Welcome to this latest issue of GPN. We are delighted to share the latest news in the world of Education for Health, including our move to new premises, and present opportunities for you to get involved with us as a student or partner. As always, we hope that you enjoy this issue of the journal and our news update.
In each issue of the Journal of General Practice Nursing, we investigate a topic currently affecting our readers. With more and more patients being seen with complex wounds in primary care, here we consider Are we asking GPNs to become wound care experts?
Chronic oedema is a perennial challenge for nurses in primary care, consuming a large proportion of time, energy and resources. Ironically, chronic oedema is both a contributory factor and a consequence of impaired mobility, infection, or wounds and delayed healing. With growing numbers of older people with multiple and complex conditions that limit their mobility, and obesity on the increase, the prevalence of chronic oedema is predicted to rise. With reports of a current prevalence of 6:1000 (National Lymphoedema Partnership [NLP], 2019), this is a depressing prediction.
People with common health conditions, such as diabetes and heart disease, can keep their health condition invisible to the outside world. Unless they want to share their medical history, nobody else need know there is anything different about them. The same cannot be said for skin conditions such as acne, psoriasis and eczema, which, while not lifethreatening, can exact a serious toll on the self-esteem and confidence of people who experience them. While these skin conditions also involve significant discomfort, it is the psychological implications that can stay with people throughout their lives.
My personal experience of the impact smoking can have on loved ones has fuelled my interest in smoking cessation. Furthermore, the percentage of current smokers in Swindon where I live and work is above the UK average, and this may lead to higher numbers of deaths and hospital admissions directly related to smoking. This is worrying because it is the first time smoking prevalence in Swindon has risen above the UK average since records began in 2012 (Office for National Statistics [ONS], 2019).
Whether it is a family member or a friend, alcoholism can affect people physically as well as emotionally, mentally and financially. The severe impact of domestic abuse means that many victims struggle to talk about what they are going through; mainly because of fear, guilt and shame.
Wound care costs are rising in the UK. Therefore, improved systems of care to address the clinical and economic burden on our healthcare provision is needed (Guest et al, 2015). It is reported that most chronic wounds contain biofilm. With an increasing understanding and acceptance of the role of biofilm within non-healing wounds, it is now widely recognised that wound treatment plans should incorporate methods to address the potential presence of biofilm (International Wound Infection Institute [IWII], 2016). The longer a wound remains open, the greater the risk of a biofilm developing and infection risk increasing (Percival et al, 2017).
Surgical wound dehiscence develops when the edges of a surgical incision separate along the suture line due to infection or suboptimal healing, leading to an open wound. Surgical wound dehiscence can have a significant impact on the patient’s quality of life, increases the demands on healthcare professionals’ time and is costly to the health economy. Over 50% of patients with surgical wound dehiscence are managed in the community and treating these types of wounds is challenging. General practice nurses (GPNs) need to be aware of those patients that are more likely to present with surgical wound dehiscence and take a preventative approach, as well as understanding the principles of best practice for assessment and management when caring for this group of patients.
Appropriate and accurate assessment and management of lower limb wounds requires a timely, holistic assessment of the patient and their wound, including the recording of an ankle-brachial pressure index (ABPI) (Wounds UK, 2019a). A manual ABPI procedure requires advanced skills, using a handheld ABPI device, and is undertaken by a healthcare professional who is appropriately trained. In addition, the procedure is time consuming, taking a minimum of 40 minutes, and is subjective in its results, based on the technique and skill of the operator. This article describes an innovative service evaluation project that has seen the introduction of 20 automated ABPI machines into 19 general practices and a community vascular clinic in Staffordshire. The project has included the development of a care pathway, recruitment of wound champions, and training within each of the practices. Evaluation of the project is ongoing but tracks ABPI readings, assessment and wound management of patients, onward referrals and outcomes for patients, to ensure that the project’s potential to improve patient care is realised.
Psoriasis is a chronic inflammatory skin condition that can have a debilitating impact on patients. It affects 2% of the UK population (Gelfand et al, 2005), and although it can develop at any age, usually occurs in adults rather than children (NHS Choices, 2015). General practice nurses (GPNs) will often encounter patients with psoriasis in their dayto- day practice, but can lack confidence when advising these patients on the effective management of the condition. This article outlines the causes of psoriasis and provides practical advice for GPNs on assessment and treatment in primary care. The author also outlines the psychological effects of psoriasis, and discusses referral guidelines.
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