Resources

As a novice or an expert (Benner, 1985), abdominal presentations can be intriguing and puzzling. It is vital to take a good patient history and conduct a systematic physical assessment, and to think about immediate management (this might be simple pain management or helping with moving bowels) and to consider the longer term — changes to the signs and symptoms, not resolving despite treatment or good management, weight loss or bleeding. Always heed the patient’s intuition — and yours. Monitoring the abdominal problem, the patient keeping a diary if symptoms are sporadic, and giving worsening care advice are as much a part of treatment as medications and investigations. Low thresholds for review include the above but should also be considered in vulnerable populations such as the very young and very old who can deteriorate quickly, and those with pre-existing and long-term conditions, e.g. malignancy and being immunocompromised.This article should be used as an adjunct to an accredited theoretical course with a completed and successful competency assessment.

Prescribing by a variety of professionals continues its progression in response to the growing demands for health care. Prescribing by nurses was initiated in the 1990s and supported by the National Prescribing Centre’s ‘prescribing pyramid’ or seven steps or principles for good prescribing (NPC, 1999). This article explores a new prescribing consultation model (RAPID-CASE), which is composed of elements from the prescribing pyramid and the Competency Framework for all prescribers (Royal Pharmaceutical Society [RPS], 2021). The RAPID-CASE consultation model is applied to a clinical scenario to illustrate how it can guide a systematic approach to decision-making, using the example of a lower limb skin tear injury.

Here, Laura King, senior asthma practitioner, North-East London, explains why the time is now to pre-emptively act to avoid asthma attacks, which commonly peak in children and young people during mid-September.

Here, Callum Metcalfe-O’Shea, advanced nurse practitioner diabetes specialist and co-chair for the Norfolk Health Professionals Diabetes Forum, looks at how remission in type 2 diabetes can be achieved in some cases. Definitions of remission are explored as well as the challenges patients may face. Dietary advice and pharmacological interventions are considered to help general practice nurses (GPNs) structure their approach in achieving remission for suitable patients with type 2 diabetes.

I enjoyed reading and reflecting upon the leadership topic covered in this issue’s ‘practice matters’ piece. For me, it is timely, as I feel it’s an important time for general practice nurses to lead in advocating for the value and importance of our role and proactively promote our work within the general practice team. While urgent care has driven general practice recently and attracted resources, long-term conditions are equally important and if not adequately resourced and managed will just continue to drive up the demand for urgent care.

There have been many renowned leaders throughout history. Alexander the Great. Cleopatra. Winston Churchill. Liz Truss… OK, maybe the last one is a bit of a stretch, but many civilizations have been defined by a single inspirational leader who was able to bend circumstances to their will. 

Evidence is increasingly showing us the negative impact of air pollution on conditions like asthma (Tiotiu, 2020). Air quality is such a pertinent issue that it has been included as
a standalone topic in the national bundle for children and young people’s asthma (NHS England, 2022a). This editorial uses asthma as an example when considering how
the air quality conversation might be embedded in day-to-day patient work, but it should be noted that air quality impacts everyone, of all ages, and every part of the health spectrum.

Healthcare professionals make important decisions every day. The ability to make decisions is central to human experience and something we often take for granted. Some decisions are of little consequence, such as what to have for breakfast, other decisions are of greater consequence, such as whether to sell one’s house. For the most part, we make these decisions ourselves, perhaps in conjunction with another person and we act upon that decision. But what if we were unable to decide for ourselves and were reliant on other people deciding for us? How can we be sure that people making decisions about our lives are doing so in a correct way?

The patient’s voice is central to health care. Patient and public involvement (PPI) is also important for an intervention, research, innovation, and education (R, I and E) project pathway which the author has developed (Figure 1). In the author’s opinion, consulting and embedding PPI, for example in this cyclical intervention process (Figure 1), can allow for better engagement in an intervention, leading to better outcomes. If PPI is considered in the ideation of a particular intervention, such as digital applications (Apps) to treat skin conditions, patients and the public will be better placed to take ownership and become embedded in the various elements of the cycle. In the author’s opinion, patients are experts in their care and can help shape R, I and E projects in line with the subject matter. Placing PPI at the heart of each stage in the cycle in Figure 1 will only have the potential to better engage participants and promote better patient outcomes.

In This Together (ITT) is an informative magazine, now in its sixth year, for people with conditions that require long-term management with compression therapy. We are excited to also launch the In This Together website so that we can offer more frequent education, resources and updates in between issues of the magazine.