Resources

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.

The Covid-19 pandemic has caused us to rapidly change the way we work. If we look back to where we were this time last year, while we may have been aware of ensuing problems, we probably had little idea of the full impact of what lay ahead and how quickly we would all need to adapt. Here, Julie Catchpole, director and founder of Rotherham Respiratory, reflects on how the organisation has adapted its courses to ensure that healthcare professionals continue to access education and training to provide optimum patient care.

Chronic prostatitis and chronic pelvic pain syndrome (CPPS) are long-term conditions which are often poorly understood, difficult to treat, and for which there are currently no cures. Here, Teresa Lynch, specialist nurse, Prostate Cancer UK, discusses how to recognise these conditions, as well as how to holistically treat and help men manage their symptoms.

In each issue of the Journal of General Practice Nursing, we investigate a topic currently affecting our readers.

Welcome to our March 2021 issue. As I sit at my desk looking out the window on a breathtakingly beautiful spring morning, I cannot help but feel hopeful. It’s nearly a year since the first lockdown, and we have made so much progress in adapting to and tackling this pandemic. This issue’s ‘Practice matters’ feature brings a wonderfully discursive and educational piece about the Covid-19 vaccine, which captures the feel of sitting around a table with colleagues sharing information and experiences. It also demonstrates the ways in which we can lead as a profession with our long history as key players in vaccination programmes, and how teamwork with our multidisciplinary colleagues and an all hands-on deck approach to fighting the pandemic is important.

Remembering our vital role in chronic disease management and the importance of continuing to develop our skills in this area I was delighted to read the article on heart failure and the nurse competency framework. The authors state that ‘heart failure should be considered as malignant a disease as cancer and treated with the same urgency’. As GPNs seeing people with multiple chronic diseases, we have the opportunity to suspect and start the process for the diagnosis of heart failure. Covid-19 infection also brings increased risk of heart failure for those who have been hospitalised and may further increase the number of people it effects.

Other articles to highlight include Naomi Berry’s piece on deaf awareness and how to promote communication (particularly pertinent with our current need for face masks and more remote consultations); Callum Metcalf, ANP/GPN in Norfolk, has written a highly insightful article on deprescribing in type 2 diabetes (I found the step-by-step guide as to what to consider with different drug groups incredibly helpful and will add it to my reference folder at the surgery); Gaynor Bussell, a freelance dietician, offers evidence and practical suggestions on how women can use diet and lifestyle changes to help with health conditions throughout their life; Sian Williams has combined her health and dance skills to write an uplifting article on her experience of dance and pulmonary rehabilitation with an online group (this is a resource I plan to look into in more detail for my patients); and there is also a practical guide to diagnosing and managing migraine from Rebecca Stuckey, CNS in Devon.

We welcome your ideas, feedback and contributions for future publications. Please continue to get involved with the journal so we can shape it to your needs and ensure we reflect your views, practice and knowledge within its pages. Thank you so much to everyone who has contributed so far to this varied, stimulating and motivating journal. I am proud to be a part of it.

Jaqui Walker, editor-in-chief