Evidence and Practice
How to ensure a successful general practice nursing placement
What are the benefits of nurse-led triage in primary care?
Ethical challenges in delivering person-centred care
Clinical
How to ensure a successful general practice nursing placement
Why you should read this article • To enhance your knowledge of the professional and personal benefits of supporting general practice nursing placements for students • To recognise that showcasing the variety and diversity of opportunities in general practice through placements may offer one way to address workforce shortages • To be aware of policy initiatives that require significant increases in the number of general practice nurses One in three general practice nurses are due to retire in 2020. Workforce shortages are intensified by government initiatives that emphasise care closer to home. General practice nursing offers exciting and diverse opportunities, including treatment room roles, specialist chronic disease management and advanced practice. Practice placements offer one way to attract future nurses to the specialty, and the number of placements must be increased. This article examines the benefits of and the barriers to a successful nursing student placement in general practice nursing from the perspective and experience of a mentor and student (the authors of this article). It identifies how forward planning before the placement begins can enhance the student’s learning experience.
What are the benefits of nurse-led triage in primary care?
Why you should read this article • To update your knowledge and ensure your practice is based on the latest available evidence • To familiarise yourself with the evidence regarding the use of nurse-led triage in primary care • To understand the main benefits of introducing nurse-led triage into primary care Background In the UK, fewer medical professionals are training as GPs, while more GPs are working part-time and planning to retire early. This is increasing pressure on primary care services, and the GP and practice nurse workforce. Aim To examine whether nurse-led triage assists with managing demand for GP appointments in primary care. Method Data on patients’ clinical outcomes were used to evaluate two nurse-led triage services that were implemented in GP surgeries in the South Powys GP cluster in Wales to reduce demand on GPs’ time. One of the services was a two-year pilot of a standard nurse-led triage service, which managed all same-day appointment requests made by patients either in person or via the telephone. The other service was a six-month pilot of a Total Nurse Triage service, which managed appointment requests for both same-day and routine appointments made by telephone. A web-based clinical template was developed to capture data from individual practices on consultation rates, times and outcomes. A patient satisfaction survey was also distributed to patients who had used the Total Nurse Triage service. Results In the standard nurse-led triage service, a total of 13,113 GP appointments were saved over the study period by, for example, providing advice to patients, providing a prescription or ‘sick note’ or providing an appointment with a nurse in the practice. In the Total Nurse Triage service, 2,270 GP appointments were saved over the study period by directing patients to other services, such as dental, physiotherapy or community pharmacy services. Conclusion The study demonstrated the usefulness of nurse-led triage services, particularly the Total Nurse Triage service, and supports the implementation of a standard nurse-led triage or a Total Nurse Triage service in other GP clusters in Wales and the rest of the UK.
Uncovering the hidden workload involved in providing cancer care in the community
Why you should read this article • To enhance your awareness of the unrecognised work involved in cancer care • To recognise the challenges that primary care and community staff commonly experience in diagnosing and caring for people with cancer • To understand the importance of recognising and recording hidden workload to improve cancer care delivery and coordination Background While the workload of primary care healthcare professionals in the UK is increasing, the precise nature of the work involved in caring for people with cancer has not been explicitly defined. Aim To explore the opinions of a small group of primary and community healthcare professionals in London, England about the workload involved in caring for people with cancer, as well as to identify elements of the role that are unrecorded. Method This evaluation used a mixed-methods approach that followed an exploratory sequential design to survey and interview primary and community care staff in London. Descriptive integration was used to merge the quantitative data from the questionnaires and the qualitative data from the interviews to enable comparison and analysis. Findings The questionnaire received 92 responses and seven interviews were completed. Interviews revealed that the recording systems of healthcare organisations did not effectively capture healthcare professionals’ cancer care workload. Participants reported the unpredictable nature of cancer care, with people often presenting with vague symptoms. Participants also reported the unrecognised but essential work that they often undertook, such as developing relationships with people with cancer and their families. Conclusion Healthcare professionals working in primary care identified that there are elements of the workload involved in cancer care that are hidden and unrecognised, such as developing relationships with people with cancer and their families. Effectively recording and recognising the hidden workload involved in caring for people with cancer has the potential to improve cancer care delivery and coordination.
Exploring the effectiveness of a brief health promotion intervention in an urgent...
Why you should read this article: • To enhance awareness of the importance of health promotion in addressing modifiable risk factors to prevent long-term conditions • To understand the role of nurses in providing health promotion in urgent treatment centre and primary care settings generally • To gain knowledge of the factors that may influence the effectiveness of brief health promotion interventions Background In Portsmouth, the prevalence of long-term conditions and presence of modifiable risk factors are often higher than in England as a whole. It has been identified that most adults presenting to an urgent treatment centre (UTC) in Portsmouth have one or more of the following risk factors: smoking, being overweight or obese, and alcohol overuse. Opportunistic health promotion may be beneficial in addressing these risk factors, but there has been little research on its use in UTCs. Aim To determine the efficacy and effectiveness of using an opportunistic brief health promotion intervention – including advice on smoking cessation, weight management and alcohol intervention as appropriate – with adult patients presenting to Portsmouth’s UTC. Method A total of 204 participants were recruited to a randomised controlled trial (RCT). Half of the participants (n=102) received the brief health promotion intervention at initial consultation within 20 minutes of their arrival at the UTC (Arm A). The other half of the participants (n=102) received the brief health promotion intervention at full consultation, between 20 minutes and four hours later (Arm B). The primary outcome measure was the number of referrals to the local well-being service for further support with behaviour change. The secondary outcome measures were the acceptability of the intervention and the time taken by the intervention. Results Participants were generally receptive to the brief health promotion intervention. Of the 204 participants, 64% (n=130) accepted the support provided at the UTC, which indicates that a brief health promotion intervention is acceptable to most patients presenting to the UTC. The same number of referrals to the local well-being service was made in Arm A and Arm B (n=11 in each, n=22 in total), indicating that the timing of the intervention did not affect participants’ decisions to accept or reject referral. Conclusion An opportunistic brief health promotion intervention with patients presenting to UTCs is feasible and potentially effective. Nurses practising in UTCs and primary care settings generally need to use every opportunity to engage patients in health promotion as part of their routine consultations. Adequate training, support and policies are required to assist nurses in integrating health promotion into their practice.
How to manage PVL-associated Staphylococcus aureus infections in primary care
Health protection and primary care teams should work together to carry out a risk assessment
Why general practice nurses need education about cancer as a long-term condition
This article outlines the results of a survey of cancer training needs conducted with general practice nurses (GPNs) in South West London in 2018. The survey determined the nurses’ views about three areas of their work related to cancer: how they see their role in cancer care, their confidence in their cancer knowledge and their attitude towards cancer education. The survey was one of the early results of a Macmillan Cancer Support-funded, two-year project developing GPNs’ role in supporting patients living with and beyond cancer. It informed the development of an ‘education and influence strategy’ designed to embed in GPNs’ roles the management of cancer as a long-term condition. The authors recommend that undergraduate and postgraduate courses for primary care nurses should incorporate education about cancer as a long-term condition.
CPD articles
Ethical challenges in delivering person-centred care
Why you should read this article • To understand the difference between normative ethics and teleological ethics, and how they are applied in everyday care situations • To enhance your knowledge on ethics derived from the principles of person-centred care • To count towards revalidation as part of your 35 hours of CPD, or you may wish to write a reflective account (UK readers) • To contribute towards your professional development and local registration renewal requirements (non-UK readers) Nurses working across community and primary care settings face a number of ethical issues in their everyday work. Ethical principles underpin optimal practice. There are two main approaches to ethical reasoning: normative ethics, based on the rights and obligations of an individual; and teleological ethics, based on anticipating the consequences of an action. Issues can arise when ethical principles based on the obligations of the nurse or an analysis of the possible consequences of an action are applied to care. Nurses have to manage patients’ expectations, service protocols and economic constraints, as well as proceed in a person-centred and ethical way. This article explains the two main approaches to ethical reasoning, before identifying their limits and proposing some person-centred principles of care negotiation that will enable nurses to provide care that is principled and practical.
How to make clear and compelling written arguments: advice for nurses
In healthcare clearly formulated arguments can mean nurses’ efforts are directed effectively
Dengue fever
Nurses involved in travel health should be aware of the signs of dengue fever and what to do
Tracheostomy care in community settings
Risks associated with tracheostomy cannot be eliminated, but they can be addressed
Continuing professional development: lymphoma in primary care
This article summarises the diagnosis, treatment and long-term consequences of lymphoma
Understanding the health risks of varicella zoster virus in pregnancy
Varicella zoster virus (VZV) is a common illness that causes varicella (chickenpox) and shingles. It is prevalent mostly during childhood but there are additional co-morbidities from this disease for a woman and her fetus, if she contracts it during pregnancy. Many developed countries vaccinate children who have not acquired immunity to prevent their developing complicated varicella as adults. Countries that have implemented widespread vaccination have fewer hospital admissions for such complications. The UK does not have a national VZV vaccination programme and there is no strategy for reporting and documenting the incidence of the illness, so it is difficult to determine the potential prevalence of gestational VZV and its associated outcomes. The aim of this article is to provide an understanding of the aetiology of VZV and the potential health risks to unimmune women who may contact it during pregnancy, to advise them about their healthcare choices.
Research focus
How can community and primary care nurses support and treat people with hoarding...
Three studies highlight the complexity of this disorder – and the provision of treatment
How to ensure better integrated care
Three recent studies look at methods to facilitate greater integrated care
How to treat eating disorders in primary care
Three studies highlight the growing incidence of eating disorders in primary care
Upper limb rehabilitation following a stroke
Rehabilitation for upper limb impairment, which occurs in a majority of strokes, is reviewed
Dementia therapy through music
Three studies examine the benefits of music-based therapies for people with dementia
Sleep health and insomnia treatment options
A look at three studies relating to sleep health, insomnia and cognitive behavioural therapy