Nurse Educators' Knowledge of Primary Health Care: Implications for Community-Based Education, Practice, and Research

By Shoultz, Jan; Amundson, Mary Jane | Nursing and Health Care Perspectives, May-June 1998 | Go to article overview

Nurse Educators' Knowledge of Primary Health Care: Implications for Community-Based Education, Practice, and Research


Shoultz, Jan, Amundson, Mary Jane, Nursing and Health Care Perspectives


Successful change of the health care system in the United States is linked to successful change in the education of health care professionals. Clearly, a cadre of health care professionals educated for a system that focuses on acute illness and hospital-based technology interventions would not perform well in a health care system that focuses on community-based primary health care. If the discipline of nursing is to continue its major role in the delivery of health care, it must ensure that nurse educators are prepared to revise nursing curricula and teaching strategies in terms of community-based primary health care knowledge and skills.

One of the most consistently identified needs in the United States is the enhancement of community-based primary health care (1). Prior to 1994, with the focus of the health care system on illness and highly specialized treatment, emphasis was placed on the education and development of highly specialized health providers for acute care and tertiary care institutions. However, in 1992, it was noted that professional education must be reformed to support the development of a health care system that has greater emphasis on primary health care (2). Several major initiatives have addressed the education of health professionals as a key factor related to the transition to a primary health care system (3,4).

The Kellogg Foundation has identified as "one of the root causes of our health care crisis, and a major source of our capacity to improve the system...the way we educate our health professionals" (3). Community Partnerships: An Initiative in Health Professionals' Education was funded by the Kellogg Foundation as a strategy to reorient the education of health professionals to primary health care (PHC). In an attempt to learn what nurse educators know about PHC, faculty from the schools participating in the Kellogg Community Partnership Initiative were surveyed regarding their work experiences, educational backgrounds, learning styles, knowledge of primary health care, and the teaching methods they use.

What Is Primary Health Care? The World Health Organization goal of Health for All, adopted by 134 nations including the United States, is based on the five principles of primary health care: community participation, equitable distribution, multisectorial cooperation, appropriateness, and health promotion and disease prevention (5). PHC emphasizes collaboration of health professionals and community members, focuses on the development of health-promoting policies, and advocates for access to care for all people (6). In 1978, at Alma-Ata, the World Health Organization defined PHC as "essential health care based on practical, scientifically sound and socially acceptable methods and technology made universally accessible to individuals and families in the community through their full participation and at a cost that the community and country can afford to maintain at every stage of their development in the spirit of self-reliance and self-determination" (7). In contrast, in 1994, the Institute of Medicine clearly differentiated primary health care from primary care by stating that "[primary care] addresses personal health services and not population-based, public health services" (8).

All major nursing organizations have developed position papers supporting a focus on primary health care (9-13). In addition, individual schools (14) and special projects (15) have identified factors associated with community-based primary health care nursing education. In 1993, Patricia Moccia described the dilemma faced by the discipline: "Faculty [must] teach what they know and at this stage the majority of faculty know the current health care system. Few have been introduced either by education, experience or research to a consumer-driven, community-based primary health care system and even fewer are facile with their role as educators for such a system" (12, p. 14).

Prior to 1992, little research had been undertaken to survey the knowledge of PHC among nurse educators. …

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