What practice nurses need to know about the NICE chronic kidney disease guidelines

Chronic kidney disease is highly prevalent in the community. Peter Ellis looks at the role of the practice nurse in diagnosing and managing chronic kidney disease in general practice Chronic kidney disease (CKD) is defined as a reduction in kidney function, or damage to kidney structure, which has persisted for greater than 3 months and which is associated with other health-related issues. While there are many causes of CKD, the most prevalent in western societies, including the UK, are diabetes and hypertension. This article identifies the role of the practice nurse in applying the National Institute for Health and Care Excellence (NICE) guidelines for CKD.

Samoan People’s Knowledge and Understanding of Cardiovascular Disease

<p>This thesis explores Samoan people’s knowledge and understanding of Cardiovascular Disease and its risks; Cardiovascular Risk Assessments; and their reasons for undertaking or not undertaking lifestyle changes, if they are found to be at risk of cardiovascular disease. An interpretive phenomenological design, facilitated by the Talanoa narrative approach, incorporating the ‘Leai se tu fa’amauga’ Pacific framework was employed to conduct this research. Participants were recruited from Primary Health Services in Wellington and Porirua. Sixteen Samoan participants aged 45 to 65, and seven practice nurses were interviewed, supported by a literature review of cardiovascular disease as one of the leading causes of premature deaths and health inequalities in New Zealand, affecting mainly Pacific peoples. Samoan people’s voices utilising fa’a-Samoa worldviews and models of care in particular the NZ health policies to improve health literacy for this population have grounded the research and its findings. My interest in this exploration was a result of my own experience working as a practice nurse in health centres with high numbers of Pacific peoples. I often questioned whether they understood the information they were provided with, when they had their cardiovascular risk assessment. Although cardiovascular risk assessment is one of the government’s primary health targets with an emphasis on increasing the number of assessments for Pacific peoples to improve their health outcomes, Pacific peoples’ health remains poor. A number of health policies and strategies have been in place for almost two decades such as; Making a Pacific Difference and Strategic Initiatives for Pacific Peoples (MoH, 1998), the Pacific Health Disabily Action Plan (MoH, 2002), Improving Quality Care for Pacific Peoples (MoH, 2008c), and Ala Mo’ui: Pathways to Pacific Health and Wellbeing 2010-2014 (Minister of Health & Minister of Pacific Island Affairs, 2010). However there is still little or no progress in Pacific peoples’ health outcomes. The results showed that the lack of health literacy and poor command of the English language limited Samoan people’s knowledge and understanding. A number of additional factors such as demographic characteristics, educational levels, the Samoan worldview and the fa’a-Samoa, patient follow up care, length of appointment times, the ambiguity of information and lack of the continuity of community programmes, all affected the uptake of lifestyle changes. The majority of participants felt there was no true value gained from completing cardiovascular risk assessment. A key question thus raised is, ‘Does completing a cardiovascular risk assessment have any health benefits for Pacific peoples?’ The implications of the key themes that emerged from the data form the basis for recommendations on the role of the practice nurse, current and future health policies as well as future research.</p>

Samoan People’s Knowledge and Understanding of Cardiovascular Disease

<p>This thesis explores Samoan people’s knowledge and understanding of Cardiovascular Disease and its risks; Cardiovascular Risk Assessments; and their reasons for undertaking or not undertaking lifestyle changes, if they are found to be at risk of cardiovascular disease. An interpretive phenomenological design, facilitated by the Talanoa narrative approach, incorporating the ‘Leai se tu fa’amauga’ Pacific framework was employed to conduct this research. Participants were recruited from Primary Health Services in Wellington and Porirua. Sixteen Samoan participants aged 45 to 65, and seven practice nurses were interviewed, supported by a literature review of cardiovascular disease as one of the leading causes of premature deaths and health inequalities in New Zealand, affecting mainly Pacific peoples. Samoan people’s voices utilising fa’a-Samoa worldviews and models of care in particular the NZ health policies to improve health literacy for this population have grounded the research and its findings. My interest in this exploration was a result of my own experience working as a practice nurse in health centres with high numbers of Pacific peoples. I often questioned whether they understood the information they were provided with, when they had their cardiovascular risk assessment. Although cardiovascular risk assessment is one of the government’s primary health targets with an emphasis on increasing the number of assessments for Pacific peoples to improve their health outcomes, Pacific peoples’ health remains poor. A number of health policies and strategies have been in place for almost two decades such as; Making a Pacific Difference and Strategic Initiatives for Pacific Peoples (MoH, 1998), the Pacific Health Disabily Action Plan (MoH, 2002), Improving Quality Care for Pacific Peoples (MoH, 2008c), and Ala Mo’ui: Pathways to Pacific Health and Wellbeing 2010-2014 (Minister of Health & Minister of Pacific Island Affairs, 2010). However there is still little or no progress in Pacific peoples’ health outcomes. The results showed that the lack of health literacy and poor command of the English language limited Samoan people’s knowledge and understanding. A number of additional factors such as demographic characteristics, educational levels, the Samoan worldview and the fa’a-Samoa, patient follow up care, length of appointment times, the ambiguity of information and lack of the continuity of community programmes, all affected the uptake of lifestyle changes. The majority of participants felt there was no true value gained from completing cardiovascular risk assessment. A key question thus raised is, ‘Does completing a cardiovascular risk assessment have any health benefits for Pacific peoples?’ The implications of the key themes that emerged from the data form the basis for recommendations on the role of the practice nurse, current and future health policies as well as future research.</p>

Clinical academic careers for general practice nurses: a qualitative exploration of associated barriers and enablers

Background The delivery of research in healthcare in the UK is dependent on a subgroup of clinicians – clinical academics – who concurrently engage in clinical practice and academic activities. The need to increase access to such roles for general practice nurses has been identified, although the need for a robust career framework remains. Aims This study, with a qualitative interview and focus group design, aimed to explore the concept of clinical academic careers for general practice nurses by identifying barriers and enablers associated with pursuing and performing such roles. Methods General practice nurses ( n = 18) and general practitioners ( n = 5) engaged in either an audio -recorded interview or focus group. Verbatim transcripts were subjected to thematic analysis. Results Four themes were identified: awareness and understanding; career pathway; personal and professional attributes; and organisational factors. Awareness and understanding were generally poor. Participants suggested that the career pathway was unclear, although it was generally assumed that such roles were ‘out of reach’ and require a minimum of Master’s level education. An interest in research and the confidence to perform such duties were reported as the required personal and professional attributes. Organisational factors included the need for employers to understand the value and benefit of general practice nurse clinical academic roles, along with ensuring that the inevitable competing demands of such a role were appropriately managed. Conclusions This study highlights the difficulties faced by general practice nurses wishing to pursue a clinical academic career. Academia is seemingly placed on a pedestal, emphasising the need to embed research training early in nursing education to alter general practice nurse perceptions that clinical academic roles are unobtainable. The development of a robust career pathway for general practice nurse clinical academic roles may have a positive impact on the retention of experienced general practice nurses and attract newly qualified nurses. This research provides evidence as to the need for one.

The CombiConsultation: a new concept of sequential consultation with the pharmacist and practice nurse/general practitioner for patients with a chronic condition.

The primary health care system is generally well organized for dealing with chronic diseases, but comprehensive medication management is still a challenge. Studies suggest that pharmacists can contribute to effective and safe drug therapy by providing services like a clinical medication review (CMR). However, several factors limit the potential impact of a CMR. Therefore, we propose a new pharmaceutical care service for patients with a chronic condition: the CombiConsultation. The CombiConsultation is a medication evaluation service conducted by the (community) pharmacist and either the practice nurse or general practitioner. It consists of 3 steps: medication check, implementation and follow-up. The pharmacist primarily focusses on setting treatment goals for 1 or 2 drug-related problems in relation to a specific chronic condition. In this manuscript we describe the process and characteristics of the CombiConsultation. We compare the CombiConsultation with the CMR and explain the choices made and the implications for implementation.

An Exploration of Language and Nursing Practice to Improve Communication in the Context of Ear Syringing

<p>Action research is a critical reflective process that involves spirals of cycles if of planning, acting, reflecting/evaluating and replanning the next cycle. This action research inquiry explores communication and nursing practice in an effort to improve practice and enhance patient care. Implications of this study indicate that action research is a method that works, and it is a satisfying way of challenging and changing nursing practice. Using ear syringing as a procedure, in the general practice setting and at two separate surgeries, another Practice Nurse and I co-researched this study during working hours. 12 people consented to participate in the research that involved the audiotaping of each ear syringing interaction. Following each transcription of the recording, my co-researcher and I read our own and then each other's transcripts, and listened to the recordings. We then met to discuss and reflect on our findings and to plan the next cycle. Throughout the process, my co researcher and I found a number of areas of practice we could change or enhance. Changes included the use of technical language such as "contraindications" and "auditory meatus", the side effects of syringing, improvements in communicating situations where ear syringing is not recommended and the options available, and post procedure information. These changes became a significant challenge and areas for improvement when both my co-researcher and I forgot the changes, thus repeating previous errors and omissions. This factor highlighted the need to practise any changes prior to interactions, and to have a cue card on hand to facilitate recollection and to cement improvements into practice. Although time constraints limited this inquiry to three cycles, at the final meeting we agreed to continue the reflective process we had begun to explore our practice.</p>

An Exploration of Language and Nursing Practice to Improve Communication in the Context of Ear Syringing

<p>Action research is a critical reflective process that involves spirals of cycles if of planning, acting, reflecting/evaluating and replanning the next cycle. This action research inquiry explores communication and nursing practice in an effort to improve practice and enhance patient care. Implications of this study indicate that action research is a method that works, and it is a satisfying way of challenging and changing nursing practice. Using ear syringing as a procedure, in the general practice setting and at two separate surgeries, another Practice Nurse and I co-researched this study during working hours. 12 people consented to participate in the research that involved the audiotaping of each ear syringing interaction. Following each transcription of the recording, my co-researcher and I read our own and then each other's transcripts, and listened to the recordings. We then met to discuss and reflect on our findings and to plan the next cycle. Throughout the process, my co researcher and I found a number of areas of practice we could change or enhance. Changes included the use of technical language such as "contraindications" and "auditory meatus", the side effects of syringing, improvements in communicating situations where ear syringing is not recommended and the options available, and post procedure information. These changes became a significant challenge and areas for improvement when both my co-researcher and I forgot the changes, thus repeating previous errors and omissions. This factor highlighted the need to practise any changes prior to interactions, and to have a cue card on hand to facilitate recollection and to cement improvements into practice. Although time constraints limited this inquiry to three cycles, at the final meeting we agreed to continue the reflective process we had begun to explore our practice.</p>