| Abstract|| |
Background: Primary health-care system of the first level of access to healthcare is essential health system. According to the extensive need, the participation and optimal training of nurses in times of crisis and lack of clarity of roles and responsibilities of nurses in primary health-care team. Objective: This study was conducted with the aim of compare the role and responsibilities of nurses in primary health-care systems in selected countries. Materials and Methods: This study was an applied research of the type analytical-comparative. In which, the data relating to the study of selected countries were collected. The George Brady method was used to achieve the objective study. This means that in four stages (collecting and describing information, interpret, categorize, summarize, and compare) to achieve the end result conducted the research. Results: About the responsibilities of nurses in primary health-care teams, in most countries serving the nurses at the undergraduate in most of the defined tasks. In addition, majority of the nurses are responsible for the duties of supervises and guides primary care team and in some countries nursing with additional courses and obtaining certificate authorities concerned to implement the above-mentioned tasks. Conclusion: While the in our country, nurses in primary health-care teams are not present in any of the sections. The equivalent of these people in Iran country are technician, paramedical and health workers. Therefore, it is recommended necessary trainings in the educational curriculum of assistant nurses should be contained or be addressed to a review the primary health-care team.
Keywords: Nursing, prevention, primary healthcare, responsibility
|How to cite this article:|
Mohammadzadeh M, Yazdani S, Hosseini F, Rahbar M. Analytical and comparative evaluation of the roles and responsibilities of nurses in providing primary healthcare in selected countries: A analytical and comparative study. Ann Trop Med Public Health 2018;11:32-6
|How to cite this URL:|
Mohammadzadeh M, Yazdani S, Hosseini F, Rahbar M. Analytical and comparative evaluation of the roles and responsibilities of nurses in providing primary healthcare in selected countries: A analytical and comparative study. Ann Trop Med Public Health [serial online] 2018 [cited 2020 May 29];11:32-6. Available from: http://www.atmph.org/text.asp?2018/11/1/32/272534
| Introduction|| |
Providing high-quality and effective health services has always been one of the most important concerns of states and governments since health is the second fundamental need of nations after security, especially in the contemporary world., The development of primary healthcare has been the main focus of the Ministry of Health from 1984. In fact, it has been a landmark in providing services to the public. In line with this plan, nowadays, health has become a priority for policy-makers and government officials. Providing services and primary healthcare should be designed in the form of basic health service package. The aim of this is improving public health, rational redesigning of health care system, developing personal accountability, reducing the costs of public healthcare, endorsing innovations, enhancing safety, social support, and availability, and reflecting organizational values along with being evidence based. Paying special attention to educational objectives and contents based on community needs is one of the important issues that should be considered in educational planning. Primary healthcare is the first level of providing health-care services in community. Primary healthcare is characterized socially as appropriate services, publicly as available services, and scientifically as the first level of access to health services by determining the appropriate task force consisting of multidisciplinary teams that are guided by a proper referral system to cover the shortcomings in this field and prioritize those who need further treatment., In addition, these services raise the confidence both individually and socially and prevent many diseases. In fact, primary care system promotes the public health in partnership with other sectors. Extensive primary care includes health promotion, disease prevention, treatment and care, spreading and advertising in society. Currently, the health-care team members on the first level consists of health workers in rural areas, health-care expert, dietitian, mental health expert, environmental health expert/technician, occupational health expert/technician, and physician. The target group for providing care services includes entire population as the following age groups: infants, teenagers, young adults, middle-aged adults, the elderly, and pregnant women. Based on the curriculums of associate in health working and bachelor in health-care training fields and the details of family physician program in Iran, it is necessary to review the duties and roles of stakeholders in the field of primary healthcare. Integrated health services are increasing day-by-day and a wide range of chronic diseases, such as cardiovascular diseases, diabetes and various disorders will be on the agenda for primary health-care team. Similarly, in recent years, hypothyroidism and diabetes programs were included in responsibilities of primary health-care team and will be expanded in the future. Therefore, it is necessary to enhance the skills and education of stakeholders in primary health-care teams. Despite the above measures, it seems necessary to anticipate higher education levels for service providers to improve mobility and promote the services. These people should be able to provide services in the form of community-oriented nursing., The place and role of nurses in primary health-care team of Iran is not clearly specified. On the other hand, evaluation of educational curriculums of health-care providers and health workers that are trained to perform a wide range of services is weakened., Although health workers have the enough ability in providing public health and disease care, as primary assistants in the field of disease control, they are not adequately skilled in disease management as a primary care like a nurse. Therefore, the present study aimed to determine the roles and responsibilities of nurses in primary health care by investigating this issue in selected countries and comparing it with the roles of nurses in Iran.
| Materials and Methods|| |
In this analytical and comparative study, the data were collected by referring to the information database of the World Health Organization and other databases on the Internet from September 2016 to March 2017. The comparative method of George Bereday in education is one of the top models that many researchers utilized in their studies. According to Bereday's model, cultural and native backgrounds are also considered in comparing various educational methods in different areas. In fact, it is recommended in this model that courses and educational system should be thoroughly in accordance with the customs and culture of the region. The comparative study of Bereday runs four stages in the comparative educational system. In the first stage, information will be collected and examined on the selected topic. Then, the information will be interpreted based on the indicators of the chosen subject. In the third stage, data will put together and classified based on the electoral framework. Finally, the collected data will be summarized and compared to gain a general overview of the study. Since the present study is adaptive research, the selection of samples (selected countries including US, Australia, Canada, UK, Austria, Germany, Turkey, and Brazil) and variables were targeted and based on the availability of data and the relative similarity of their health system to Iran's health system. United States is recognized as a country with best-care services in all levels. In fact, nursing profession in this country is one of the most reliable and well-structured occupations among developed countries. Therefore, US was selected in collection of information from other countries, and information on primary care system of this country was used for extraction of research framework to conduct other steps of this research. The general information was gathered from other countries as well and accordingly the framework for comparison was obtained. The literature review and data extraction were done using the Internet and related articles and resources, and tables were prepared to integrate the information obtained from various countries. After evaluation of tables from different countries, an overall understanding was obtained regarding the role and place of nurses in primary health-care systems. The inclusion criteria in this study were as follows: countries with similar primary health-care systems to Iran in terms of life expectancy, chronic disease management, and cultural and climate factors; countries with more accessible resources and information so as an acceptable criterion for comparing can be obtained in the respected framework for future comparison with Iran. The exclusion criteria in this study was countries that did not have an adjusted health care system (The referral system uses public resources and free market for financing). According to the above criteria, the selection of countries was based on having adjusted health system with referral system and fair health market.
| Results|| |
The findings on the frequency of nurses' responsibilities in primary health-care team of selected health systems of the world revealed that more than half (62%) of nurses with master's degree have guidance and leadership role in primary health-care teams in selected countries and <20% of them perform their duties with bachelor's degree in the country. In half of the selected countries, nurses with master's degree and in more than half (75%) of the countries nurses with bachelor's degree supervise on assistant and practical nurses. In half of the selected countries, nurses with master's degree have the counseling and supporting role for patients and their families and in more than half of the countries, nurses with bachelor's degree, and in 37% nurses with associate's degree, and in one case assistant nurses had the role of counseling and supporting patients' family. In half the selected countries nurses with master's degree, nurses with associate's degree, and assistant nurses played the role of caring for critically ill patients, and in 75% of the countries nurses with bachelor's degree had the role of caring for critically ill patients. In only three of the selected countries, nurses with bachelor's degree and above had the role of performing the diagnostic tests and analyzing the results. This role has not been defined in the primary health-care team of five other countries. Nurses with bachelor's degree in 37% of cases (three countries) performed laboratory specimen collection and doing baseline laboratory tests while nurses with associate's degree, and assistant nurses provide this service in only one country. In half of the countries, this role is not defined for the primary health-care team. In 37% (three countries) of selected countries, nurses with master's degree manage chronic illnesses. However, in more than half (75%) of the selected countries, this service is offered by nurses with bachelor's degree, and in one of the two countries, the service is provided at the level of associate and assistant nurses. This role is not defined in Canada, but managing chronic diseases exists in different levels in primary health-care teams of other countries. In half of the countries, the role of health promotion, is provided by nurses with master's degree, while in 87.5% of the countries (seven countries), this role is offered by nurses with bachelor's degree, and finally, in three countries this service is provided by nurses with associate's degree and assistant nurses. This role is defined at different levels in primary health-care team of all the countries. In half the countries, the role of monitoring the status of the elderly exists in levels of master and associate degree along with assistant nurses. While in 87.5% (seven countries) of the countries, nurses with bachelor's degree evaluate the situation of the elderly. This role is defined in all the countries at different levels for the primary health care teams. In less than half of the countries the role of evaluation of caring needs is performed by nurses in levels of master's degree, associate's degree, and assistant nurses. However, in 87.5% (seven countries), the role of care at home for patients is conducted by nurses with bachelor's degree. In all the countries, except Turkey, this role is defined at different levels in primary health-care team. In less than half of the countries, nurses visit families that have infant, toddlers, or elderly people, in levels of master's degree, associate's degree, and assistant nurses. While in 62.5% of the countries (five countries) this role is performed by nurses with bachelor's degree. In all the countries, except Turkey and Canada, this role has been defined at different levels for the primary health-care team. In less than half of the countries, nurses play the role of prevention of diseases at levels of master's degree and associate's degree along with assistant nurses. The role of prevention of diseases is carried out in 87.5% of the countries, by nurses with bachelor's degree. In all the countries, this role is defined at different levels for the primary health-care teams. In half of the countries, nurses with master's degree, associate's degree, and assistant nurses do the role of education. However, in 87.5% of the countries (seven countries) nurses with master's degree play this part. The role of education is defined in all the countries at different levels for the primary health-care teams.
| Discussion|| |
In general, nurses have 14 responsibilities in primary health-care teams, including: monitoring the activities of practical and assistant nurses, counseling, and supporting patients' families, taking care of critically ill patients, performing the diagnostic tests and analyzing the results, management of chronic diseases, health promotion, evaluating the status of elderly people, providing in-home services for patients, assessing the care needs, visiting families who have infants, young children, and elderly, disease prevention, and education. These duties can be classified into four areas: leadership and management role, consultation, patient care, and education. The role of leadership and management is offered in most of the countries at specialized and master's degree levels in primary health-care teams. However, the role of leadership and management, such as management of chronic diseases, is not defined for nurses in health-care team. In consultation role, in half of the selected countries, nurses with master's degree, had the role of consultation and support of patients' family. In more than half of the countries, nurses with bachelor's degree and in 37% of the countries, nurses with associate's degree and assistant nurses had the role of consultation and support of patients' family. This role has only one subset that is the role of patient care. In fact, this role is the most important part of nursing activities that includes nine tasks under the selected 14 tasks of primary care nurses. This task is often conducted by nurses with bachelor's and associate's degrees along with assistant nurses. This role is one of the most important roles of nurses, which is done with the highest frequency at bachelor's degree. In line with the findings of a study that was conducted to evaluate the role of nurses in families that have patients who need special care, the public survey revealed that families must have a supporting role in the treatment of their patients without having any interference with therapeutic interventions conducted by nurses. More than 75% of critical care nurses participated in providing psychological support for the families. However, more than one-third of respondents believed that they did not have the necessary knowledge to meet the psychological needs of the families. Among the factors that were effective in participation of critical care nurses was nursing for patients who were dying or were in critical conditions that had psychological problems facing with it. The findings of this study indicated that nurses maintained several influential factors on their roles. They highlighted supportive and emotional roles for the family more than therapeutic roles.
| Conclusion|| |
In terms of responsibilities of nurses in primary health-care team, in most countries, nurses with bachelor's degree provide health services. Therefore, it can be noted that nurses with bachelor's degree have a fundamental role in performing their duties in primary health-care team. It is suggested that the necessary education be included in the curriculum of health workers or the primary health-care team be monitored and reviewed closely. One of the limitations of this study was the diversity of countries in terms of health and economic status and health market. Literature review showed that each of these countries had different insurance systems, health needs, and social and organizational needs. Therefore, in performing these comparisons, all the factors should be considered to prevent confounding the data although this may be difficult to do. Finally, we recommend various comparative studies be conducted between developed countries and Iran regarding primary healthcare of nurses.
This article is adapted from Master's Thesis Medical Education of Shahid Beheshti University of Medical Sciences. We would really like to express my gratitude to those who have supported our work include Shahid Beheshti University of Medical Sciences.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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Dr. Shahram Yazdani
School of Medical Education, Shahid Beheshti University of Medical Sciences, Tehran
Source of Support: None, Conflict of Interest: None