The health and well-being of families is an important consideration for federal, state, and/or local levels of government. Family health policies based on recent knowledge of early childhood development have evolved to emphasise the importance of providing every child with the best possible start to life. Childhood sets the foundation for future health and well-being and is recognised by the 1979 United Nations Convention on the Rights of the Child. To impact health inequalities, government policies and services must address the social determinants of early child health, development and well-being.

This chapter explores the relationship between primary health care (PHC), health literacy and health education with empowering individuals, groups and communities to improve and maintain optimum health. PHC philosophy encompasses principles of accessibility, affordability, sustainability, social justice and equity, self-determination, community participation and intersectoral collaboration, which drive health care service delivery and health care reform. Empowerment is a fundamental component of social justice, which seeks to redistribute power so those who are disadvantaged can have more control of the factors that influence their lives. Lack of empowerment is linked to poorer health outcomes due to limited control or agency, associated with poorer social determinants of health. This influences personal resources, agency and participation, as well as limited capacity to access services and opportunities. Health care professionals and systems need to work in ways to promote the empowerment of individuals, groups and communities to achieve better health outcomes.

Good nursing practice is based on evidence, and undertaking a community health needs assessment is a means of providing evidence to guide community nursing practice. A community health needs assessment is a process that examines the health status and social needs of a particular population. It may be conducted at a whole-of-community level, a sub-community level or even a subsystem 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 the client.

Chronic conditions, or non-communicable diseases, are the leading cause of death worldwide. Chronic conditions are responsible for 41 million deaths and 17 million premature deaths across the world each year. Most of these deaths are due to four major conditions: cardiovascular disease, cancer, chronic respiratory disease and diabetes. 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 need to manage these are major healthcare concerns of the industrialised world.

Primary health care (PHC) is a philosophy or approach to health care where health is acknowledged as a fundamental right, as well as an individual and collective responsibility. A PHC approach to health and health care engages multisectoral policy and action which aims to address the broader determinants of health; the empowerment of individuals, families and communities in health decision making; and meeting people’s essential health needs throughout their life course. A key goal of PHC is universal health coverage, which means that all people have access to the full range of quality health services that they need, when and where they need them, without financial hardship.

In the ‘classic’ sense, health professionals often view the health of individuals from a three-part biopsychosocial model of health. In this case, the ‘psych’ part relates directly to ‘mental health’. However, it is important to resist the temptation to separate this part from the bio and social aspects of the well-established model. Instead, it is best to view all parts of the established model as equally important and inter-related to each other. For instance, it is difficult to maintain good mental health and well-being if we lack either good social or ‘bio’ (physical) health. Traditionally, however, health professionals have tended to focus on the physical health component of the biopsychosocial model, especially those working in acute hospital/clinic environments. From a primary health care perspective, the ‘social’ (community development-focused) aspect is supposed to be the most dominant part of the model.

Sexual health nurses are employed to work in a range of practice settings and work with diverse population groups. Sexual and reproductive health care is considered a human right and is fundamental to positive well-being. The nurses role in sexual and reproductive health varies between settings within and across different jurisdictons. 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. In some juristictions, nurses also provide care in publicly funded sexual health clinics aimed at providing services to specific priority population groups to increase their access to services and reduce the prevalence of adverse sexual and reproductive health outcomes including sexually transmitted infections and unplanned pregnancy.

Home-based care is common practice in many countries and has had a long tradition in Australia and Aotearoa New Zealand. Home-based care now takes many forms, including the acute care program Hospital in the Home, a range of chronic disease programs and community aged care. Home-based care provides many benefits to consumers, reducing their need to travel to services and associated costs. It also allows the health care provider to have a holistic picture of the consumers and for the consumers to feel empowered to manage their health care issues in their own homes, while continuing with normal daily activities in a setting that they are comfortable in.

Approximately one in every six people have some form of disability and about one-third of these people have a severe or profound limitation to their daily activities and function. As a subgroup, they are some of the most marginalised and disadvantaged, often experiencing disparate chronic and complex health problems when compared to the general population. In addition, they sometimes encounter disabling challenges accessing the health system and have experienced poor quality care from health professionals whose capacity to understand their needs, and how to best respond to them, is limited. This chapter seeks to inform health care professionals about the intersection of health and disability so that they can better work with people with a disability no matter the health context.

The terms ‘health promotion’ and ‘health education’ are often used interchangeably. Often this is a problem as they are distinct and different concepts. Whitehead attempted to overcome this problem by separating and defining the terms. When it comes to primary health care program planning and evaluation, the terms health promotion and health education are also often used interchangeably but this is less of a problem in this specific case than already stated. Health promotion approaches, often by default, include health education interventions. Reflecting this, many ‘health’ planning and evaluation tools and models incorporate health promotion and health education processes.

The school nurse is a nurse who works in a range of education settings, across all age groups. While Australia does not have a formal national school health service, nurses have worked in schools for over a century. Today, they are employed in various independent schools, colleges and fragmented programs within government schools. There has been interest in recent years in growing the presence of nurses in Australian schools to facilitate access to health care for students from disadvantaged backgrounds.

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. The third and fourth revolutions have had a large impact on health care, shaping how health and social care are 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 the development of health informatics as a discipline and how health care innovation, technology, governance and the workforce are supporting digital health transformation.

Despite current and predicted ongoing primary health care (PHC) nursing workforce shortages, the undergraduate nursing curricula in Australasia and internationally remain largely directed towards acute care. 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. Registered nurses are integral members of the multidisciplinary PHC team and fulfil various roles. These roles include managing acute presentations, coordinating care for people with complex chronic conditions, providing preventive care, promoting the health of individuals and communities, and supporting end-of-life care.

The role of occupational health nurses is to improve mental and physical health outcomes and the well-being of workers. These benefits can often extend to family and community. Workers’ health is impacted by several factors including fatigue, gender, culture, age, language, living conditions, access to nutritious food, level of physical activity, sleep patterns, personal health practices and coping strategies, levels of social support and inclusion, personal safety and freedom from violence.

Nurses work in a wide variety of settings, and this includes a wide variety of communities. In Australia and Aotearoa New Zealand, many of these communities are rural and require nurses to have a broad general range of skills to meet the diversity of needs that their clients present with. 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. An increased scope of practice and greater reliance on collaboration, interdisciplinary and transdisciplinary practice is common.

Nurse practitioners (NPs) are a valued addition to the primary health care (PHC) team and are well-placed to increase accessibility to quality health care services while offering consumer choice. NPs have undertaken advanced education and clinical training. In addition, they have demonstrated their competency, capacity and capability to provide high-quality, effective and efficient clinically focused health care delivery. Although many NPs practice in rural or underserviced communities, NPs practice across a diverse range of health care settings, delivering either specialist or generalist health services. Recognised as advanced practice nurses internationally and nationally, the NP role has emerged as a response to meet the challenges of rising health care demand and is proving effective in promoting transformational changes within the PHC sector.

A general practice nurse is a registered or enrolled nurse employed in a primary care (general practice) setting. Approximately 82 000 nurses are working outside of hospital settings in Australia and two-thirds (68 per cent) of these work in general practice. It is estimated that over 90 per cent of general practices employ nurses. Aotearoa New Zealand workforce data reveals that in 2018–19, 5.5 per cent of the total nursing workforce worked in general practice, accounting for some 3018 nurses. This places general practice as one of the ten largest practice areas within the Aotearoa New Zealand nursing workforce.

Community and primary health care nursing is experiencing a rapid metamorphosis as our population ages and the prevalence of chronic and complex conditions increases. To meet these changing needs, our health workforce has evolved with a range of specialised disciplines now working in diverse health settings. Throughout these changes, nursing continues to be the largest global health workforce providing the most direct client care. Historically, nurses were the original transdisciplinary health care workers, providing basic physiotherapy, occupational therapy, nutritional advice and all other care as required. As more detailed knowledge developed in an area of practice, specialised areas of care evolved, and a variety of allied health professions emerged. In turn, nursing itself became more specialised, due to developments in clinical practice, technological advances and the need for more complex care.

This chapter focuses on the theory, skills and professional role of a drug and alcohol nurse in community settings. It describes substance use and drug-related harms and provides a brief overview of the guiding principles and professional practice drug and alcohol nurses follow when providing care for people who use alcohol and other drugs (AOD). The chapter also describes the considerations for co-occurring needs and integrated care. Reflective activities throughout the chapter will guide the reader to consider how they can support people living with AOD in their nursing practice.