Clinical

Our clinical nursing articles aim to inform and educate nurse practitioners and students. This is achieved through the publication of peer-reviewed, evidence-based, relevant and topical articles.

How to ensure a successful general practice nursing placement

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?

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

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 treatment centre

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

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

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.

Improving women’s uptake of cervical screening in primary care

Improving women’s uptake of cervical screening in primary care

Strategies healthcare professionals can implement to improve the uptake of cervical screening

Measles: the role of health protection teams and primary care

Prompt notification by clinicians and appropriate public health actions can prevent infection

Death: a social disadvantage? How one hospice is addressing inequality at end of life

Death: a social disadvantage? How one hospice is addressing inequality at end of life

How a small independent hospice developed an equalities steering committee for the community

Brief health promotion in urgent care centres: a qualitative study of patients’ and nurse practitioners’ attitudes

Brief health promotion in urgent care centres: a qualitative study

Patients’ and nurse practitioners’ attitudes to brief health promotion

 ‘Why didn’t I say something at the time?’ A reflective account of a public incident

‘Why didn’t I say something at the time?’ A reflective account of a public incident

A reflection on an incident observed while commuting relating to the issue of data protection

Family members’ and carers’ perceptions of palliative care provided by district nurses

Family members’ and carers’ perceptions of palliative care provided by district nurses

This literature review identifies the challenges of delivering consistent palliative care

Identifying barriers to engaging older adults with primary care sexual health services

Despite the prevalent cultural stereotype that people’s sexual activity declines or ceases...

Nurse-led advanced cardiovascular assessment: a case study

A study of the process of diagnosing a patient and other factors

Preparedness of practitioners to care for people with motor neurone disease at home

Qualitative study on how health and social care staff perceived their preparedness

Invasive meningococcal infection

An understanding of the need for immunisation against meningitis is essential in primary care

The lived experience of women with faecal incontinence after childbirth

Bringing together women’s perspectives using a thematic synthesis

Reflections on appraisal training for practice nurses

This article reflects on the value and outcomes of two projects commissioned by NHS England...

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