Nursing: Primary Healthcare - A National Health Priority Area

This article discusses the importance of primary healthcare in managing Cardiovascular Disease (CVD) in Australia. It covers the screening and assessment strategies for CVD and the role of healthcare education in reducing the risks of CVD. The article also highlights the importance of cultural competencies while engaging in the education of culturally diverse groups such as Aboriginals.

Running head: Nursing in primary healthcare
Nursing: Primary Healthcare
-A National Health Priority Area
Name of the Student
Name of the University
Author Note

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Introduction:
Cardiovascular Disease (CVD) is one of the biggest causes of mortality and morbidity
in Australia. According to the Department of Health, Australia, about 4.2 million Australian
adults (or 18.3% of the population) is diagnosed of circulatory dysfunction as of 2014-2015,
which includes 1.2 million diagnosed of CVD (such as heart disease and stroke. Additionally,
as of 2015, 45,392 (29%) cases of death have been recorded for CVD (health.gov.au
health.gov.au, 2018).
In the given scenario, the patient is 72 year lady and a member of the Aboriginal
community: Wiradjuri Nation. Her risks of CVD could have been affected by many different
factors: improved health and healthcare, which allowed people to live longer with CVD.
Also, her risks could have been increased due to her lack of regular exercise (due to the back
pain), occasional drinking and the possible stress due to the diagnosis of cancer in her son,
and her husband’s knee replacement surgery.
Section 1:
Screening is a short procedure that is conducted after a person seeks healthcare
service and it helps to indicate of the person is likely to have the disease. Individuals who are
screened positive are understood to have the disease, and should be given a thorough
assessment (sbirt.vermont.gov, 2018). Screening can identify the need for further evaluation
and preliminary intervention, can be administered as a part of the routine clinical visit, help to
assess the progress of treatment, its outcome and change in clinical symptoms in time
(apapracticecentral.org, 2018; Huysentruyt et al., 2016)
Assessment is the procedure that occurs after screening, and it involves the collection
of key data in order to conceptualize the problem and develop a plan for treatment. The goals

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of assessment is to establish or rule out the presence or absence of any co morbid conditions,
identify the readiness for change in the person, identify the strengths and weaknesses that can
affect the treatment and recovery from the disease and then start the development of proper
treatment (sbirt.vermont.gov, 2018; Huysentruyt et al., 2016).
For the Screening of CVD, the Systemic Coronary Risk Evaluation (SCORE) Chart
can e utilized, which is based on gender, age, total cholesterol levels and systolic blood
pressure as well as smoking status to produce a relative risk chart for CVD (Vlachopoulos et
al., 2014). Breccia et al. (2015) proposed that SCORE chart evaluation can be a useful tool
for the identification of patients at high risk of artherosclerotic dysfunctions. This was also
supported by Tomasik et al. (2017), who proposed that SCORE could help to screen for
CVD. Breccia et al (2014) cased the SCORE chart on the stratification of sex (female vs
male), age (40-65 years), non smoker vs smoker status, systolic blood pressure (120-180 mm
of Hg) and blood cholesterol (150-300 mg/dl). Based on these values patients can be
classified into low, moderate, high and very high risks. These measures can be used in the
given scenario, for screening the patient.
For the assessment of CVD, physical assessment technique can be used. The physical
examination comprises of several components: Checking the skin color of thorax, point of
symmetry of thorax and point of maximum intensity (PMI). For eyes, presence of
Xanthelasma and Arcus Senilis can be a predictor of CVD (Khode et al., 2018; Ang et al.,
2018). The patient can then be palpated for further evaluation if abnormalities are noticed in
thorax or eyes. The skin can also be checked for temperature, lumps, tenderness, bumps and
moisture. Extremities can be checked for edema. Breathing patterns can also help to assess
CVD risk, by studying the movement of the ribs during inhalation and exhalation (Ayerbe et
al., 2016). Abnormal pulsations on the chest wall can be monitored, and arteries checked for
pulses. The pulse can be checked by apical heart rate, radial pulse, or from the carotid,

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brachial, femoral, popliteal, posterior tibialis and dorsalis pedis pulse. The central venous
pressure of the veins can be checked from the neck, arms or legs (Ryan et al., 2017).
Clubbing of the nails is useful indicator of CVD, which can be used for the assessment
(Morton et al., 2017; Forbes & Watt, 2015; Jyotsna & Tharakan, 2017).
Section 2:
Health education is a strategy that can be used to support the implementation and
promotion of programs on disease prevention. Through educational programs, learning
experiences can be parted on topics related to health and well being. To be effective the
health education programs should be tailored to the target population. This can help to
provide information to the target population on specific health topics (such as CVD), the risks
of the disease, strategies for reducing the risks, and also helps to develop tools to build
capacity of the individuals for change their behavior to adopt a healthy lifestyle (Shah et al.,
2015). The health education activities can include lectures, educative courses, seminars,
webnairs, workshops and classes (ruralhealthinfo.org, 2018).
Effective healthcare education should be able to encourage participation of the target
groups; involve community needs assessment to understand the capacity, resources and
priorities and needs of the community; involve planned activities of learning which focuses
on increasing the knowledge and skills of the participants, utilize audiovisual and computer
based learning materials to provide information and develop the skills of the program staff
through training and ensure fidelity to the program structure (ruralhealthinfo.org, 2018; Shah
et al., 2015; Thomas, 2015).
The National Strategy for Heart, Stroke, and Vascular Health In Australia (2004)
proposes that a population based strategy for health education can include the provision of
education for the patients which includes the strategies for managing the condition and

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information on healthy lifestyle (health.gov.au, 2018). Recommendations from the Heart
Foundation of Australia points out that the patients as well as their families or caregivers
should be given healthcare education and counseling which would focus on behavior changes
and self management strategies for CVD, as well as increasing the awareness of the support
system they can access for CVD. The following strategies can be used to provide health
education to the target population:
1. Community Based Education Program: These programs can be conducted in
hospitals, community based organizations, wellness centers and fitness centers.
These programs help in the development of health promotion, disease prevention,
fitness, and health education. These programs can involve all the community
members and activities that can foster a healthy lifestyle among the community
members, help to increase awareness of the disease risks, preventative strategies
and support community based group activities that can help to reduce the risks of
the disease among the population. These activities can include exercise routines,
or any other actions that improves physical exercise (Sallis et al., 2015).
2. Cardiac Rehabilitation program for patients: Cardiac rehabilitation provided at an
individual level by a team of medical professionals, such as doctors, nurses,
pharmacists and also families, caregivers and friends and helps the patient to take
active control towards their lifestyle choices and habits that effect the cardiac
health (Grace et al., 2016).
3. Healthy Lifestyle and Diet program: This can be provided by professional
dieticians and lifestyle experts, who can educate the patients and their caregivers
and families on healthy lifestyle choices such as healthy diet, daily exercises and
relaxation techniques. This also can support lifestyle modification of the patients,

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which can thus help to reduce the risk factors of the CVD (Arena et al., 2015;
Khera et al., 2016; Tawalbeh & Ahmad, 2014).
For a culturally diverse group such as the Aboriginals, it is important that health
education strategies should involve cultural competencies in order to better understand the
cultural needs of the community, and tailor a program that suits their specific conditions and
requirements (Cushman et al., 2015). Healthcare education for Aboriginal communities
should also involve improving cultural competencies among the program staff by focusing on
developing the foundation of knowledge and involving local specific training, which will
help the professionals to gain information on both the disease as well as gain insights into the
cultural background of the population that can help to decrease the risks of the disease
(Bainbridge et al., 2015). Freeman et al. (2014) suggested strategies that can foster cultural
competency and respect towards the aboriginals, which includes: understanding the social
views of the aboriginals towards health, involves health advocacy, understanding the social
determinants that effect their health, including aboriginal health professionals, ensuring a
welcoming atmosphere for the people, improving access to education and information for the
target population, involving health outreaches and home visits for high risk individuals, and
setting up cultural protocols such as gender specific services, cultural advocacy boards,
incorporating cultural events in the program to foster the participation of the community
members in health education programs. Also, certain barriers must also be reduced to
enhance the cultural competencies of the healthcare professionals such as communication
barriers, racism and discrimination, and externally developed programs for the target groups
all of which can adversely affect the success of the health education strategies (Clifford et al.,
2015; Bainbridge et al., 2015).
Conclusion:

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Cardiovascular Disease is a National health Priority Area for Australia, owing to its
rapidly ageing population as well as improvement in healthcare that allows more people to
survive with CVD. The disease has resulted in si8gnificant healthcare expense, and also
increases the risks of morbidity and mortality among the population. It is important therefore
that risks of such disease should be minimized. Primary Healthcare can play an important
role in the improvement of the health outcomes of people at risk of or suffering from CVD.
The improvement can be made on the bases of several strategies such as screening,
assessment and healthcare education. The process of screening for CVD can help to identify
patients with CVD, especially in asymptomatic cases, and thus help to understand the high
risk population. Assessment strategies can be useful to identify the type of disease and the
extent of physiological changes that have occurred due to it. It is also useful to understand the
risks of co morbidities associated with CVD, and thus develop strategies for treatment and
management for the disease and its possible co morbid constitutions. The primary health care
setup can also be an effective setting for delivering healthcare education for individuals as
well as groups. Healthcare professionals can be engaged in healthcare education both at
individual levels (with patient), group levels (with patients, families and care givers) and
community levels. This can help to increase the awareness of the individuals as well as
communities towards CVD, its risks (due to lifestyle and behavior) and strategies to minimize
those risks and management strategies. Information of the support that the individuals and
communities can opt for can also be incorporated in the education programs. However, it is
also important to consider the importance of cultural competencies while engaging in the
education of culturally diverse groups such as Aboriginals.

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APPENDIX I: Framingham Coronary Heart Disease Risk Score

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Framingham: Men score

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Framingham : Women Score

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APPENDIX II- Framingham Coronary Heart Disease Risk Score

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APPENDIX III: Framingham Coronary Heart Disease Risk Score