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.

Here, Laura King, senior asthma practitioner, North-East London, explains why the time is now to pre-emptively act to avoid asthma attacks, which commonly peak in children and young people during mid-September.

Here, Callum Metcalfe-O’Shea, advanced nurse practitioner diabetes specialist and co-chair for the Norfolk Health Professionals Diabetes Forum, looks at how remission in type 2 diabetes can be achieved in some cases. Definitions of remission are explored as well as the challenges patients may face. Dietary advice and pharmacological interventions are considered to help general practice nurses (GPNs) structure their approach in achieving remission for suitable patients with type 2 diabetes.

I enjoyed reading and reflecting upon the leadership topic covered in this issue’s ‘practice matters’ piece. For me, it is timely, as I feel it’s an important time for general practice nurses to lead in advocating for the value and importance of our role and proactively promote our work within the general practice team. While urgent care has driven general practice recently and attracted resources, long-term conditions are equally important and if not adequately resourced and managed will just continue to drive up the demand for urgent care.

There have been many renowned leaders throughout history. Alexander the Great. Cleopatra. Winston Churchill. Liz Truss… OK, maybe the last one is a bit of a stretch, but many civilizations have been defined by a single inspirational leader who was able to bend circumstances to their will. 

Evidence is increasingly showing us the negative impact of air pollution on conditions like asthma (Tiotiu, 2020). Air quality is such a pertinent issue that it has been included as
a standalone topic in the national bundle for children and young people’s asthma (NHS England, 2022a). This editorial uses asthma as an example when considering how
the air quality conversation might be embedded in day-to-day patient work, but it should be noted that air quality impacts everyone, of all ages, and every part of the health spectrum.

Healthcare professionals make important decisions every day. The ability to make decisions is central to human experience and something we often take for granted. Some decisions are of little consequence, such as what to have for breakfast, other decisions are of greater consequence, such as whether to sell one’s house. For the most part, we make these decisions ourselves, perhaps in conjunction with another person and we act upon that decision. But what if we were unable to decide for ourselves and were reliant on other people deciding for us? How can we be sure that people making decisions about our lives are doing so in a correct way?