Resources

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.

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.