1. Chinn, Peggy L. RN, PhD, FAAN

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Despite the fact that I am an avid explorer of words and word meanings, I have grown quite impatient with semantic battles over the meanings of "primary care" and "primary health care." The battles rage in academic meetings and classrooms, with little or no connection to how nurses outside these rooms perceive the world of health care to be, much less any connection with how practitioners in other disciplines use or respond to the words. All of the authoritative and worldwide definitions aside, it seems to me that the rest of the world is moving along in either a guided or misguided manner trying to respond to various pressures for health care reform. There seems to be no question about the need to move toward models of care that include such features as illness prevention, continuity of care, and health promotion-all notions consistent with the most adamant advocate for primary health care but still promoted in the current climate as "primary care." The real debates and dilemmas seem to be over how much of what can the public afford and how far-reaching the needed changes can be.


This issue of Advances in Nursing Science (17:4), originally devoted to "Innovations in Primary Care," was planned over two years ago when it was clear that the health care system was headed for major change. Despite the timeliness of the topic, it drew amazingly few manuscripts. When I commented on this fact among colleagues around the world, on at least three occasions someone noted that those who are "doing" primary care in nursing are not well positioned to write about what they are doing-yet. And our conversations then turned to wondering what those who might write are doing or thinking about primary care. Perhaps my choice of the term "primary care" rather than "primary health care" gave pause to academic nurses who would prefer to write under a topic focused on primary health care.


I chose the term "primary care" primarily because of its common use in the arena of health care reform and the consistent references under this label to activities that I associate with primary health care. Now, in reflecting back on that choice, I think it is one that bears serious consideration. Words can be carefully chosen for any number of reasons, and in this instance I opt toward terminology that will bring us as nurses toward the center of the action and the discussion. To do so will require abandoning the semantic battle. The term "primary care" can acquire the meanings that nurses intend as nurses move forward to put into practice that which is embedded in the fullest meaning of the idea of "primary health care." The more nurses move outside the walls of the academic rooms of debate and begin to participate in meaningful primary care action, the more nurses will have to say about the value and worth of nursing's fundamental visions for health care in the future.


The articles in this issue of ANS, now presented as the topic "Primary Care and Knowledge Development," include several articles that illustrate shifts that can occur in how primary care is done and how it is conceived or conceptualized. This issue also contains articles that were originally developed for the previous issue focused on knowledge development. It is clear that there is much to be accomplished in acquiring a body of knowledge about primary care and other dimensions of health care for the future. It is my hope that in the near future we will see a more complete merging of these two important aspects of nursing knowledge development and practice.


Peggy L. Chinn, RN, PhD, FAAN