Primary care nurses are having to transform their ways of working
Asthma is a common problem managed in primary care, however many patients do not have good control of their condition. This article looks at routine asthma care, indicating where the findings from the 2014 National Review of Asthma Deaths might change current practice. It examines triggers and exacerbations and considers the four key areas identified in the report: the use of services, medical and professional care, prescribing and medicines use, patient factors and perception of risk of poor control. The article also highlights the role of medications, including helping patients understand stepping up and stepping down, the place of current and future therapies in asthma care, and how to review patients effectively while managing their concerns.
This article considers the place of palliative and end of life care in the management of people with end-stage chronic obstructive pulmonary disease (COPD). This respiratory disease has considerable morbidity and mortality, which affect patients, their families and carers, and healthcare provision. Many nurses working with older people will encounter patients with advancing COPD which may be their main problem or part of multiple comorbidities. This article aims to help nurses recognise declining respiratory status and understand the challenges faced by this particular group of patients, their families and carers. It follows recommendations that end of life care should be considered and dealt with in this group of patients ( Department of Health 2008 , National Clinical Guideline Centre 2010 ). It explores palliation and end of life and then considers more practical applications to support nursing care at the end stage of the disease.
In 2004 the first National Institute for Health and Clinical Excellence (NICE) guidelines for chronic obstructive pulmonary disease (COPD) were published. They have recently been revised taking into account further evidence and publications. This article details the updated changes relevant to current practice alongside previous relevant recommendations. NICE guidance informs best practice but it does not negate our individual circumstances and responsibility and as practitioners we have a duty of care to be aware of the latest guidance.