Useful information

This chapter provides other useful topics for nurses working in primary care or community settings. It defines telecare and telehealth, assistive technologies (ranging from special educational needs equipment to moving and handling systems) and home adaptations (including complex equipment, methods of hiring or buying disability equipment, and wheelchair services), and complementary and alternative therapies (including acupuncture, aromatherapy, faith healing, herbal medicine, homeopathy, hypnotherapy, osteopathy, chiropractic treatments, and reflexology). It also outlines processes for the verification of the fact of death, certification of death, and the registration of births, marriages, civil partnerships, and deaths.

Adult health problems

This chapter covers primary care and nursing of various conditions that adults may present with including frailty, skin infections (bacterial, fungal, and viral), skin cancer, eczema, psoriasis, pigmentation and hair problems, and allergies. It also covers deafness, mouth and throat problems, adrenal disorders, anal conditions, gastro-oesophageal reflux and disorders of the bowels, viral infection, and food-borne disease. It also covers bowel disease, coeliac disease, appendicitis, hernias, intestinal obstructions, problems of the liver, gallbladder, and pancreas, as well as common musculoskeletal problems, and bone and connective tissue disorders. Sexual health problems are extensively described, including how to conduct a consultation, sexually transmitted infections, sexual problems, and sexual health in the context of adults with learning difficulties. Breast and gynaecological cancers are covered, alongside problems with menstruation, the ovaries, uterus, and vagina. The final section covers issues relating to termination of pregnancy.

Care of adults with long-term conditions

Multiple comorbidities necessitate care from a number of healthcare providers. Continuity of care is important for both patient satisfaction and quality of life. This chapter outlines primary care for adults with a variety of conditions, including osteoarthritis, rheumatoid arthritis, lower back pain, asthma and acute asthma, and stable and chronic obstructive pulmonary disease. It covers drugs commonly used in the treatment of respiratory conditions, including long-term oxygen and nebulizers. It then goes on to cover coronary heart disease, angina, hypertension, cardiac rehabilitation, heart failure, abnormal cardiac rhythms and atrial fibrillation, patients on anticoagulant therapies, and drugs used in cardiovascular diseases. The chapter also includes information on anaemia, varicose veins, diabetes, multiple sclerosis, motor neurone disease, and Parkinson’s disease.

Service users with extra needs

This chapter covers populations who have special circumstances that increase their needs when accessing healthcare. This includes asylum seekers and refugees, homeless people, gypsies and other travellers, those affected by domestic violence, adults at risk from harm and abuse, victims of crime, and young people transitioning to adult services. It also covers adults with learning disabilities, carers, people living with HIV, people with eating disorders, those who abuse substances, people with bipolar disorder, psychosis, and post-traumatic stress disorder, patients with dementia, and armed forces veterans. The chapter also covers female genital mutilation (FGM), and identifying women and girls who have been subject to FGM.

Nursing in primary care

This chapter begins by outlining the different roles that nurses can occupy in primary and community care. It provides information on learning to work in primary and community care, the focus and responsibilities of general practice nursing (including advanced nurse practitioners), school nursing, health visiting, and district nursing. It covers clinical supervision and appraisal, continuing professional development, and facilitating nursing in practice. Research ethics and research governance in primary care and community nursing is discussed, alongside teamwork and leadership development, and innovation and project planning. Finally, it considers information for changing and informing practice.

The context of healthcare

This chapter begins by covering the UK health profile, then defines the key concepts in primary care and public health, and outlines the generic long-term conditions model. It provides a brief overview of the National Health Service, including differences in England, Northern Ireland, Scotland, and Wales. It covers current NHS entitlements for people from overseas, commissioning of services, and public health in a broader context. It also describes health needs assessment, and provides an overview of the services in primary care, the role of general practice, and other primary healthcare services. Further services, including those to prevent unplanned hospital admission, aid hospital discharge, those that support children and families, housing, social support, and care homes are all covered.

Adult care provision

This chapter covers the provision of primary care to adults. This includes urinary incontinence, catheter care, constipation and incontinence, stoma care, spinal cord injury, the prevention of pressure ulcers, wound infection and debridement, malignant fungating wounds, wound dressings, leg ulcers and their dressing, compression therapy for venous ulcers, and lymphoedema. It also covers palliative care, including services for the dying patient, pain assessment and management, nausea, breathlessness, fatigue, depression, and spiritual care, and caring for patients in the dying phase. Emergencies, assisted dying, legal issues around the end of life, and bereavement are all covered. Common technical procedures including the care of central venous catheters, injections, venepuncture, recording a 12 lead electrocardiogram, tracheostomy care, and ear irrigation are also described.

Child health promotion

The Children Act (2004) places a responsibility on health practitioners to work together to help a child be healthy, stay safe, enjoy and achieve, make a positive contribution, and achieve economic well-being. This chapter covers the assessment of children, screening tests for vision and hearing, the immunization schedule, and accident prevention. It includes information for working with parents, providing support to new parents, and new birth visits. It then covers pre-term infants, new babies (including twins and multiple births), breast and bottle feeding, and weaning. Growth and development milestones are explained for different age ranges. The promotion of development, toilet training, good food habits, speech and language acquisition, and communication are all covered. The chapter also covers puberty and adolescence, health promotion in schools, sex and relationship education, and child and adolescent mental health. Separately, the care of children with complex health needs, disabilities, and special educational needs is described. Safeguarding children, identifying at-risk individuals, child protection processes, and the care of looked-after children are all included.

Approaches to individual health needs assessment

The purpose of assessment at an individual level is to establish a baseline of the health and well-being of the person and create a mutually agree plan of care. This chapter explains an integrated assessment for adults, the core components of a case management programme, and consultation models and frameworks, alongside standardized assessment tools. The principles of good communication in patient assessment are outlined, as well as more detailed instructions for situations where the patient has additional needs (for example, deafness, where English is a second language, non-fluent English speakers, or those with learning difficulties). Assessment by remote consultation is covered, as well as motivational interviewing.

Quality and safety

This chapter covers quality governance, clinical audit, evidence-based healthcare, the Quality and Outcomes Framework (QOF), patient and public experience, complaints procedures, and clinical risk management. It includes professional conduct, the provision of anti-discriminatory healthcare, and consent. Professional accountability is outlined, as well as the role of chaperones, methods of whistleblowing, correct record keeping and access to records, confidentiality, and client- and patient-held records. Health and safety at work for both employers and employees is discussed, together with specific issues that arise with lone working in the context of community nursing. Personal safety measures such as hand washing and personal protective equipment are covered. Occupational exposure to blood-borne viruses and the appropriate response is described, as well as notifiable diseases, managing healthcare waste, and the management of sharps waste.