Philosophical Framework Of Primary Health Care Nursing Essay


The case study presents an eighty-four-year-old man, named Bruce, with osteoarthritis in the hips and deterioration of eyesight and hearing. The man is not able to socialize and ends with staying home due to his painful hips, which cannot be controlled by medication. This learning program, however, will be focusing merely on Bruce’s osteoarthritis, which refers to the degenerative joint disease that causes bone and joint to progressively break down and wear away (Christensen & Kockrow 2011, p. 125). Philosophical framework of primary health care and the principles of wellness will be discussed in relation to the client. Teaching method and learning activities and available resources for the client will also be included in details to make the learning program more complete.

Part 1: Philosophical Framework of Primary Health Care

Primary health care is the first level of care for consumers (Commonwealth of Australia 2013). It also refers to any health care service provided outside the hospitals (Government of Western Australia 2011). Generally, a person with the absence of disease or illness is viewed as healthy. However, health is defined by the World Health Organization as ‘a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity’ (WHO 2003). Such definition is holistic as it recognises multiple determinants of health including physical, psychological, social and cultural factors. The inclusion of social factor as one of the determinants of health is related to Bruce in terms of his social wellbeing, and the learning program will not be able to maximize the client’s health and quality of life if only physical factor is taken into consideration.

With regard to the client, features of primary health care should also be discussed. These features include community control over health service, health promotion and disease prevention, accessible, affordable and acceptable technology, research-based methods and equity of care. Provision of primary health care services requires the involvement of Bruce and community in the control of health problem. Education is another key strategy to help the client gain understanding of health promotion and disease prevention (Rogers & Veale 2000). In addition to recommending resources that the client can access by taking into account his age and current health condition, primary health care should be also based on social, biomedical and health service research. Balance between preventive care, illness treatment and health promotion is also required to provide effective health care for the client (Rogers & Veale 2000). Primary health care services for Bruce should include not only medical and nursing health professionals but also community workers and educators.

Part 2: Principles of Wellness

Incorporation of the principles of wellness into the client’s life is believed to be able to effectively improve his health condition. One of the principles of wellness states that wellness is an active process in which the patient pursues activities to obtain their wellbeing (Faye 2004, p. 400). This principle should be introduced to Bruce in order to encourage him to take action to improve his own health. He should understand that staying at home watching television and listening to radio will not improve his wellness or bring him back to his previous lifestyle when he was able to participate in functions organized in the community.

Wellness is also an integration of body, spirit and mind. The way people think, feel and believe can result in either positive or negative impact on their health (Koutoukidis, Stainton & Hughson 2013, p.79). Bruce’s limited mobility and not being able to get along well with his wife may cause anxiety, depression and a feeling of self-worthlessness. Bruce should, therefore, be informed about the principle of ‘positivity is empowerment’ as positive thinking can result in better health and wellness. It has demonstrated that improvement of depression can reduce painful joints and promote quality of life (The Royal Australian College of General Practitioner 2009, p. 22).

The learning program should be, therefore, designed to support Bruce by taking into consideration all the mentioned aspects in order to produce the best outcome of care.

Part 3a: Incident and Pathology

Better understanding of the incident and pathology of osteoarthritis can help improve the client’s wellness and increase healthcare effectiveness. It allows the client to understand the abnormality of the affected part of his body and prepares him for better management of the disease and risk minimization.

Osteoarthritis is a disease that causes painful joint due to the breakdown of cartilage that covers the end of bones in a joint. The rubbing of bones together without this slippery tissue causes pain, swelling and loss of motion of the joint. More pain and damage also occur when small parts of the bone or cartilage break off and float inside the joint space. The pain is frequently seen in the hand, knee, hip and spine (Department of Health and Human Service 2010). Osteoarthritis is common in older people as it is the consequence of aging. The disease can lead to severe chronic disability (Christensen & Kockrow 2011, p. 125).

The Department of Health and Aging shows that more than 1.6 million Australians had osteoarthritis between 2007 and 2008, and more women than men were diagnosed with the disease (Department of Health and Aging 2010). The figure increased comparing to the previous years, with only 1.2 million in 1995 and 1.4 million in 2001. It is also suggested that osteoarthritis is the main reason leading to joint replacement, accounting for 96% of knee replacement and 88% of hip replacement (NAMSCAG 2004, p. 12).

Part 3b: Learning Program

It is important for the client to acknowledge that osteoarthritis is incurable, but the painful condition can be relieved by adjusting the lifestyle. Since the client is not able to leave the house, primary health care services should be provided within the vicinity of the client’s residence.

In the client’s context, the teaching method that should be used is to have health professionals to provide all available information about causes, symptoms and possible treatment of osteoarthritis in the hips to the client and his wife. Better understanding of the causes of disease, for example, eases the client’s concern and boosts his self-worthiness. The awareness promotion should be conducted in a place that is not exposed to noise and should be explained with clear and loud voice as the client has hearing impairment (Miller 2009, p. 327). If any reading material is to be presented to him, it has to be well printed with large font size as his eyesight is also deteriorating.

Behavioural change plays significant role in reducing the pain. Bruce should avoid climbing stairs, bending, stooping or squatting as these body postures can cause more pain for those with hip osteoarthritis (Christensen & Kockrow 2011, p. 125). It is also highly recommended that the client’s bedroom should be on the ground floor of the house as it can help avoid pain in the hip when moving up and down (Agency for Healthcare Research and Quality 2002). All equipment used in a daily basis should be placed at the location that is easily accessible for him to avoid frequent movement.

The client should be able to perform activities of daily livings with assistance from the devices recommended by occupational therapists such as elevated toilet seats or wall bars for bathtubs (Agency for Healthcare Research and Quality 2002). He should also be encouraged to do slow exercise as it helps reduce stress and pain by strengthening muscles to support the joint in his hip (Arthritis Victoria 2013).

Part 3c: Available Resources

Available resources for Bruce include the following:

Arthritis Information Sheet gives an overview of the cause, symptoms and treatment of osteoarthritis, which helps promote the awareness of Bruce and his wife of the disease. The information sheet can be obtained from

Arthritis Victoria provides a service for arthritis people to inquire about their condition through telephoning. Bruce’s wife can make a phone call to ask about her husband’s joint condition via 03 8531 8000.

A booklet, entitled Osteoarthritis Chronic Care Program, should also introduced to Bruce and his wife as it helps give better understanding of the care for Bruce’s hip osteoarthritis. This booklet can be obtained by downloading from

Taking Control of Your Osteoarthritis is another booklet designed to provide a practical guide to service, treatment and lifestyle choice for people with osteoarthritis. The booklet also includes details of organization dealing with the disease, which Bruce can seek for help. It can be obtained from