Resources

In the treatment of chronic, hard-to-heal wounds, managing destructive chronic wound exudate, removing devitalised tissue and addressing wound biofilm/infection are high priorities (Atkin et al, 2019). To optimise the rate and likelihood of a chronic wound healing, it is important to identify its cause and any factors that may impede the healing process (Wounds UK, 2018). This can only be achieved by undertaking holistic wound assessment followed by effective wound management — having a logical set of actions, or pathways to follow, aids this (Atkin et al, 2019; Box 1). When managing lower limb ulcers, accurate diagnosis is crucial so that they can be categorised as venous, arterial or mixed aetiology. The case study presented here highlights the care pathway of a mixed aetiology leg ulcer, including wound bed preparation.

Pelvic organ prolapse (POP) and urinary incontinence are common problems experienced by women of all ages. With the publication of Seizing the opportunity to improve patient care: Pelvic floor services in 2021 and beyond (Pelvic Floor Society, 2021) comes recognition of how common pelvic floor disorders are but how little investment has been put into these services. Such publications highlight the need for services to be provided which encourage women to come forward to be assessed and treated. This article, the first in a two-part series, discusses the signs and symptoms of POP and urinary incontinence. It details important issues to consider and remember when assessing a patient with either of these conditions in primary care. The second article will explore treatment options which should be started in primary care before considering onward referral.

Salbutamol is the most widely prescribed bronchodilator belonging to a class of drugs known as beta-2 adrenoceptor agonists, more commonly known as short-acting beta agonists (SABA). Their role is to relax airway smooth muscle (ASM), thereby reducing symptoms of wheeze, shortness of breath or cough in airways diseases such as asthma and chronic obstructive pulmonary disease (COPD). Salbutamol is generally regarded as a safe medication when used correctly. This article looks at the history of this class of medications, how they work at a cellular level, and the associated risks if they are overused or incorrectly used. It includes a discussion on the most commonly used SABA-containing device — the pressurised metered dose inhaler (pMDI). An understanding of the clinical and potential cellular effects of overuse will be discussed in the context of associated risks, as well as discussion on the drive to reduce greenhouse gases to care for the planet, and how this can be achieved while providing best care for patients 

Despite the recommendations of the original Marmot Report in 2010 (Marmot, 2010) and the subsequent Marmot review (2020), the widening gap causing health inequalities has impacted on life expectancy, particularly in areas with elevated levels of multiple deprivation. The gap has resulted in those living in the least deprived areas living longer than those in the most deprived areas. Moreover, the past 18 months has witnessed an exponential rise in the numbers of people developing significant health issues, such
as mental ill-health and obesity because of the Covid-19 pandemic (World Health Organization [WHO], 2021). Here, Michelle Howarth, senior lecturer in nursing, Salford, Jo Ward, change maker, North West strategic lead for social prescribing, Cheshire and Merseyside Women and Children’s Partnership Museum Development Yorkshire consultant, and Daisy Jackson, North West regional mentor for care coordination and lead care coordinator, explore why there is an increased precedent to support communities to reduce this gap and address the wider determinants of health for citizens.

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

We all learn in different ways and so it is important that teaching and educational materials embrace the different styles, or learning preferences, to make training more appealing and more effective (Xu, 2016).

An effective learning experience is one that is well understood, memorable and results in a new or enhanced way of thinking or practising. (Anderson, 2016).

This article covers areas such as how we learn, factors affecting learning and professional responsibility. 

Contributors:

• Karen Harrison Dening (Head of research and publications and professor of dementia nursing, De Montfort University)
• Lisa Ashworth (Lecturer in district nursing, pathway leader community specialist
  practitioner district nurse, module leader management of leg ulcers,
  University of Central Lancashire; Queen’s Nurse)
• Annemarie Brown (Lecturer, BSc Adult Nursing, School of Health and Human Sciences, University of Essex)
• Teresa Burdett (Senior lecturer in integrated health care, Bournemouth University)
• Anne Williams (Lecturer, University of the West of Scotland, lymphoedema nurse consultant, Esklymphology)

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/