Exudate is produced as part of the inflammatory phase of wound healing and assists the healing process by providing essential nutrients to the wound, promoting moist wound healing and naturally debriding the wound bed. However, exudate can also be detrimental to the healing process and managing excessive exudate in clinical practice is often challenging. The key to managing exudate is accurate assessment and identifying the underlying cause of excessive production. Accurate diagnosis and assessment will assist general practice nurses (GPNs) in selecting appropriate treatment options and strategies that can help in managing exudate efficiently. This article discusses what exudate is and its function in wound healing. It also explores the causes of excessive exudate production and what GPNs can do to manage high volumes to prevent skin damage and improve patient quality of life.
Frailty is becoming increasingly recognised as a long-term condition associated with ageing that should be primarily managed in primary care. Diagnosing frailty identifies a high-risk population group and highlights areas of clinical importance that can be treated and managed. In 2017, NHS England introduced new elements into the GP contract, which require practices to identify moderately and severely frail patients, and to offer a clinical review to those who are severely frail (NHS England, 2017b). This review should include assessment of falls risk, medication review and seeking of permission to activate the enriched Summary Care Record (SCR). This article examines the general practice nurses’ role in the care and support of older people who live with frailty, and gives guidance on how to review medication, assess falls risk and use the SCR to ensure patients’ wishes and care preferences are recorded.
Lymphoedema is a debilitating condition that results in significant discomfort for patients and has no cure. However, with careful assessment and accurate diagnosis, appropriate treatment can relieve symptoms such as swelling and pain and improve patients’ quality of life. This article outlines the physiology of lymphoedema, before exploring the assessment and treatment measures, which include compression therapy to reduce oedema, skin care, manual manipulation of lymph fluid and exercise.
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.
Chronic urticaria is a relatively common complaint in clinical practice. It often has an unknown aetiology or a difficult-to-avoid trigger and although rarely life-threatening, it has a profound impact on quality of life, reaching beyond the
impairment directly related to physical symptoms. All these aspects make its management complex and often frustrating both from a patient and professional perspective. Most patients with urticaria will be seen first in primary care, often by practice or community nursing staff. With good knowledge on diagnosis and management, up to 80% of these patients can be managed adequately in primary care.
Wheezing is a common problem among preschool children (Bhatt, 2013), and its prevalence is rising in the UK (Kuehni et al, 2001). This has an inevitable impact on healthcare costs. Indeed, it is estimated that caring for this patient group costs around £53 million (Brand et al, 2008). This article informs general practice nurses (GPNs) about the condition which can vary greatly in frequency and acuity, so that appropriate supportive management and follow-up can be offered when a child presents with this condition to the surgery. The patient story sets the scene of a typical wheezing preschool child, and raises the questions about whether to treat or not to treat; the concerns parents have about treatment, acute episodes and the overall management of preschool children with wheeze.
Frailty is a clinical syndrome which focuses on loss of reserve, energy and wellbeing. Currently, older people with frailty tend to present late and often in crisis to health and care services so their care may be hospital-based, episodic, and unplanned. There is a need to reframe frailty as a long-term condition that can be mainly managed within a primary and community care setting, with timely identification for preventative, proactive care underpinned by supported self-management and person-centred care. General practice nurses (GPNs) will play a vital role in this new paradigm for frailty as key workers, coordinators of care, and supporters to patients and their carers at all stages of the frailty trajectory.
Asthma is a common long-term condition affecting adults and children. Despite a number of evidence-based guidelines for treatment and new medications and inhaler devices, mortality rates remain static. Key findings from the National Review of Asthma Deaths (Royal College of Physicians [RCP], 2014) highlighted the importance of personalised asthma action plans (PAAPs) in good asthma care. This article looks at how healthcare professionals need to work with adults and children with asthma, involving them throughout the process, to produce a meaningful, useful plan that has been developed with the person, and parents or carers. The plan should be used as an educational tool to help understand how, when and why asthma medication should be used, what is meant by asthma control, and recognition of when control is slipping.
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