NUR134: A Critical Analysis of Primary Health Care in Practice

Introduction

Integrated Primary Health Care (IPHC) is one of the unconventional models of primary health care which is focused on the delivery of “comprehensive, effective, and sustainable health care services.” It focuses on equity, accessibility, and preventive health care measures that should be implemented in collaboration with other line sectors and involving the members of the community (World Health, 2019). In this regard, the Refugee Health Nurse (RHN) faces multifaceted challenges of refugee populations, who are systemically disadvantaged and face inequity in health access (Desmyth et al., 2021). This essay will discuss and compare between PHC and primary care, define the role of the RHN, discuss the practices of using the PHC principles, assess the characteristics of the refugee clients, and explain how the community needs assessment helps in providing a responsive and client-centered care.

Body

According to the WHO (2019), PHC involves five key components that include equity, community involvement, intersectoral coordination, and the social factors that shape health. Primary care on the other hand is the first point of contact within the health system and embraces general practitioners as well as a biomedical illness model of care (Behera & Prasad, 2022). PHC promotes an illness prevention approach that is also preventative, population health oriented, community-centered and addresses the structural determinants of health. This distinction is important for the nursing profession since it moves the focus of the nursing profession not only to the clinical practice level, but to a higher level of a social justice advocacy, education, and facilitation of change (Kirkbride et al., 2024). The Refugee Health Nurse (RHN), working within this broader PHC framework, is a good example of such a shift that considers both disease and illness as well as social determinants of health including trauma, housing and cultural exclusion, that influence the health of refugees.

Refugee Health Nurses (RHNs) are involved in community practice whereby they perform health assessment, health promotion, client advocacy and referral among other things (Gold et al., 2025). They work in a variety of contexts including community health facilities, local government offices and in outreach vehicles, especially for refugee populations. All RHNs reflect the Nursing and Midwifery Board of Australia (NMBA, 2016) Standards, but particularly Standard 2: Person-centred and culturally safe care. To engage the clients and build rapport with them, RHNs must have cultural sensitivity and be knowledgeable about trauma-informed care since some of the clients may have faced persecution, or have been displaced for a long time (Ranjbar et al., 2020). Situated in the PHC context, RHNs do not limit their practice to the medical model but engage in the management of social determinants such as housing, language, and work. This leads to a further elucidation of how RHNs practice the tenets of PHC in real life.

The values that the RHN embodies are the actualization of five fundamental principles of PHC. Equity is achieved by engaging with the refugee population who bear more health risks due to unfair practices, which include, lack of Medicare, low health literacy, and racism (Geller et al., 2023). RHNs fill these gaps since they provide care that is culturally sensitive to the forcibly displaced. This is done through service delivery models like the drop-in clinic, home visits, interpreter services, and culturally appropriate material, which helps to overcome the traditional barriers to access to health care (Anawade et al., 2024).

Refugee involvement is achieved by working with the refugee leaders and the bicultural workers in developing health programs to enhance credibility. This is in line with the concepts of PHC where the individual is encouraged to take an active role in her or his health process. Another important function is the intersectoral collaboration where RHNs work with the settlement agencies, housing providers, legal aid, and schools because the health outcomes are closely related to the social determinants (Najafi et al., 2023). Finally, the integration of technology is done by translating educational materials, using visual aids and implementing mobile health technology to enhance health promotion.

Real-world programs like the Victoria’s Refugee Health Program are good examples of the principles described above, as they demonstrate how RHNs play a crucial role in delivering primary, community-based, client-focused, and health promotion-oriented care for refugees (Hughes et al., 2022). In this way, RHNs play an important role in translating PHC concepts to effective community-based interventions.

The refugees in Australia include those from Afghanistan, Myanmar, Syria, and the Democratic Republic of Congo, and most of them have been displaced, exposed to violence, and vulnerable to human rights abuses (UNHCR, 2023). Such people come with undiagnosed or untreated chronic diseases, mental health disorders, PTSD, other infectious diseases, and poor dental health due to limited access to healthcare in transit or detention (Valenti, 2022). Refugees also experience several social and cultural barriers such as low literacy level, language barriers, financial problems, and discriminated against based on mental health status and their immigration status.

They are compounded by the lack of understanding of the Australian healthcare system and restricted access to services at the time of visa changes (Khatri & Assefa, 2023). From the lens of the social determinants of health, these elements such as unemployment, inadequate housing and low education levels exacerbate health disparities. This situation requires Primary Health Care model which focuses on comprehensive, preventive, and community-oriented rather than disease-oriented model of care. Refugee Health Nurses are therefore crucial in assessing for these multiple needs and provide care that is sensitive to both the medical and social determinants of ill health.

Community Needs Assessment (CNA) is a structured and community involved process of identifying health problems and priorities, developing context appropriate interventions in primary health care (Ravaghi et al., 2023). As for Refugee Health Nurses (RHNs), CNA is core to providing care to populations with needs that are defined by forced migration, trauma, and cultural difference. RHNs use both numerical data (such as settlement statistics, rate of diseases) and non-numerical data (for example, focus group discussions, interviews with leaders of the community).

Through identification of areas of health inequities and the trends, RHNs can target some conditions such as mental health or maternal health among ethnic groups. This is in line with the social determinants of health, which acknowledge that health care is not enough to address the needs of the refugee population. Most importantly, it entails the engagement of the communities in the identification of priorities and development of services hence increasing its chances of success (Rong et al., 2023).

Cultural safety, client’s consent and no retraumatisation of the RHNs: These are the ethical considerations that need to be put into consideration in the assessment of the RHNs. In addition, with the help of bicultural workers and interpreters, CNA processes become more diverse and responsive. For instance, the Refugee Health and Wellbeing Action Plan (Fennig & Denov, 2020) shows how CNA enhances the delivery of services and health outcomes in strategic planning. Most importantly, CNA takes healthcare from being an illness-oriented system to a wellness-oriented system, which is crucial in addressing equity in healthcare for refugees and aligning with the PHC’s prevention-focused approach.

Conclusion

Primary Health Care (PHC) is a key point of contact in the struggle against health inequalities because of its focus on prevention, community orientation, and social justice. The Refugee Health Nurse (RHN) role shows how PHC is realized in practice, as it provides culturally appropriate comprehensive care that addresses the specific needs of refugees. By conducting CNA, RHNs ensure that the services provided are relevant, informed by research, and initiated by the community. As Australia remains to accept refugees and asylum seekers, it is crucial to expand the roles of PHC nurses especially to the vulnerable groups to address existing social determinants of health and disparities among the minority groups.

Assessment Requirements Summary

The assessment required students to write a detailed essay on Primary Health Care (PHC) and the role of Refugee Health Nurses (RHNs) in addressing the health needs of refugee populations. Key points to be covered included:

1. Comparison between Primary Health Care (PHC) and Primary Care – highlighting differences in approach, focus, and scope.

2. Definition and Role of the Refugee Health Nurse (RHN) – exploring how RHNs function in community-based care and their responsibilities in refugee health.

3. Application of PHC Principles in Practice – demonstrating how PHC principles such as equity, community involvement, intersectoral collaboration, and health promotion are operationalized by RHNs.

4. Assessment of Refugee Clients – analyzing the social, cultural, and medical characteristics of refugee populations and how these impact healthcare delivery.

5. Community Needs Assessment (CNA) – explaining how CNA helps RHNs provide responsive, client-centered, and culturally appropriate care.

6. Ethical and Professional Considerations – such as cultural safety, informed consent, and trauma-informed care.

The essay required referencing current research and best practices, using APA 7th edition, and demonstrating critical thinking in connecting theory to practice.

Assessment Approach by Academic Mentor

The Academic Mentor guided the student through the assessment in a step-by-step process:

Step 1: Understanding the Task

• The mentor first explained the distinction between PHC and primary care and why it is relevant to refugee populations.

• Students were encouraged to identify the scope of the essay, noting the need to discuss both theoretical and practical aspects of PHC and RHN roles.

Step 2: Research and Source Collection

• The mentor directed the student to use reliable sources including WHO reports, peer-reviewed journals, and Australian healthcare guidelines.

• Guidance was given on selecting sources that addressed refugee health, social determinants, and community-based nursing practice.

Step 3: Structuring the Essay

• Introduction: Framed the context of PHC and refugee health, highlighting equity and access issues.

• Body Sections: The essay was divided into clear sections:

  • Comparison between PHC and primary care

  • Role of RHN in the community

  • PHC principles in practice

  • Characteristics of refugee populations

  • Community Needs Assessment

• Conclusion: Summarized key insights, highlighting the importance of PHC and RHNs in promoting equitable health outcomes.

Step 4: Critical Analysis and Linking Theory to Practice

• The mentor emphasized connecting theory to real-world practice, showing how RHNs operationalize PHC principles.

• Students were encouraged to provide examples from programs such as Victoria’s Refugee Health Program to strengthen the application of theory.

Step 5: Ethical and Professional Considerations

• Guidance was given on discussing cultural safety, consent, and trauma-informed care, reinforcing ethical nursing practice.

• Students were prompted to discuss the importance of engaging bicultural workers and interpreters in CNA.

Step 6: Editing and Referencing

• The mentor reviewed drafts for clarity, flow, and APA 7th edition compliance.

• Emphasis was placed on avoiding plagiarism by paraphrasing, proper citations, and using original critical analysis.

Outcome Achieved

The final essay demonstrated:

• A clear understanding of PHC versus primary care and the importance of social determinants of health.

• An in-depth description of RHN roles, showing how community-based nursing improves refugee health outcomes.

• Application of PHC principles in real-world programs.

• Evidence-based insights into the health and social needs of refugees in Australia.

• Effective use of CNA methodology to guide responsive and culturally appropriate care.

• Ethical awareness and professional standards relevant to nursing practice.

Learning Objectives Covered

1. Knowledge and Application of PHC Principles: Understanding equity, community involvement, intersectoral collaboration, and preventive care.

2. Critical Thinking and Analysis: Comparing PHC with primary care and linking theory to practice.

3. Research and Evidence-Based Practice: Selecting and synthesizing relevant literature on refugee health.

4. Cultural Competence and Ethical Practice: Applying cultural safety, consent, and trauma-informed care principles.

5. Community Engagement: Using CNA to develop client-centered interventions.

Summary:

Through structured guidance, the student developed an essay that combined theoretical understanding with practical applications. The Academic Mentor ensured a stepwise approach, focusing on research, analysis, application, and ethical considerations. The final essay not only met the assessment requirements but also demonstrated a comprehensive understanding and professional insight into the role of PHC and RHNs in refugee health.

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