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Community and Primary Healthcare Nursing Service ModelsWhat’s possible and Lessons Learnt
PRIMARY AND COMMUNITY HEALTH NURSING HUI ON 16 APRIL 2015
Anushiya Ponniah ( a n u s h i ya @ x t ra . c o . n z)
It's far more important to know what sort of person
has a disease than to know what sort of disease a
person has.
Hippocrates, 400 BC
Outline•Context•Overview - paper on community and district nursing service models and lessons
•Common emerging themes•Relevance to primary care and integration•The possibilities…
Integrated primary healthcare nursing
What does ‘integration’ mean?
•No single, accepted definition of integrated healthcare
•Most include references to care co-ordination, seamlessness, person centeredness, and whole-of-system working together
New models of care development
What does ‘models of care’ mean?
•Northland’s guidance on models of care
•Ministry of Health on consistent themes from national and international literature about models of care
Ministry of Health (2015)Consistent themes from national and international literature about models of care
Personalised and flexible
Effective prioritisation
function
Accessible and equitable
service outcomes for all
Effective decision making
Integrated and coordinated
care
Access to relevant
information
Collaborative approach
Move from supply/demand to needs based model
Sustainability
Team based approach
Person/Whanau centred
Reflective of community
needs, resources and culture
Environment
Integrated and Innovative Models of Community Nursing Care, NZ•Nurse Maudeo Specialist and Generalist (palliative, home dialysis, district nursing)o Horizontal integration of services (Home based care, nursing, allied health, residential care,
dementia facilities, palliative care, hospice, care coordination, school nursing, occupational health nursing etc.)
o Nurse led clinics (wound, stoma, infusion, diabetes, dietician)o GP relations (networks and geographical teams)o Technology and education (CRISTA and NZ Institute of Community Healthcare)
•Lessonso Collaboration at the heart of service modelo Enablers are seen as basic must have (technology, education, coordination)o Specialist and generalist distinctiono Home based care team’s input and working with DNs
Integrated and Innovative Models of Community Nursing Care, NZ•Healthcare Hawkes Bayo Access to Medtech system, shared patient notes, book doctor
appointmentso Assigned to practices but employed by DHBo Service model to be finalised in April 2015 after 18 month pilot
•Lessonso Improved relationships – partnershipo Patient experience – connected care between nursing and GPs
Integrated and Innovative Models of Community Nursing Care, NZ•Counties Manukau Localities Model - CHS Integrationo Proactive planned care for at risk individualso Unplanned rapid (urgent) careo Short term reablement, rehabilitation recovery careo Coordinated access to long term care
•Lessonso First contact care type serviceo Break the funding barriers – the business caseo Flexible roles
Integrated and Innovative Models of Community Nursing Care, International•Royal District Nursing Service (Australia)o Homeless persons programmeo Hospital in the home programmeo Consumer directed careo Nurse led clinicso Customer Service Centre – 24/7 resolve first contacto RDNS Institute
•Lessonso Person first before patiento HiTH fundingo Research, trials and evidence based careo Technology and telehealth
Integrated and Innovative Models of Community Nursing Care, International•Regional Redesign of Community Nursing, Northern Irelando First contact care - rapid response at point of entryo Continuing care – proactive case management of chronic diseaseo Public health approach – prevention strategies and self management
•LessonsoFirst point of contactoFundamental role shift in defining nursing titles to patient needsoFlexible to work across boundaries and new settingsoPerson centred, needs based and use of patient pathwaysoDevolved power to teams of nursesoUnderpinned by public health principles and thinking
Common Themes•Multi disciplinary approach and intense case management for some•Specifically established network of services alongside general practices•Generalist nursing with specialist input•Nurse led specialist clinics for ambulatory clients•Use of smart technologies•Education, training and research support for nurses•24/7 contact centres or telephone support
Key elements of effective primary care
Barbara StarfieldHarry Rea
ComprehensiveContinuity
First contact
accessibility
Coordination
Community
Compassion
Declare the pastdiagnose the present
foretell the future
Hippocrates, 400 BC
The possibilities…Imagine a healthier communitiesChallenging because it is a complex social issue that impacts on health and well being of our community.•What would that picture look like?•How much of it is about health as we know it?•What is our role as health workforce, nurses and leaders?
•Public health approach – how will we prevent history occurring?•Promote Self management - how do we empower people?•First contact care – the freedom to do whatever is required for the person•Free nursing care – what would this mean for our communities?
A patient is a person before they are a patient
Conclusion
