Resources

Continence is not a life-threatening condition, but does affect an individual’s quality of life and the lives of their family and carers. This article explores the most common types of bladder and bowel problems and how to improve patient care. It looks at the prevalence of conditions, different types of continence issues, how they can affect quality of life and the complications that can occur when poorly managed.

Like type 2 diabetes, developing prediabetes is a growing and concerning trend; affecting around 15% of the population. If not kept in check, it commonly progresses to type 2 diabetes. Certain population groups are at risk, such as African-Caribbean, as are those who experience certain medical conditions, such as gestational diabetes. Although blood sugar levels do not reach the level of type 2 diabetes, living with prediabetes does increase the risk of diabetes complications. Yet, individuals often do not realise that they have the condition. Insulin resistance is present in prediabetes so preventing this from developing means preventing insulin resistance from occurring. Diet and lifestyle can halt the progress of this disease and it can be reversed. Weight loss is key, as is eating a healthy diet, such as the Mediterranean diet. Physical activity can also help to offset prediabetes and this should include resistance training as well as aerobic exercise. It is a growing trend in younger adults not normally associated with developing this condition, and so it is important that prediabetes is identified to prevent the longer term health consequences.

Awareness of the detrimental effects of smoking, environmental factors and pollution on lung health are well established. There is also awareness of the impact of obesity on the cardiovascular system with, for example, the development of diabetes, raised cholesterol levels and hypertension, but less attention is given to obesity and the association with respiratory symptoms, particularly breathlessness (both exertional and at rest) and cough, with the potential to cause either under or over diagnoses of respiratory conditions. The  relationship between obesity and respiratory diseases is complex, as it is not simply related to the physical and mechanical impact of obesity, but also associated with inflammatory cellular function and mediator activity. This article explores the evidence for the impact of
obesity on lung health.

General practice nurses (GPNs) play a critical role in supporting the health and well-being of culturally and linguistically diverse patients. This paper reports on a review and synthesis of qualitative research exploring the experiences and perspectives of GPNs caring for culturally and linguistically diverse patients. Three electronic databases were
systematically and comprehensively searched. Searches were limited to articles published in English language between 2012 and 2022. The title/abstract and full text articles were independently double screened. Qualitative findings are presented in themes and reported narratively. Eight studies met the inclusion criteria reporting perspectives of 60  GPNs working across seven different countries. Three themes were generated;  experiencing uncertainties, developing crosscultural communication skills and limitations in cultural knowledge. The findings of this review highlight the intricacies of adapting nursing practices to meet the needs of culturally and linguistically diverse patients. Strengthening the commitment to providing culturally responsive care at both individual and organisational levels is paramount. 

Heart failure (HF) is a complex clinical syndrome which arises when the heart is unable to pump blood adequately around the body, leading to a range of symptoms from shortness of breath and fatigue to fluid retention. HF care is complex, multifaceted, and is often delivered in varied settings by a range of healthcare workers depending on
local resources and services. To this end, the British Society for Heart Failure (BSH), using Delphi methodology (Barrett and Heale, 2020), has collaborated with cardiologists, specialist nurses, pharmacists, leads from primary and secondary care, as well as those from the wider multidisciplinary team (MDT), to develop an online resource with the aim of supporting this complex management, clinician competence and confidence, and increasing guideline-directed care. This article encourages use of this pathway and raises the importance of HF management from detection to palliative care (Karauzum et al, 2018).

Rectal cancer is common in the UK, affecting about 12,000 people each year. The common treatment for rectal cancer is surgery, such as an anterior resection which may also be combined with chemoradiation. Treatment for rectal cancer, however, is likely to cause subsequent problems with bowel function. Changes to the bowel can present with faecal incontinence and the need to rush to the toilet. Nurses can assist with some simple interventions, such as medication to bulk up the bowel motion or changes to the diet to thicken the bowel motion. If symptoms are severe and are not resolved using these methods, there are other interventions that can be tried, such as sacral nerve modulation which will require referral to a specialist.

Childhood eczema, also known as atopic dermatitis, is a chronic skin condition that affects millions of children worldwide. The condition is characterised by dry, itchy, and inflamed patches of skin that can appear anywhere on the body. While the physical symptoms of eczema are often the focus of treatment, the condition can also have
a significant impact on a child’s emotional wellbeing. Added to this, the strain that it can put on families in terms of loss of sleep, time off work, financial and time of managing a chronic condition, and sibling jealousy of attention given to the child with eczema can mean that the stresses of eczema are shared by the whole family, not just the affected child. This article examines these issues further with recommendations for how the emotional impact of eczema may be more effectively managed.

Here, Callum Metcalfe-O’Shea, advanced nurse practitioner diabetes specialist and co-chair for the Practice Nurse Diabetes Forum for Norfolk, looks at how general practice nurses (GPN) can discuss nutrition with patients newly diagnosed with type 2 diabetes to ensure that they feel motivated and engaged in their healthcare journey. This article, the second part in our diabetes digest series, focuses on the initial consultation when patients are still coming to terms with their diagnosis. While individual diet plans are not discussed, a review of carbohydrates and their role in diabetes management, alongside medication considerations, are explored.

General practice nursing has adapted and evolved many times in the two decades I have been one. I have developed many new skills in this time and I now practice at a level way
beyond what I would have imagined when I started my nurse training in 1986. I probably wouldn’t have believed you then if you had told me I would be diagnosing, investigating,
prescribing, and referring in the same way my medical colleagues do 37 years later. We were not even able to take blood or give paracetamol in 1986. Times have changed and
continue to change.

Despite the medical advances of the past century, modern healthcare services often seem to treat our bodies as a series of unconnected parts, our ailments divided according to arbitrary physical labels. We may see a urologist for our weak bladder, a cardiologist for a malfunctioning heart, and a psychiatrist for any mental health issues. While it makes sense to apportion separate parts of the body to qualified specialists, these divisions can result in an inability among healthcare staff to see the ‘bigger picture’ — or to use modern healthcare terminology, to treat the patient ‘holistically’.