Health promotion Resources

Moisture-associated skin damage (MASD) is an umbrella term to describe the trauma that occurs when there is prolonged exposure to moisture. Incontinence-associated dermatitis (IAD) is an MASD condition caused by urinary and/or faecal incontinence. It often causes significant pain and has a negative impact on an individual’s quality of life. Prompt diagnosis of IAD is key to successful management, but the early symptoms of erythema and redness may not be obvious in those with a dark skin tone. Delays in assessment and treatment mean that maceration, infection and the development of pressure ulcers become more of a risk. This is compounded by the lack of education and awareness of the significance of skin tone in relation to wound care. This article is based on published research, together with the practical experience of healthcare professionals at the Complex Wound Clinic (CWC) in North West London. The aim is to highlight the importance of considering skin tone when managing IAD. This can be achieved by using a validated skin tone assessment tool which shows a range of six skin tones. The importance of skin tone is a critical subject as the latest 2021 Census data shows that in England and Wales, 18% belong to a black, Asian, mixed or other ethnic group (Gov.UK, 2021 Census data).

This article looks at amenorrhoea and oligomenorrhoea, both of which can be a cause of concern for those women affected. Such issues can be difficult for clinicians to diagnose and treat, because of variations in bleeding patterns, complicated history in some patients, and associated problems. Signs and symptoms, causes, diagnosis, treatment, and complications are covered here, in the hope that general practice nurses (GPNs) and non-medical prescribers will feel more confident in recognising concerns and can then get earlier investigations and treatment, thus reducing the risk of complications and improving quality of life for women affected.

As a novice or an expert (Benner, 1985), abdominal presentations can be intriguing and puzzling. It is vital to take a good patient history and conduct a systematic physical assessment, and to think about immediate management (this might be simple pain management or helping with moving bowels) and to consider the longer term — changes to the signs and symptoms, not resolving despite treatment or good management, weight loss or bleeding. Always heed the patient’s intuition — and yours. Monitoring the abdominal problem, the patient keeping a diary if symptoms are sporadic, and giving worsening care advice are as much a part of treatment as medications and investigations. Low thresholds for review include the above but should also be considered in vulnerable populations such as the very young and very old who can deteriorate quickly, and those with pre-existing and long-term conditions, e.g. malignancy and being immunocompromised.This article should be used as an adjunct to an accredited theoretical course with a completed and successful competency assessment.

Prescribing by a variety of professionals continues its progression in response to the growing demands for health care. Prescribing by nurses was initiated in the 1990s and supported by the National Prescribing Centre’s ‘prescribing pyramid’ or seven steps or principles for good prescribing (NPC, 1999). This article explores a new prescribing consultation model (RAPID-CASE), which is composed of elements from the prescribing pyramid and the Competency Framework for all prescribers (Royal Pharmaceutical Society [RPS], 2021). The RAPID-CASE consultation model is applied to a clinical scenario to illustrate how it can guide a systematic approach to decision-making, using the example of a lower limb skin tear injury.

Wound management can be challenging, with both clinicians and patients wanting to follow care pathways and treatment regimens that promote wound healing. The National Wound Care Strategy Programme (NWCSP) for lower limbs endorses the use of compression garments, such as leg ulcer hosiery kits and compression wraps, to utilise NHS resources in the most effective way, and encourages patient participation where possible (NWCSP, 2020). This article looks at the pro-active work of a general practice nurse (GPN) team in Bristol, who shared their wound care expertise with local colleagues by showcasing good practice and pathways together in a new style leg clinic.

Diabetes care in general practice is facing increased pressure to improve access for and engagement from patients to reduce long-term problems associated with poor diabetes control. Digital diabetes methods aim to bridge the gap between patient engagement and poor service delivery by improving flexibility for patients to access suitable care. Digital methods include both video and SMS services to allow patients to undertake consultations or reviews in a variety of settings. This article provides general practice nurses (GPNs) with the foundations of how digital diabetes care can be established in practice in relation to initiating and managing both oral and injectable therapy. Indeed, digital health care is the way forward for managing issues of limited staff and lack of appointments, while improving patient engagement across the board.

Understanding commonly used drugs and their interactions is vital for the safety of patients and the efficacy of these medicines. Non-prescribers and prescribers alike need to be aware when to query and/or stop medications if the patient is unwell and why this needs to be done. Although stopping and restarting a medication may seem daunting and possibly confusing for patients and clinicians alike, there must be awareness around the medications that can cause problems in the very sick patient. There are many resources available for general practice nurses (GPNs) to check. This article gives a brief summary of some of the most common pitfalls and how to avoid these with useful resources at the end.

The influenza immunisation programme in the UK started in the 1960s and has since been extended to offer protection to those groups most vulnerable to the infection. The extension of the programme to children aims to directly protect them and reduce transmission of the virus to those around them. General practice nurses (GPNs) are among those most trusted in informing and reassuring parents about the benefits of immunisation. This article will primarily describe arrangements for the flu immunisation programme 2021–22 in England. The programme is, of course, delivered in Scotland, Northern Ireland and Wales and there may be subtle differences in programme delivery in the devolved nations. Nurses working in countries other than England should ensure that they are following relevant guidance specific to the area in which they practice (Scottish Government, 2021; Public Health Agency Northern Ireland, 2021, and Welsh Government, 2021).

The National Review of Asthma Deaths (NRAD) (Royal College of Physicians [RCP], 2014) identified many shortcomings in the way that asthma care is delivered, citing preventable factors in 90% of asthma deaths. Among deaths in children, poor recognition of risk of adverse outcome was found to be an important avoidable factor in 70% of deaths in primary care, rising to 83% in young people (RCP, 2014). The challenges of the pandemic over the past 18 months have arguably compounded the difficulties in providing good asthma care, with asthma reviews necessarily being managed in different ways, largely undertaken remotely. To further prevent avoidable deaths, it is important that primary care nurses are confident and competent in undertaking remote asthma reviews so that risks of adverse outcome are identified and effectively managed. As highlighted by the NRAD, parents/carers and children should be taught ‘how’, ‘why’ and ‘when’ to use their asthma medication, be able to recognise when asthma is not controlled, and know when to seek emergency help. This article gives a structured approach to undertaking a remote asthma review with children so that good asthma control and better outcomes can be achieved.

With the last year bringing issues of its own, and children and young people returning to school, the post-attack review is as important as ever. As we start to see a ‘new normal’, it seems even more important to embrace brilliant basics as the foundation to excellent asthma care for adults and children alike. This article explores the post-exacerbation review, with reference to a small-scale survey carried out pre-Covid, to put into context some common conceptions (and misconceptions) around the 48-hour review. It discusses how and why we carry out the review, as well as signposting to helpful resources and recommendations for practice.