One in two people born after 1960 will be diagnosed with cancer in their lifetime (Cancer Research UK, 2018a). But, four in 10 cancers can be prevented (Cancer Research UK, 2018b), and, for some of the most common cancers survival at one year is more than double when diagnosed at its earliest stage compared to the latest stage (Office for National Statistics [ONS], 2016).
Debridement is a key component of wound bed preparation, which should not be seen as a one-off procedure, but rather as something to be done on a regular basis and included in the patient care pathway. It plays a vital part in removing dead and contaminated tissue, which harbour bacteria posing a barrier to timely healing. Debridement can also remove the presence of biofilm. Wound cleansing is also an integral part of wound care practice. However, there is little evidence about the best method, frequency, or solution to use, which causes wound cleansing often to be seen as a controversial procedure. With developments in the wound care product market and smarter dressings and wound care therapies becoming available, little attention has been given to the use of cleansing solutions. Wound cleansing is technically defined as the use of fluids to remove loosely adherent debris and necrotic tissue from the wound bed to create an optimal wound healing environment.
Holistic patient assessment remains central to informing wound management plans, despite the nature and origin of the wound. As with any other type of wound, the management of surgical wounds is multifaceted, with both intrinsic and extrinsic factors needing to be addressed to achieve wound healing. In addition to the challenges these pose to the wound healing process, surgical wounds are at risk of dehiscing and overgranulation. Advances in research and technology have resulted in an increase in the use of disposable topical negative pressure devices in the community to manage surgical wounds (Khanbhai et al, 2012; Hudson et al, 2015), which has demonstrated positive patient outcomes in most studies (World Union of Wound Healing Societies [WUWHS], 2016).
Idiopathic pulmonary fibrosis (IPF) is a relatively rare chronic, progressive lung disease with a poor prognosis. General practice nurses (GPNs) have a pivotal role in supporting patients and their families at all stages of the disease trajectory. This article aims to raise the profile of this terminal lung condition and provide nurses with an introductory understanding of the disease, the diagnostic pathway, and treatment options available for patients. As core members of the multidisciplinary team, GPNs are well-placed to provide access to other healthcare professionals and services who together can improve the lives of patients living with this condition.
Frailty is becoming increasingly recognised as a long-term condition associated with ageing that should be primarily managed in primary care. Diagnosing frailty identifies a high-risk population group and highlights areas of clinical importance that can be treated and managed. In 2017, NHS England introduced new elements into the GP contract, which require practices to identify moderately and severely frail patients, and to offer a clinical review to those who are severely frail (NHS England, 2017b). This review should include assessment of falls risk, medication review and seeking of permission to activate the enriched Summary Care Record (SCR). This article examines the general practice nurses’ role in the care and support of older people who live with frailty, and gives guidance on how to review medication, assess falls risk and use the SCR to ensure patients’ wishes and care preferences are recorded.
This article provides general practice nurses (GPNs) with a brief history of asset-based community development (ABCD). It considers how the principles of asset-based approaches are currently used and may be further developed to tackle modern challenges in health and social care. It considers one particular approach, ‘social prescribing’ — this is perhaps best known to GPNs. Social prescribing has emerged as an early asset-based solution to improve wellbeing. The article also explores some of the advantages and limitations of social prescribing and gives glimpses as to how asset-based nursing may evolve.
There is a variability and inconsistency in how GPs carry out cancer care reviews (Meiklejohn et al, 2016). Many people report feeling abandoned after treatment finishes (Scottish Cancer Experience Survey 2015/16). This article looks at an evaluation undertaken by NHS Lanarkshire as part of the Macmillan Transforming Care after Treatment (TCAT) programme to ascertain the acceptability and feasibility of general practice nurses (GPNs) taking on the role of delivering cancer care reviews using a Macmillan Holistic Needs Assessment Tool. After Macmillan cancer training, 10 GPNs invited people with a new diagnosis to a cancer care review. A concerns checklist was sent to the patients before the review. Four hundred people were invited, with 250 accepting the offer. People reported that the time afforded by the GPN was valued and they saw them as a point of contact in the future. Fatigue, pain and worry were the top three concerns raised. It was concluded that, with training, GPNs can offer quality-assured cancer care reviews and therefore shift some of the workload from GPs.
A project in Leeds is improving health outcomes for Gypsies and Travellers. Here, Liz Keat, outreach nurse, Leeds Community Healthcare NHS Trust and Queen’s Nurse, and Ellie Rogers, deputy CEO, Leeds GATE, discuss what they have learnt about primary care nursing and Gypsy/Traveller communities.
Success!