Editorial Resources

It’s easy to worry about the things we might get wrong in our working lives and the level of consequences that could potentially follow, but what about focusing and celebrating what we get right (sometimes harder to see) and the potential for helping people achieve longer, healthier lives.

Last week at the end of a triage call a patient said, ‘thank you — I really feel you have listened to me’. The feedback meant a lot to me on a day when I was struggling a bit to keep ahead and helped me to stop for a moment and reflect on what our role in primary care is all about. It’s holistic, it’s often the patient’s first port of call and it’s important to the
people who reach out to us for help. Reading this issue’s ‘practice matters’ discussion about food insecurity, I have reflected further that it’s not just listening that we need to do, but rather use all of our senses to help us in our role and let us see the bigger picture that is required for good general practice consultations.

A friend told me at the beginning of the pandemic that she had made an active decision not to judge others and their behaviour and reaction to Covid-19. She would do her best to act responsibly, but would not question or worry about what others were doing. This seemed a good approach and I have tried to reflect on it when feeling annoyed about various examples of lack of adherence to the rules.

Here, Meg Burgess, specialist nurse at Prostate Cancer UK, talks about her role in providing a Fatigue Support Service by telephone, why it is needed, how it is structured, and the small changes that can help reduce the impact of fatigue on quality of life for men with prostate cancer. 

Around three in four men with prostate cancer (74%) will have fatigue at some point (Stone et al, 2000). For some it may be a short-term problem and manageable, for others it can be longer lasting and can affect quality of life.

As healthcare professionals, it can be a hard symptom to address as treatments or solutions may feel limited. Men say there is often little discussion about their fatigue with healthcare professionals and there may be differing perceptions of the impact of fatigue on quality of life (Sonn et al, 2009).

Since 2013, Prostate Cancer UK has provided a telephone fatigue support service to provide this much needed support.

Please click the link to read the full article.

With an adaptable and creative approach, we kept as much of our GPN work at the surgery going during the various lockdowns. Much of this has led to a more flexible service for our patients and certainly many respiratory reviews will continue to take place remotely (it was helpful to read how Jude Harford approaches remote paediatric asthma reviews in the journal, pp. 56–61).

This, however, has not prevented the colossal feeling of ‘catch up’ we are now experiencing. Our service is busier than ever, and many people bring extra problems which need signposting, rebooking, or managing within the consultation.

Managing stress is now an integral part of our role. Daily routines can help ensure we remember to be kind to ourselves as well as others. I often reflect on the importance of the simple routines I learnt about from the webinar held by Donna Booth (www.vitality-innersanctum.com). I make sure even in a hectic week that I still take time to enjoy nature, cook something nice or get some exercise.

As nurses we are committed to lifelong learning and, with this in mind, I found the ‘practice matters’ feature about learning styles very interesting to reflect upon from several perspectives: 

• How I help those I teach learn and how much I consider/discuss their learning styles 
• As a writer of educational modules and editor of this journal, how much do I think about different learning styles when bringing together educational content? I now plan to make a note of the styles and think about them in my planning and editing processes 
• What is my own learning style and how much of this is based on convenience (webinars/websites are much easier for me to access because life is busy, but I used to love attending a teaching day or even a conference) and how much is my core learning style?

I found the articles in this issue very helpful again. I think they do often have a conversational style as well as being packed with evidence and useful resources. I enjoyed expanding my understanding about heart failure, as this is often a factor when trying to understand what is causing a patient’s shortness of breath. It was also very useful to get a clear update on analgesic prescribing. I often find it’s the simple things like explaining why it’s better to take paracetamol regularly, rather than as required, that helps in people with chronic pain.

I hope you all find ways to use simple routines to relax and look after yourselves as summer begins to fade and we prepare ourselves for an uncertain winter. As a profession, we are known for our caring attitude and also our resourcefulness and resilience.

Jaqui Walker, editor-in-chief

The long awaited, now published, ‘Getting it Right First Time’ (GIRFT) cardiology report (www. gettingitrightfirsttime.co.uk/wpcontent/uploads/2021/08/Cardiology-Jul21k-NEW.pdf), places significant emphasis on the importance of diagnosis of heart failure and on rapid treatment in ambulatory care centres or in the community. However, the impact of the Covid-19 pandemic on cardiovascular disease in general cannot be denied or ignored. The pandemic has rewritten healthcare reality, as starkly recounted in the recent British Heart Foundation (BHF) ‘Untold Heartbreak’ report which highlights growing issues such as burgeoning waiting lists (www.bhf.org.uk/what-we-do/policy-and-publicaffairs/legacy-of-covid).

Across the UK, people living with heart disease have experienced progressive worsening of their health while avoiding hospital or waiting for care, potentially missing windows of opportunity for treatments, leading to long-term disability from heart failure. But, the good news is that detection and early diagnosis can dramatically improve outcomes for people with heart failure (www.nicor.org.uk/nationalcardiac-audit-programme/about-heartfailure/), and recent approvals allow new, highly beneficial treatments to be offered — including for those with heart failure with HFpEF (heart failure with preserved ejection fraction), historically more difficult to manage.

The British Society for Heart Failure (BSH), the professional association for heart failure care in the UK, together with charities such as the BHF, professional associations, royal colleges, NHS England and Public Health England, has launched the ‘Freedom from Failure — The F Word’ campaign to expedite early detection and diagnosis by raising awareness of the need for self-recognition of the symptoms of heart failure (such as fighting for breath, fatigue and fluid retention) and to seek timely medical help. Early diagnosis is crucial to improving outcomes for those with heart failure (Taylor et al, 2019). And, with the now more widely available blood test (NTproBNP), easily conducted in general practice, the opportunity to eliminate a diagnosis of heart failure or strengthen the likelihood if levels are raised, is eminently possible (National Institute for Health and Care Excellence [NICE], 2018). Raised NP (natriuretic protein) indicates the need for more confirmatory tests (such as chest x-ray/echocardiogram) and referral to a specialist.

For this stage of the F Word campaign, the BSH is set to deliver informational, educational infographics and a series of webinars for healthcare professionals across all care settings, which build towards the BSH flagship annual Meeting in December. On 8 September there will be a live webinar called ‘The Heart Failure Observatory — Levelling Up’ on the subject of personalised medicine (does one size fit all...?). This webinar will focus on balancing the need for personalised care with the implications of the new European Society of Cardiology (ESC) guidelines for heart failure care (https://pace-cme.org/2021/06/29/previewof-the-2021-esc-hfa-heart-failureguidelines/); a complete overview of which will be presented at the ESC 2021 congress (27–30 August, 2021).

On World Heart Day, 29 September, a case study-based webinar called ‘Freedom from Failure — differentiating the symptoms of heart failure’ will examine differential heart failure diagnosis from other potentially masking conditions, such as fighting for breath/breathlessness. Also on this day, one of BSH’s infographics is planned for release, depicting our campaign ambassador, Brian Blessed, on an epic journey. On 21 October, a webinar showcasing devolved practice from the four nations of the UK with a focus on improving outcomes and patient experience is to be held. And in November, there will be a joint webinar event with the King’s Fund, with a lens on population health and heart failure. Over 1–3 December 2021, this year’s annual BSH meeting will take place as a hybrid event designed to appeal equally to in-person and virtual attendance. Come and join us, there should be something to appeal to everyone with an interest in heart failure.

To learn more about the F Word campaign, please visit: www.bsh.org.uk/the-f-word/ and for the BSH, visit: www.bsh.org.uk/

How fortunate we are to have specialist teams and services that provide wound care across the UK. But, these teams and services are frequently overwhelmed. Even in pre-pandemic times, increasing referrals, rising caseloads, and the complexities of supporting people with multiple morbidities conspire to challenge service delivery (Guest et al, 2020). At the same time, an over reliance on these teams’ skills by the rest of the system gives rise to the de-skilling of some groups, while inhibiting fundamental wound care skills development in others.

When I started as the education delivery lead for the National Wound Care Strategy Programme (NWCSP), it rapidly became clear from research, conversations, and a deep dive into existing wound care education that, for those not working in a specialist wound care service, wound care was often considered the role of the nurse. And within nursing, the role of the tissue viability nurse.

Changing this mindset is not going to be easy, or fixed by any one act. A cultural shift towards lasting improvement in wound care provision requires buy-in from all professions, service providers, regulatory and professional bodies, coupled with supporting policy. And most importantly, this needs to happen collaboratively. This is exactly what we have done in developing the first multi-professional National Wound Care Core Capabilities Framework for England, published on 9 June, 2021.

Please click the link to read the full article. 

The Queen’s Nursing Institute (QNI) and the National Garden Scheme (NGS) have announced the creation of a new scholarship programme for community nurses, the NGS Elsie Wagg Scholarship. The new programme will support five community nurses each year to undertake projects to improve the health and wellbeing of their own community through gardens and gardening initiatives.

The new scholarship was launched at the Queen’s Nurse Annual Meeting on 12th May by the chief executive of the National Garden Scheme, George Plumptre, who said, ‘Elsie Wagg’s name has always been the historic binding of the National Garden Scheme and our founder, the Queen’s Nursing Institute. The scholarship will be a vehicle through which we will together provide tangible evidence of the health benefits of gardens in a series of new projects and I am full of expectation at the exciting projects that I know community nurses are going to come up with.’

Please click the link to read the full article. 

The pandemic has highlighted that speaking up has never been more important, yet some workers who feared for their safety in this challenging time were let down by leaders who were not listening. NHS and key workers, who were applauded as heroes by the public, are now overwhelmed, exhausted, and burnt out.

As general practice nurses (GPNs), you have a key role to play in patient safety, looking after some of the most vulnerable members of society, so you will be well aware of the importance of being able to speak up, whether to raise a concern or with an idea for improvement. Listening and acting upon matters raised means that Freedom to Speak Up helps to deliver on the promise of the NHS as the best place to work.

In the five years since the National Guardian’s Office was set up, much has been achieved. A network of Freedom to Speak Up Guardians has been developed, who are amplifying the voices of those who might otherwise not be heard, breaking down barriers to speaking up, and promoting the use of speaking up as a valuable opportunity to learn and improve. There are now over 700 Freedom to Speak Up Guardians supporting more than 400 organisations.

Please click the link to read the full article.

Infection prevention and control (IPC) is a fundamental component of all disciplines of health care. It affects the health of both patients and healthcare providers by preventing the occurrence of healthcareassociated infections (HCAIs) (Storr et al, 2017; Cattini and Kiernan, 2020). General practice nurses (GPNs) have a key role in preventing the transmission of infections in their healthcare setting by understanding and adhering to IPC best practice as part of everyday care delivery (Royal College of Nursing [RCN], 2017; Carrico et al, 2018).

In light of the greatest healthcare challenge in recent times, the Covid-19 pandemic, IPC best practice is more important than ever to save lives (Flynn et al, 2020; Peters et al, 2020). A pre-existing challenge for the NHS is HCAIs (Guest et al, 2020). HCAIs are not only confined to hospitals, and while the type and level of risk may be different, GPNs have the same responsibility as those working in hospitals to prevent the occurrence of infections (RCN, 2017).

Please click the link to read the full article.