Resources

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.

Here, Joan Gracie, talks about the importance of addressing blind spots in preconception health and why she wanted to get involved in the Queen’s Nursing Institute Scotland’s (QNIS’) new programme, Healthier Pregnancies, Better Lives, to support women to better prepare for pregnancy.

Chronic obstructive pulmonary disease (COPD) is a term often used for two common incurable lung conditions, chronic bronchitis and emphysema. Breathlessness is the main symptom experienced by patients, which can be frightening and patients can develop symptoms of anxiety, panic, low mood and depression. General practice nurses (GPNs) are ideally placed to address these symptoms. This article describes the importance of considering psychological well-being to improve self-management in COPD and how cognitive behavioural therapy (CBT) techniques can be used to assess and manage the psychological impact of breathlessness. Addressing mental health is a key area to improve self-management in COPD and research has found that respiratory nurses were able to learn and deliver CBT techniques to patients with COPD and improve symptoms of anxiety and depression, as well as quality of life, while also reducing use of healthcare resources (Heslop-Marshall et al, 2018). GPNs can likewise improve self-management by incorporating CBT techniques.

With the last year bringing issues of its own, and children and young people returning to school, the post-attack review is as important as ever. As we start to see a ‘new normal’, it seems even more important to embrace brilliant basics as the foundation to excellent asthma care for adults and children alike. This article explores the post-exacerbation review, with reference to a small-scale survey carried out pre-Covid, to put into context some common conceptions (and misconceptions) around the 48-hour review. It discusses how and why we carry out the review, as well as signposting to helpful resources and recommendations for practice.

The environmental impact of healthcare delivery in general, and respiratory-related healthcare specifically, has gained increasing attention in recent years. Reducing national carbon emissions and improving sustainability has become a high priority both at governmental level and for the NHS across the UK. General practice nurses (GPNs) have a critical role to play in addressing the environmental impact of respiratory healthcare. While the priority must always be to do the right thing clinically for individual patients, there are a range of strategies which can be introduced to day-to-day practice to reduce the carbon footprint of respiratory healthcare. This article reviews a range of strategies from protecting and improving the indoor air quality of healthcare facilities and ensuring patients understand and use their prescribed medications effectively, to undertaking a quality improvement initiative to address environmental issues. Integrating sustainable healthcare principles in every aspect of clinical practice can drive the delivery of greener respiratory healthcare that will benefit us all without detriment to delivering high quality care.

With the care of lower limb wounds taking up a considerable amount of caseload time for general practice nurses (GPNs), it is vital to look at services to ensure that they can both meet demand and improve patient outcomes. This paper explores how one practice created, implemented and streamlined a pathway of care for patients with lower limb issues. The pathway followed best practice evidence for lower leg care, i.e. initiating assessment of the patient and wound as quickly as possible, implementing compression therapy where appropriate, and then providing patients with education on how they can support their own long-term care. The practice team were able to adapt processes to utilise their local resources and remove some of the barriers to improving wound healing. The results significantly reduced patient numbers with lower limb wounds on the caseload and audit indicated that healing rates improved.

Malignant fungating wounds (MFWs) arise in 5–10% of all cancers. These wounds are distressing for patients, their families and caregivers, with both physical and emotional symptoms impacting greatly on quality of life. Symptoms include severe pain, bleeding, depression, malodour and negative body image. MFWs present considerable challenges in the application and retention of dressings. These wounds deviate from the normal healing trajectory and the theory of wound healing is not always appropriate; they may expand and progress during the terminal stages of a patient’s life. This article discusses the challenges of treating and managing MFWs and presents some practical solutions to the major symptoms. It also looks at dressing choice and pain management — including pharmacological and topical treatments — managing malodour, as well as assessing and addressing quality of life.

Disorders affecting the brain cover a wide spectrum of conditions and many increase in incidence and prevalence with older age. Their symptoms are variable affecting each individual person differently, with some diseases following a progressive pattern. In these instances, as progression occurs, symptoms may impact on family and friends, as well as having a significant effect on the health and wellbeing of those affected. This article, the first in a two-part series, looks at dementia and strokes and the various types of these two conditions. A brief insight into the signs and symptoms, diagnosis, treatment and management and long-term outlook is discussed to improve knowledge and confidence among general practice nurses (GPNs) and non-medical prescribers when caring for patients and their families affected by these devastating diseases.