Resources

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.

Heart failure is an insidious long-term condition. It is defined as a clinical syndrome characterised by symptoms including fighting for breath, fatigue and fluid build-up, often noticeable in the ankles, and as weight gain. It is caused by a structural and/or functional cardiac abnormality and results in reduced cardiac output (Ponikowski et al, 2016). Here, Delyth Rucarean, advanced heart failure nurse practitioner, Swansea Bay University Health Board, talks about her role to improve in-patient treatment to heart failure patients and coordinated transition of care once they are fit to be discharged into the community heart failure specialist team.

When the skin is subjected to prolonged or continuous exposure to moisture the result can be mild, moderate or severe skin damage known as moisture-associated skin damage (MASD) (Parnham et al, 2020). To ensure that the correct preventative or management strategy is implemented, it is vital to perform holistic assessment which should incorporate tools that help alert practitioners to potential damage and categorise existing skin damage (Parnham et al, 2020). One such tool, Skin Moisture Alert Reporting Tool (S.M.A.R.T), has been endorsed by the National Institute for Health and Care Excellence (NICE, 2019). As a result of assessment, different products will be selected depending on whether the skin is intact or there is mild, moderate or severe skin damage.

Online events, such as webinars and the GPN Facebook Live ones, have become a regular feature in my life now, and it does make balancing both home and work commitments easier. Rather than needing to take an afternoon, evening or even a day or two out of normal commitments, we can just disappear for an hour or so and access a multitude of training at quite literally a press of the ‘join’ button. Meeting people face-to-face is great, but online events are convenient and accessible for today’s busy life.

My favourite webinar recently was one called ‘Just how stressed are you?’ I signed up for it as I was aware life was running at a fast pace with stressors flying in at me from every angle. Donna Booth’s calm, authoritative voice spoke clearly over the webinar, helping me to work out where it was all going a bit astray and to find simple ways to recognise this and adjust. Taking her audience through a careful explanation of what stress is and the different responses we can have to it; fight, flight, freeze and fawn (fawn was new to me, but described as those times when you try to please everyone, which is tricky because you can’t in fact please everyone). Donna explained that we all have an invisible stress bucket and that while some stress is good for us, if the bucket is constantly slopping over with too much we will eventually run into difficulty. To remedy this, we need to make some space for self-care in our lives; small, simple routines that help us relax. It doesn’t need to take long, but building simple relaxing routines back into life can be effective. This awareness has helped to make me more relaxed and my stress bucket is no longer set to overflow. To learn more about Donna, visit: www.vitality-retreat.com.

This issue of GPN has some helpful respiratory articles with Laura King, clinical nurse specialist for children’s asthma, exploring the importance of the post-asthma attack 48-hour review and Karen Heslop Marshall, a nurse consultant, who has written a thought-provoking article about COPD, CBT and self-management. This article has stimulated me to look at including resources for mental well-being, as well as COPD symptom control, within self-management plans. Carol Stonham, a respiratory senior nurse practitioner, encourages us to consider the environmental impact of respiratory healthcare, looking at everything from inhaler choice to how people access their appointments.

The NMC are working on a review to modernise general practice standards and are currently seeking consultation on this. In her editorial, Professor Geraldine Walters CBE, executive director of professional practice at the NMC, explains some of the changes within the new draft specialist standards and encourages us all to get involved with the consultation process.

I hope you enjoy this issue and wish you all a warm and relaxing summer and, as Donna teaches on her courses, remember, self-care is NEVER selfish.

Jaqui Walker, editor-in-chief

Nutrition and Hydration Week has historically taken place every March since 2012. It was even held in March 2020 at the very beginning of the Covid-19 pandemic. The challenges of the pandemic on all of us has meant that Nutrition and Hydration Week this year will be held from 14–20 June 2021 — so there is time to get involved.

Some clinical issues never seem to reach the top of clinical or health policy priority lists, and asthma is one of them. The International Primary Care Respiratory Group (IPCRG) has initiated a social movement, Asthma Right Care, to disrupt this. For us, right care means doing the right things and only the right things in the right way for the right people at the right time in the right place, whatever that means in the local context. This piece summarises what we have learnt, what tools we have created, and what progress we have made. It invites you to join the Asthma Right Care movement by committing to have a different conversation about asthma with at least one colleague and person with asthma.

Many of you reading this piece will know that the final project in our five-year programme to review all of our nursing standards is concerned with post-registration qualifications in specialist community and public health nursing.

There are currently five specialist practice qualifications in community nursing, and one of these is the specialist practice qualification (SPQ) for general practice nursing. In renewing the standards, we have updated the standards of proficiency, which describe what people need to know or be able to do to gain the qualification, and the standards of education and training, which describe the characteristics of the educational programmes that universities and their partners must meet to deliver the courses leading to the qualifications.

Recent stories in the media about some patients suffering blood clots after the Astra-Zeneca v accine for Covid-19 has brought into sharp focus the need for information regarding the risks (and benefits) associated with medical treatment, which should be shared with patients.

A vaccination is no different to any other form of medical treatment when it comes to ensuring you have the patient’s informed consent.