Health promotion Resources

The environmental impact of healthcare delivery in general, and respiratory-related healthcare specifically, has gained increasing attention in recent years. Reducing national carbon emissions and improving sustainability has become a high priority both at governmental level and for the NHS across the UK. General practice nurses (GPNs) have a critical role to play in addressing the environmental impact of respiratory healthcare. While the priority must always be to do the right thing clinically for individual patients, there are a range of strategies which can be introduced to day-to-day practice to reduce the carbon footprint of respiratory healthcare. This article reviews a range of strategies from protecting and improving the indoor air quality of healthcare facilities and ensuring patients understand and use their prescribed medications effectively, to undertaking a quality improvement initiative to address environmental issues. Integrating sustainable healthcare principles in every aspect of clinical practice can drive the delivery of greener respiratory healthcare that will benefit us all without detriment to delivering high quality care.

Keeping clear and accurate patient records is key to safe and effective practice (Nursing and Midwifery Council [NMC], 2018). In wound management, systematic and timely wound assessment can lead to correct diagnosis, the implementation of clinically effective treatments and subsequent improvement in patient and wound-related outcomes (Atkin and Critchley, 2017). Updating records at every subsequent reassessment can ensure continuity of care between healthcare professionals. This article examines the importance, requirements and barriers to documentation in wound care, how ongoing comprehensive holistic assessment contributes to keeping records up to date and relevant, and looks at the increased use of digital photography in a virtual setting.

None of the 13 million of us in the UK who watched the final of ‘Strictly Come Dancing’ 2020 will need convincing of the joy of dance and dancing with others — nor of the endurance, strength, flexibility and balance required. But, have you ever considered how dance can be used therapeutically? This article presents evidence and practice about the use of dance in chronic disease management, in particular, its role in alleviating breathlessness. One of the main causes of breathlessness is chronic obstructive pulmonary disease (COPD). Pulmonary rehabilitation (PR) is an effective treatment for COPD, including tailored exercise and education, but it is not available or suitable for everyone. There is potential for dance to be offered as a therapeutic intervention for people with COPD and other chronic respiratory diseases in several ways: by incorporation into existing programmes to increase the variety of exercise, post-PR as maintenance therapy, as an alternative for those who choose not to attend PR, and for those who are not offered PR.

In a busy general practice setting, some women’s health issues are perceived by the patients to have been dismissed with a prescription for Prozac, or just played down and the woman told that there is nothing wrong. Wanting women’s health issues to be addressed fully and respectfully is why the Royal College of Obstetrics and Gynaecology developed its publication and campaign, ‘Better for Women’, with the aim of steering the UK away from providing a disease intervention service towards a preventative health service, which addresses the determinants of health throughout the woman’s life course. Without doubt, some women’s health issues can be helped with medication; but this should not be the first approach. Further, medication is more likely to work well if women’s health and lifestyle issues are also addressed. Top diet and lifestyle issues include excess weight, lack of physical activity, and stress; and many of these are intertwined. Addressing these issues when dealing with the three top women’s health conditions: menopause, polycystic ovary syndrome (PCOS) and premenstrual syndrome (PMS), is essential — to move straight into the medication option and ignoring lifestyle changes often means the problem may never truly be solved long term.

In primary care, there is a lack of understanding and awareness among some clinicians regarding mental health issues that military veterans experience. The aim of the project outlined here was to identify military veterans in one primary care centre, screen them for anxiety and depression, and offer them the most appropriate treatment and support. An emotional health check template was used to identify military veterans for anxiety and depression. Training was also offered to staff in the practice and appropriate services were identified and listed on a leaflet. By the end of the project, the number of military veterans identified in the practice had increased from 19 to 200, 45 with a diagnosis of depression and five with post-traumatic stress disorder (PTSD). Only four veterans were offered emotional health checks during the project period due to restrictions in place for the COVID-19 pandemic. This article shows how the process of identifying military veterans and developing a system of screening for depression and anxiety as well as introducing new staff training has been effective. Adding missing elements to the template will improve follow-up and evaluation in the future.

Cervical cancer is the fourth most common cancer in women worldwide, with around 311,000 women dying of the disease in 2018 (World Health Organization [WHO], 2020). In the UK, cervical cancer accounts for approximately 870 deaths each year. Effective primary (human papilloma virus [HPV] vaccination) and secondary (screening and treating precancerous lesions) strategies are therefore paramount in preventing unnecessary mortality, especially given that cervical cancers are one of the most successfully treated if caught early (WHO, 2020). Obtaining an adequate sample during cervical screening is of the utmost importance to ensure early histological changes are detected. Whether lubrication should be used during the screening process is a contentious issue, since contamination of the sample with lubricant can mean that vital histological changes are missed, thereby putting women at risk. This also needs to be balanced with women’s comfort, since an uncomfortable experience may lead to women failing to attend for future screening. This article looks at the current literature available, with recommendations for further research.

As the NHS and general practice changes, the authors raise questions about of one of the fundamental human responses we all can have to each other. This article looks at the dynamics and impact of listening in health care for nurses and staff. The close relationship between active listening and safe, lawful and ethical health care are explored. It combines current academic doctoral work, wider research, practical experience and psychological thinking on how listening is a conduit of care and humanity. The article shares stories, research and observation to ask what communicative listening looks like, why it matters, and how we practice this powerful skill. The authors come from different and complementary backgrounds, bringing together a wealth of experience and knowledge to challenge and explore the concept and practice of listening.

Lockdown, as a result of the current health crisis, has demonstrated the risks that social isolation can have on physical and mental wellbeing. Social isolation and loneliness in the UK are rising, with nine million adults reported to be lonely and little chance of this changing once full restrictions are lifted post lockdown. While four million of this group are elderly, the remaining five million come from a diverse range of age and social groups, highlighting the diversity of this complex problem. To address the challenges loneliness produces, a multifaceted approach needs to be taken to find solutions and tools to help those working in primary care support the most vulnerable patients. Digital technology, in particular virtual reality (VR), may be one area that could provide some answers.

Cannabis has been around for millennia and is a popular recreational drug. A recent survey found that it is the most frequently used substance in the 16–59-year age group (Home Office, 2018). Recently, it has been approved for medicinal purposes and the National Institute for Health and Care Excellence (NICE, 2019) has published guidance for specialist medical staff on prescribing cannabis. There have been studies on the potential beneficial effects of cannabis on pain, particularly in conditions such as multiple sclerosis and terminal cancer (Calignano et al, 1998; Russo, 2008; Whiting et al, 2015). There have also been publications on the use of cannabis in some dermatological conditions (Whiting et al, 2015), but very little published evidence on how or whether cannabis impacts on wound healing. With the widespread use of cannabis, it is likely that healthcare professionals will care for cannabis users who also have wounds. This article discusses some of the current available evidence to establish if and how cannabis may affect the wound healing process in order to advise patients on how to optimise wound healing.

Hay fever and allergic rhinitis are common conditions seen in primary care which can have a huge effect on the quality of life of sufferers The most important step in diagnosing hay fever or allergic rhinitis is to take an allergy focused clinical history. There are many treatment options available, including allergen avoidance, antihistamines and nasal corticosteroids. Many medications are now available over the counter; patients need to know how to take their medication correctly. Asthma frequently co-exists with allergic rhinitis and can make asthma symptoms much worse. General practice nurses (GPNs) are ideally placed to offer advice and support to these patients. If initial treatments fail, patients should return to primary care as there are a wide range of therapeutic interventions which may help. For those whose symptoms are very severe or not responding, immunotherapy may be an option, and the patient should be referred.