This chapter discusses the impact of chronic conditions on idividuals, their families and the broader community. The World Health Organization (WHO, 2018) has reported that chronic conditions, or non-communicable diseases, are the leading cause of deaths worldwide. In 2016, chronic conditions were responsible for 41 million of the 57 million deaths occurring globally (WHO, 2018). The majority of these deaths are due to four major chronic diseases: cardiovascular disease (CVD), chronic respiratory disease, diabetes and cancer (WHO, 2018). However, other chronic conditions, including injuries that result in persistent disability and mental health disorders, also contribute to increased morbidity and mortality. The significant increase in preventable chronic conditions and the management of these are major health care concerns of the industrialised world.

Substance use has always been a feature of societies with the use of alcohol and plants with psychoactive properties for medicinal, recreational, religious, cultural and ceremonial purposes. While the use of substances is common, and some substances such as those used as medicines can be helpful, the misuse of medicines, alcohol and other drugs can cause physical, psychological, social, family and community harm. Working in the area of substance use and the treatment of substance use disorders can be confronting. For health practitioners, there are often competing moral and ethical dilemmas. An understanding of the impact of substance use and awareness of one’s own attitudes towards substance use is important if nurses are to be effective in assessing the impact of substance use and ensuring that individuals and families have access to appropriate and timely care. This chapter focuses on this specialised area of drug and alcohol nursing practice including supporting people using alcohol, tobacco and other drugs.

This chapter introduces Indigenous approaches to health care that have relevance for the Australian and Āotearoa New Zealand contexts. Several of the principles for practice are readily transferrable to other culturally and linguistically diverse populations. The challenges are undeniably major but the rewards are potentially transformative. Nursing training and education is most often located within mainstream, non-Indigenous settings. Health professionals who want to make a positive difference to the health outcomes of Indigenous clients should be equipped with knowledges and understandings that will facilitate effective engagement. Further, this chapter examines the historical influences that impacted on the health and well-being of Indigenous peoples in both Āotearoa New Zealand and Australia, and considers the need for adopting Indigenous approaches to health care practice and engagement such as cultural safety, cultural responsiveness and other cultural frameworks. Finally, it examines the role of the community nurse in Indigenous primary health care

Workers have a right to feel safe in their workplaces and employers have a responsibility to ensure that workers have a safe work environment. Employers also have the opportunity to protect the health of their employees which can help improve their overall health and well-being. An effective occupational health and safety (OHS) program reduces injuries and illnesses, work absenteeism and staff turnover and improves staff morale, operational efficiency, productivity, and work cover insurance premiums. The strength of an organisation as a preferred place to be employed often relates to its attention to OHS. Occupational health nurses (OHNs) play an important role in ensuring safety and promoting healthy workplaces. This chapter begins with a discussion of OHS. The roles and major responsibilities of the OHN, which vary depending on the size and nature of the organisation, are also explored. This chapter explains the importance and key components of OHS, identifies how OHNs support safe work policies and strategies, and describes how OHNs contribute to health-promoting workplaces.

Nurses are the best distributed and largest professional group in the rural health workforce in Australia (Bragg & Bonner, 2015; Gardner & Duffield, 2013). In New Zealand, the rural nurse specialist has developed in response to the declining numbers of GPs who practice in rural areas (Adams, Carryer & Wilkinson, 2017; Bell, 2015). Usually, rural health nurses have well-defined catchment areas or communities in which they practise. Community nurses practising in rural areas are necessarily generalists as they need to provide care for clients who have a broad range of health issues and contexts (Barrett et al., 2016; Knight, Kenny & Endacott, 2016). An increased scope of practice and greater reliance on collaboration, interdisciplinary and transdisciplinary practice is common. Rural health nurses may be sole practitioners, providing health care on their own, or as part of a small team that sometimes may include doctors. This chapter describes the purpose and key functions of this community nursing role, identifies the main focus of the role in terms of primary care and primary health care, and explains how the role does or does not address issues of social justice, equity and access.

Some people living with long-term intellectual, physical or mental disability, whether present at birth or acquired later in life, are among the most disadvantaged and marginalised groups in our community. They experience poorer health status and significantly higher morbidity and mortality rates than the general population, and often encounter a health system that fails to meet their needs (Australian Institute of Health and Welfare, 2016; World Health Organization, 2018). This chapter focuses on informing health care professionals and better equipping them to understand and respond to the needs of people living with disability so that they might attain the highest possible outcomes in health and well-being throughout their lives.

Cultural competence and cultural safety support health professionals to recognise each individual as unique in order to promote optimal health outcomes (Hoare, 2019). This allows for the acknowledgement of diversity that exists within and between individuals and groups in health care (Australian Human Rights Commission, 2018; Nursing Council of New Zealand, 2011). In practice, this represents the broader understanding of culture in health care, and encompasses the dynamic influences of culture on attitudes, values and beliefs (Cox & Taua, 2017; Stein-Parbury, 2018). Health professionals have a responsibility to provide culturally competent and safe care based upon mutual respect for all people. A key consideration when working with individuals is to seek an authentic understanding of their cultural context. This may include family, significant others or a notable absence of kinship (Ramsden, 2002; Wepa, 2015). In this chapter, the discussion focuses on understanding culture, cultural diversity and the need for health professionals to integrate cultural competence into everyday care to support culturally safe practice.

Sexual health nurses are employed to work in a range of practice settings and with diverse population groups. Sexual and reproductive health care is considered a human right and social justice issue (Simmonds et al., 2017; World Health Organization, 2011). Work settings include dedicated sexual health clinics, family planning services, community health centres, women’s health services, correctional services, general practices and tertiary education settings. The scope of practice varies between settings within and across states and territories. Some practice settings may be gender-specific but in general, sexual health nurses work with people of any gender and diverse sexualities. As there is a lack of consistency in role expectation, this chapter explores a range of activities that may be undertaken by sexual health nurses.

Substance use has always been a feature of societies with the use of alcohol and plants with psychoactive properties for medicinal, recreational, religious, cultural and ceremonial purposes. While the use of substances is common, and some substances such as those used as medicines can be helpful, the misuse of medicines, alcohol and other drugs can cause physical, psychological, social, family and community harm. Working in the area of substance use and the treatment of substance use disorders can be confronting. For health practitioners, there are often competing moral and ethical dilemmas. An understanding of the impact of substance use and awareness of one’s own attitudes towards substance use is important if nurses are to be effective in assessing the impact of substance use and ensuring that individuals and families have access to appropriate and timely care. This chapter focuses on this specialised area of drug and alcohol nursing practice including supporting people using alcohol, tobacco and other drugs.

The health and well-being of families is an important consideration for all governments – federal, state and local. Based on past morbidity and mortality rates and recent knowledge of early childhood development (Marmot, 2010), family health policies have evolved to emphasise the importance of providing every child with the best possible start to life. This acknowledges that childhood sets the foundation for future health and well-being and recognises the 1979 United Nations’ Convention on the Rights of the Child (United Nations Children Fund, 2009). In order to have an impact on health inequalities, government policies and services must address the social determinants of early child health, development and well-being (Brinkman et al., 2012; Marmot, 2010). This chapter introduces maternal, child and family health nursing and outlines the key functions of this crucial community nursing role. Foundational principles of primary health care practice are explored and case studies used to explain strengths-based, family-centred care.

The third industrial revolution saw the creation of computers and an increased use of technology in industry and households. We are now in the fourth industrial revolution: cyber, with advances in artificial intelligence, automation and the Internet of things. Both the third and fourth revolutions have had a large impact on health care, shaping how health is planned, managed and delivered, as well as supporting wellness and the promotion of health. This growth has seen the advent of the discipline of health informatics with several sub-specialty areas emerging over the past two decades. Informatics is used across primary care, allied health, community care and dentistry, with technology supporting the primary health care continuum. This chapter explores health informatics by examining the building blocks of the discipline and analysing how technology, governance and the workforce are supporting digital health transformation.

Nurse practitioners (NPs) are well placed to provide an alternate source of primary health care offering increased accessibility and consumer choice, particularly for those in rural and subregional communities (Kelly et al., 2017). They have the capacity and capability to provide high-quality, effective and efficient clinically focused health care delivery in a variety of contexts (Nursing and Midwifery Board of Australia, 2018). Recognised as advanced practice nurses internationally and nationally, the NP role has emerged as a potential response to meet the challenges of rising health care demand and is proving effective in promoting transformational changes within the primary health care sector (Contandriopoulos et al., 2016; Grant et al., 2017; Gray, 2016). The concluding chapter of this text discusses the key attributes that contribute to the uniqueness of the NP's role, discusses the scope of practice and key functions of the primary care NP, and provides an understanding of career progression for nurses considering the NP role within the Australian context.

Good nursing practice is based on evidence and undertaking a community health needs assessment is a means to providing the evidence to guide community nursing practice. A community health needs assessment is simply a process that examines the health status and social needs of a population. It may be conducted at a whole-of-community level, a sub-community level or even a sub-system level. Nursing practice frequently involves gathering data and assessing individuals or families to determine appropriate nursing interventions. This concept is transferable to an identified community, when the community itself is viewed as being the client. This chapter focuses on exploring the principles and processes involved in undertaking a community health needs assessment.

The third industrial revolution saw the creation of computers and an increased use of technology in industry and households. We are now in the fourth industrial revolution: cyber, with advances in artificial intelligence, automation and the Internet of things. Both the third and fourth revolutions have had a large impact on health care, shaping how health is planned, managed and delivered, as well as supporting wellness and the promotion of health. This growth has seen the advent of the discipline of health informatics with several sub-specialty areas emerging over the past two decades. Informatics is used across primary care, allied health, community care and dentistry, with technology supporting the primary health care continuum. This chapter explores health informatics by examining the building blocks of the discipline and analysing how technology, governance and the workforce are supporting digital health transformation.

Despite current and predicted ongoing primary health care (PHC) nursing workforce shortages (Heywood & Laurence, 2018), the undergraduate nursing curricula in Australia and internationally remain largely directed towards acute care (Calma, Halcomb & Stephens, 2019; Mackey et al., 2018). Additionally, the efforts of schools of nursing in supporting the career development of new graduate nurses and their transition to practice also remain largely focused on employment in acute care tertiary settings. This chapter highlights the extent to which current undergraduate nursing curricula prepare registered nurses to work in PHC, reviews the attitudes of nurses regarding PHC employment and discusses the current challenges regarding nurse transitions between acute and PHC practice environments. Understanding the preparation nurses have for a PHC career, nurse attitudes towards and knowledge of PHC, andchallenges associated with transitions between practice environments are important to promote recruitment and retention of the PHC nursing workforce.