyword(s):  
Neural Networks ◽  
Primary Care ◽  
Health Care ◽  
Artificial Neural Networks ◽  
Primary Health Care ◽  
Health Sector ◽  
Welfare Programs ◽  
Primary Health ◽  
The Social ◽  
Artificial Neural

The social determinants of health are relevant in the main strategies of Primary Health Care. However, it is known the difficulties of the health sector to overcome the factors that negatively interfere with the health of the population. Thus, it was aimed to create a computer model to present in detail the factors that somehow are related to the Primary Health Care, enabling public health managers to make decisions efficiently. Using artificial neural networks, it was possible to create a classifier model that could show which variables are related to the efficiency in Primary Care and which lead to inefficiency. Moreover, it was used the NICeSim simulator as a tool to evaluate the behavior of each variable identified as relevant to the efficiency in Primary Care of cities. The results demonstrate that the created model was superior to previously proposed models. Furthermore, our model has been demonstrated to be very effective in identifying variables that affect Primary Health. The created model shows that factors, such as illiteracy and welfare programs, considerably affect the efficiency of health care, reinforcing the argument that the focus of the public policies should be dealt in an intersectoral way, improving the factors that positively influence the population health.

scholarly journals Nurse practitioners and pharmacist prescribers in primary health care: A realist evaluation of the New Zealand experience

2021 ◽  
Author(s):  
◽  
Tara Officer
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
New Zealand ◽  
Health Services ◽  
Health System ◽  
Nurse Practitioners ◽  
Nurse Practitioner ◽  
Health Workforce ◽  
Primary Health ◽  
Advanced Practitioner

<p>Internationally, health workforce redesign provides a means to cope with an increasing demand for health services. The development of advanced practitioner professions provides a major change in health service delivery that challenges traditional practice boundaries. Yet, we know very little about how to introduce such roles into existing health systems successfully. This research investigates how nurse practitioner and pharmacist prescriber roles are developing in New Zealand primary health care, and what is needed to better support the future development of these roles.  A realist methodology guided this research. The study used a qualitative research design involving semi-structured interviews of (1) policy, training, and advocacy stakeholders; (2) primary health care nurse practitioners, pharmacist prescribers, and general practitioners; and (3) patients of advanced practitioners and carers of patients using such services. Documents provided by interviewees relating to practice-specific roles supplemented these interviews. Data analysis facilitated the generation, testing, and refinement of theories on nurse practitioner and pharmacist prescriber role development.  This research provided an account of the complexities of developing new health professional roles in an already established health system. Theories formed in this research considered advanced practitioner role creation, realisation, and subsequent delivery of health services. Mechanisms for their development included: (1) engagement in planning and integrating roles; (2) establishing opportunities as part of a well-defined career pathway; and (3) championing role uptake and work to full scopes of practice. Various health system and workplace contexts, practitioner goals, and patient needs influenced the ability for these mechanisms to trigger and thus have an effect on role development.  Theories arising from this research emphasise the complexity inherent in the development of advanced practitioner roles. In addition, the findings demonstrate that a structured and informed health workforce redesign could improve use of roles, such as those of the nurse practitioner and pharmacist prescriber. In light of these results, this study recommends, implementing a national strategy that aligns policy and practice decisions if we are to succeed in making better use of such practitioner skills and expertise.</p>

scholarly journals Community oriented primary care in Tshwane District, South Africa: Assessing the first phase of implementation

2013 ◽  
Vol 5 (1) ◽  
Author(s):  
Hans-Friedemann Kinkel ◽  
Tessa Marcus ◽  
Shehla Memon ◽  
Nomonde Bam ◽  
Jannie Hugo
Keyword(s):  
South Africa ◽  
Primary Care ◽  
Health Care ◽  
Primary Health Care ◽  
Health Care Providers ◽  
Service Providers ◽  
Health Sector ◽  
Political Commitment ◽  
Care Providers ◽  
Primary Health

Background: Re-engineering primary health care is a cornerstone of the health sector reforminitiated nationally in South Africa in 2009. Using the concept of ward based NGO-run healthposts, Tshwane District, Gauteng, began implementing community oriented primary care (COPC) through ward based outreach teams (WBOT) in seven wards during 2011.Objectives: This study sought to gain insight into how primary health care providers understood and perceived the first phase of implementing COPC in the Tshwane district.Method: Qualitative research was performed through focus group interviews with staff of the seven health posts during September 2011 and October 2011. It explored primary health careproviders’ understanding, perception and experience of COPC.Results: Participants raised organisational, workplace and community relationship issues in the discussions. Organisationally, these related to the process of initiating and setting up COPC and the relationship between governmental and nongovernmental organisations. Issues that arose around the workplace related to the job situation and employment status and remuneration of health post staff. Community related issues centred on the role and relationship between service providers and their communities.Conclusion: COPC touched a responsive nerve in the health care system, both nationallyand locally. It was seen as an effective way to respond to South Africa’s crisis of health care. Initiating the reform was inevitably a complex process. In this initial phase of implementing COPC the political commitment of governmental and nongovernmental organisations was evident. What still had to be worked through was how the collaboration would materialise in practice on the ground.

scholarly journals Nurse practitioners and pharmacist prescribers in primary health care: A realist evaluation of the New Zealand experience

2021 ◽  
Author(s):  
◽  
Tara Officer
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
New Zealand ◽  
Health Services ◽  
Health System ◽  
Nurse Practitioners ◽  
Nurse Practitioner ◽  
Health Workforce ◽  
Primary Health ◽  
Advanced Practitioner

<p>Internationally, health workforce redesign provides a means to cope with an increasing demand for health services. The development of advanced practitioner professions provides a major change in health service delivery that challenges traditional practice boundaries. Yet, we know very little about how to introduce such roles into existing health systems successfully. This research investigates how nurse practitioner and pharmacist prescriber roles are developing in New Zealand primary health care, and what is needed to better support the future development of these roles.  A realist methodology guided this research. The study used a qualitative research design involving semi-structured interviews of (1) policy, training, and advocacy stakeholders; (2) primary health care nurse practitioners, pharmacist prescribers, and general practitioners; and (3) patients of advanced practitioners and carers of patients using such services. Documents provided by interviewees relating to practice-specific roles supplemented these interviews. Data analysis facilitated the generation, testing, and refinement of theories on nurse practitioner and pharmacist prescriber role development.  This research provided an account of the complexities of developing new health professional roles in an already established health system. Theories formed in this research considered advanced practitioner role creation, realisation, and subsequent delivery of health services. Mechanisms for their development included: (1) engagement in planning and integrating roles; (2) establishing opportunities as part of a well-defined career pathway; and (3) championing role uptake and work to full scopes of practice. Various health system and workplace contexts, practitioner goals, and patient needs influenced the ability for these mechanisms to trigger and thus have an effect on role development.  Theories arising from this research emphasise the complexity inherent in the development of advanced practitioner roles. In addition, the findings demonstrate that a structured and informed health workforce redesign could improve use of roles, such as those of the nurse practitioner and pharmacist prescriber. In light of these results, this study recommends, implementing a national strategy that aligns policy and practice decisions if we are to succeed in making better use of such practitioner skills and expertise.</p>

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