The ability to recognise the need for debridement is a vital skill for general practice nurses (GPNs), since it is an important part of preparing the wound for healing. Debridement removes dead tissue within the wound that can otherwise provide a physical barrier to healing, while also providing an ideal environment for micro-organisms, increasing the risk of infection. In order for healing to progress, it is important to debride the wound promptly. Failure to do so can result in wound chronicity and an associated impact on resources and patient quality of life. While there are different methods of debridement available, this article focuses on autolytic and mechanical, explaining how they work and their benefits and limitations.
Despite the availability of effective treatments, uncontrolled asthma is associated not only with mortality, but also morbidity affecting health-related quality of life. The aims of asthma management are to achieve control of symptoms, reduce the risk of exacerbations, and limit the future risk of fixed airway obstruction. Poor asthma control can arise from inadequate treatment, poor adherence to medications, poor inhaler technique, poor perception of control, along with risk factors such as psychosocial/emotional and altered breathing patterns, as well as comorbidities such as rhinitis, depression or obesity. This article focuses on the role of general practice nurses (GPNs) in the management of asthma, with particular emphasis on medications. It also looks at the benefits and drawbacks of short-acting ßeta-2 agonists, inhaled corticosteroids and longacting ß2 agonists, as well as non-pharmacological interventions.
Hay fever and allergic rhinitis are common conditions seen in primary care which can have a huge effect on the quality of life of sufferers The most important step in diagnosing hay fever or allergic rhinitis is to take an allergy focused clinical history. There are many treatment options available, including allergen avoidance, antihistamines and nasal corticosteroids. Many medications are now available over the counter; patients need to know how to take their medication correctly. Asthma frequently co-exists with allergic rhinitis and can make asthma symptoms much worse. General practice nurses (GPNs) are ideally placed to offer advice and support to these patients. If initial treatments fail, patients should return to primary care as there are a wide range of therapeutic interventions which may help. For those whose symptoms are very severe or not responding, immunotherapy may be an option, and the patient should be referred.
With the ever-expanding role of general practice nurses (GPNs), alongside increased clinical scope and capacity, and increasing pressures of targets, it can be easy to simply ‘tick the boxes’ during an asthma review. However, an asthma review is not only to get an enhanced view of the child or young person’s asthma control in general, but also their individual perceptions, triggers, along with their own agenda or drivers (which may not be the same as the clinicians). By considering social, family or emotional influences, the review can answer crucial questions, such as, ‘Why has this child been to A&E again?’, ‘Why is this child getting through four reliever inhalers each month?’, or, ‘Why have these siblings missed their review again when one was so ill last year?’. This article explores how GPNs are well placed to educate patients and their families about asthma, to discuss inhaler technique, medication use and asthma triggers, as well as to ensure that children and families are aware of the importance of attending their next asthma review. It also discusses the use of tools in assessment and planning.
The terms sexually transmitted diseases and sexually transmitted infections (STIs) are used to cover a number of individual conditions that vary in their presentation, treatment, management and risk, and severity of complications. Statistics indicate that the prevalence of some diseases is rising, while others are falling. Yet, in spite of these findings, in 2017 there were 422,147 new diagnoses of STIs made in England alone (Public Health England [PHE], 2018). Current data shows that young people experience the highest diagnosis rates, thought to be likely due to more frequent rates of partner change among younger adults, with females more likely to be diagnosed than males (PHE, 2018). Early detection and treatment is key if complications and avoidance of spread are to be achieved. Given the incidence of some STIs, it is likely that general practice nurses (GPNs) and GPs will be approached by patients asking for help and advice. This article gives an overview of some of the more common STIs, with the aim of improving knowledge and confidence in this area of clinical practice.
In this first of a two-part series exploring leadership in general practice, Jaqui Walker, general practice nurse/advanced nurse practitioner, Falkirk, Scotland, looks at the context for leadership in general practice nursing, our role as leaders, and perceived barriers to nurses fully utilising their leadership potential in the general practice setting. Part two will explore why we should lead, who can lead, leadership styles and behaviours for ANP/GPNs and how to develop leaders.
The current Covid-19 pandemic has thrown countries and societies into a crisis management situation, resulting in lockdowns and unprecedented high demand on health and public services. Here, Teresa Burdett, senior lecturer in integrated health care, unit lead for foundations of integrated care and person-centred services and unit lead for foundations of general practice nursing and Lee-Ann Fenge, professor of social care, both at Bournemouth University, look at integrated health and social care provision to improve existing care delivery methods and promote person-centred care.
Highly exuding wounds can affect people of all ages, often causing distress, anxiety and social isolation. Managing these challenging wounds can also represent a significant cost to the NHS. This article looks at exudate and the difference between normal and excessive exudate and examines the causes of a high volume of exudate and its effect on the patient. Exudate assessment is an important part of holistic assessment, which is also explored in the article. Strategies GPNs can employ to manage exudate, including wound dressings and other devices, are then discussed.
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