In each issue of the Journal of General Practice Nursing we investigate a topic currently affecting our readers. Here, Binkie Mais, considers patient care and asks...
Toby Capstick highlights why healthcare professionals and patients need the new UK Inhaler Group standards.
Teaching correct inhaler technique has long been known to be key in the management of respiratory conditions; the British Thoracic Society (BTS) and Scottish Intercollegiate Guidelines Network asthma (BTS/SIGN, 2016) and National Institute for Health and Care Excellence chronic obstructive pulmonary disease (COPD) (NICE, 2010) guidelines give almost identical advice to healthcare professionals; namely, that inhalers should be prescribed only after patients have received training in the use of the device, and have demonstrated satisfactory technique, which is repeated regularly thereafter. This recommendation is emphasised in the NICE asthma and COPD quality standards (NICE, 2013; 2016).
Kathryn Evans gives her views on what needs to be done to provide high value wound care.
I have always been passionate about wound care and, as a practising district nurse, I learnt by experience and training to measure wounds, take photographs and undertake Doppler assessments (a noninvasive method to identify arterial insufficiency in the leg). This helped me to establish the treatment that each wound needed.
What I did not know was the effectiveness of my prescribed care and how my healing rates compared with another nurse’s care. I also could not say with any accuracy how quickly a patient could expect their wound to heal. I wish I had known…
So, my questions to you would be: Do you know? And, why is it important?
Malnutrition (undernutrition) affects three million people in the UK (Brotherton et al, 2010) and is responsible for health and social care costs exceeding £19 billion annually in England alone, half of which is due to people over 65 (Elia, 2015). While it is accepted that good nutrition is important to maintain health, there is a general lack of responsibility and ownership around the problem of undernutrition in primary care. Lack of understanding, including how to identify and treat it is also widespread. Despite National Institute for Health and Care Excellence (NICE) guidelines stating that all healthcare professionals should be involved in nutritional screening and treatment (NICE, 2006), there are barriers stopping primary care nurses from screening, i.e. challenges of organisational culture and competing priorities (Green and James, 2013; Green et al, 2014).
The 21st September 2016 saw the launch of the latest version of our national asthma guideline, published jointly by the British Thoracic Society and the Scottish Intercollegiate Guidelines Network (BTS/SIGN, 2016).
The original BTS guideline was published in 1990, and SIGN’s own version dated back to 1996. In 1999 the two organisations recognised the need to develop a joint guideline, the result of which was the 2003 BTS/SIGN asthma guideline (SIGN/BTS, 2011).
This is the seventh version of this guideline, which has been produced in conjunction with a range of stakeholders including the Royal College of Physicians (RCP), Primary Care Respiratory Society (PCRS), Asthma UK and Health Improvement Scotland (HIS).
The ‘General Practice Nursing – Leadership for Quality’ (GPNLQ) programme was developed by Judi Thorley and Sally Rogers (both chief nurses and directors of quality and safeguarding at NHS South Cheshire and NHS Vale Royal clinical commissioning groups [CCGs] and NHS Eastern Cheshire CCG respectively), after local discussions within their CCGs around the need for further support and learning opportunities for general practice nurses (GPNs).
They felt that GPNs were unintentionally professionally isolated, and had to work in a climate that did not support personal development, with some GPNs not being released for clinical training, let alone training for personal development in an area as ‘non-clinical’ as leadership.
Judi and Sally invested a significant amount of their own time in scoping out the programme, planning and, indeed, delivering the training. They also networked assiduously and gained the support of key individuals promoting the role of GPNs on the national stage.
Over the past five years, NHS commissioners have started to practise outcomes-based commissioning. Many of the new provider-led models of care heralded in the Five Year Forward View (NHS England, 2014) build on the concept of ‘accountable care organisations’ (ACOs). The ACO model is predicated on payment for outcomes.
While still in its infancy, our understanding of outcomes that matter most to people and families is growing — and those outcomes may be different to the clinical biomarkers we have traditionally measured.
Accounting for person-centred outcomes would fundamentally change conversations with patients and the focus of clinical practice, because we would worry less about the numbers and more about supporting people to live full, productive lives. Let’s imagine how that might work.
With wound and skin care taking up a considerable part of general practice nursing time, the new GPN ‘nurse consultation’ series follows the therapy chain for the management of patients with venous leg ulcers and looks at the skills needed to ensure safe, competent and professional consultations with patients.
Here, Kimberley Socrates, tissue viability nurse specialist, Oxleas NHS Foundation Trust, looks at the first link, i.e. the importance of accurate wound assessment aided by skin/ wound cleansing and debridement, and offers a simple, clinical and cost-effective method of debridement.
The NHS agenda is increasingly focused on promoting self-care for patients with long-term conditions and
healthcare professionals are being encouraged to empower patients to become equal partners in their care. This
article discusses some of the self-care strategies that patients with venous leg ulceration (VLU) can undertake
to promote healing or prevent recurrence. The evidence base to support the effectiveness of these activities will
also be discussed. Furthermore, with the very real shift in wound care from the domain of specialist nurses to
clinicians working in primary care, namely general practice nurses (GPNs) (Guest et al, 2015), it is vital that they are
prepared and trained to care for patients with venous leg ulcers, the number of which is likely to rise with an ageing
population (Atkin and Tickle, 2016).
There has been an increase in non-cancer-related cases of lymphoedema across the UK and there is a need to raise awareness of this chronic non-curable condition (Williams, 2003; Keen, 2008). Lymphoedema can be effectively managed in primary care; however, frontline clinicians should have an understanding of the difference between lymphoedema and other lower limb conditions, especially with regards to lower limb lymphoedema. There are also gaps in knowledge around the practice of managing poorly drained interstitial fluid, which need to be addressed. However, for management to be effective, a patient-centred approach needs to be established with patients directing their care. As the management of lymphoedema involves patients doing exercises, it impacts on their day-to-day lives. Slight modifications, such as personal massage to improve lymphatic drainage, skin care to improve skin texture and theraband exercises to aid mobility, may need to be considered as part of the management process and, as the medical model on its own is not effective in managing this condition, patients may need to be referred to a team of specialist practitioners.
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