Resources

Being awarded the Queen’s Nurse title is a great honour and one I would not have received if I had given up general practice nursing three and a half years ago.

We have to remember that life is a journey and not a destination, which is why I think I was ready to give up and have a change of career. A chance meeting with an army reservist at our annual CPR update changed the course of my nursing journey, but not where I thought I would end up.

Here, Jaqui Walker, chats about how experience has taught her to stop and think when something just doesn’t feel quite right.

Chronic wounds create poor health (e.g. infection and immobility) and personal issues for patients (e.g. malodour, pain and sleepless nights), as well as substantial costs to healthcare systems (Guest et al, 2017; Atkin et al, 2019). They present many clinical challenges, but two key areas are wound bed preparation and exudate management (Atkin et al, 2019), which are intrinsically linked. A chronic or cavity wound bed which has not been prepared for healing through cleansing and debridement (Mahoney, 2020), containing slough, necrotic tissue or wound biofilm, usually produces a high volume of exudate (World Union of Wound Healing Societies [WUWHS], 2019).

Delivering the flu vaccination programme this coming season will be a greater challenge than ever before. The impact of COVID-19 on all healthcare services will also be felt when trying to deliver a vaccination programme in a short period of time to numerous patients, and perhaps an even greater number of patients than in previous years. There are various options in terms of delivery models and plans, but it is important that those who give the majority of vaccines in general practice, general practice nurses (GPNs), are involved in the planning of a delivery model which best suits the practice and the practice population. Careful risk assessment and documentation of decisions is important, as well as the ability to be flexible during the season and ready to offer flu vaccine to other eligible groups as the season progresses.

This article is the second in a two-part series on respiratory assessment. The first article looked at the importance of taking a patient history as part of assessment. This article goes on to address the various stages and techniques involved in physical assessment. It will give an overview of the process, looking at inspection, palpation, percussion and auscultation, and provides insight to technique. Integrating the physical assessment outcome with information gained from history-taking is also discussed. Using all of the gathered information and vital signs enables clinicians to process and decide on the patient’s problems. While this two-part series provides an overview of the assessment process, further in-depth training is essential for safe and effective patient outcomes.

This article discusses the assessment and management of vitamin B12 deficiency. The author examines the causes of this condition, such as pernicious anaemia, and the different methods that can be used to manage it, for example vitamin B12 supplements, diet and medication review. Primary care nurses are frequently responsible for ordering blood tests and managing B12 deficiency. However, there is a lack of consistency in the management of the condition, partly because there are a number of different blood tests that can be performed, not all of which are available in every hospital laboratory.

One of the key components of comprehensive holistic wound assessment, particularly of venous leg ulcers, is measuring a patient’s ankle brachial pressure index (ABPI), as this will help to rule out the presence of arterial disease and guide treatment decisions, i.e. the introduction of compression therapy. However, it has been identified that performing ABPI assessment is an area that needs improvement (Guest et al, 2015) to ensure that all patients get a timely diagnosis. Indeed, such meaurements should not only be taken at initial presentation, but regularly to ensure that there has been no deterioriation in a patient’s arterial status (National Institute for Health and Care Excellence [NICE], 2013; Wounds UK, 2016). This article outlines the impact on one GP surgery of implementing a standardised lower limb pathway, in addition to introducing new technology to calculate ABPI, which resulted in improved patient outcomes and effective use of nursing time and resources.

Venous leg ulcers (VLUs) present a huge burden, not just in terms of healthcare costs (Guest et al, 2017), but also in their negative impact on patient quality of life (Marczak et al, 2019). A holistic, multifaceted approach to assessment is needed to ensure that all factors contributing to their development are considered to allow optimal healing to take place. The European Wound Management Association (EWMA, 2016) however, has highlighted a disparity in care between community and specialist settings, with some nurses lacking the necessary skills needed to undertake effective assessment. Since wound assessment is a core component of wound management, impacting directly on therapeutic choices and thus healing (Lázaro-Martínez et al, 2018), it is imperative that general practice nurses (GPNs) are supported in being able to assess wounds accurately. This article discusses and reflects on the value of effectively assessing wounds in primary care using the Triangle of Wound Assessment framework, which focuses not just on the wound bed, but also the periwound skin.

People experiencing long-term physical conditions are predominantly cared for within primary care settings by nurses. These patients are two-to-three times more likely to develop mental health problems as a result of the detrimental impact of their illness on their physical and social functioning. They are also more likely to disclose mental health issues to nurses working in primary care — therefore, general practice nurses (GPNs) need to be able to recognise both mental distress and mental illness to ensure that their patients receive appropriate assessment, care and management. This article discusses the prevalence of mental health problems in patients with long-term physical conditions and how nurses in primary care settings can recognise, assess and support them.