This module and my placements using the Gibbs

This assignment will
investigate the role of a practice/ community nurse and discuss an aspect of
care, I will be discussing wound management. I choose this subject because as a
practice nurse, wound management would be an important part of everyday clinics.
I will also discuss a number of qualities and skills needed to be a general
practice nurse (GPN) and reflective on the module and my placements using the
Gibbs (1988) reflection model, to help learn and improve personal practice.

The primary health care team,
play a vital role in helping the NHS, meet the needs of patients who may not be
able to visit the hospital and helps to lower hospital admissions, frees beds
for patients and helps to prevent long-term admissions (Edwards, 2014).

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Relevant
competencies and training as a GPN

With the movement of care
shifting from hospitals to general practice, it is important that GPN has the
skills and knowledge to deliver optimum care. Utilising a wide range of
clinical and diagnostic skills will be an everyday occurrence. An extensive
amount of expertise is required in order to support patients with all types of
conditions (Cooke, 2017). Relevant training needs to be updated and guidelines
need to be followed. For example, training on infection control is essential
and guidelines (Nice guideline, 2012) need to be followed (Evans et al,
2012).  In addition, there are a number
of competencies that need to be completed to become a GPN. Some of the
competencies needed are: communication with patients, have an understanding of
the ethical issues and clinical audit that impinge on general practice, manage
clinical risk within consultations and Being able to assist the patient to make
decisions in a style appropriate to their wishes. These competencies and others
are to be signed off before a nurse would be seen as competent and safe to
practice (Ruscoe et el, 2012).

While on placement in a
General practice surgery, I had to complete a set of competencies in my first
two weeks before I was deemed competent to take my own clinic. It was an
exciting thought to take my own clinic. However, I wasn’t feeling confident in
doing this and felt I did not know enough to do so. It gave me a chance to
develop and grow as an individual and as a professional. However, I feel the
only downside was the unsure feeling of being on my own. I learned to work
within a time limit, keeping myself and my patients safe, gaining consent with
everything I did and the importance of documentation. It showed me that I do
know more than what I thought and I always asked for help when unsure. If I had
this opportunity again, I would have done more reading on wound care and
utilised staffs knowledge and skills a little more. Overall, the experience has
improved my knowledge, practice, and self-confidence.

Teamwork
in primary care

An essential aspect of general
practice nursing is teamwork. The importance of teamwork in nursing cannot be
overemphasised, it depends on teams to meet objectives. Effective teamwork
means less stress and a higher quality of care is provided to patients
(Kalisch, Weaver& Eduardo, 2009).

GPNs need to communicate and
work as a team alongside doctors, pharmacists, and dieticians, as well as other
specialists (Cooke, 2017). The NMC (2015) states “nurses should respect the
skills, expertise, and contributions of colleagues, referring matters to them
when appropriate”. Working in partnership with other professionals and
organisations is vital for general practices to provide effective services for
patients, but it is vital to acknowledge that joint working must adhere to
primary care trust policies. For example, if community nurses and practice
nurses set a wound care clinic together, there may already be a primary care
trust policy on wound management that need to be adhered to (Campbell,
Longbottom & pooler, 2007).

Reflecting back on the module
there has been activities that have required me to work within a team. I didn’t
feel that this would be a problem as through my training and previous work it
has been essential for me to work in a team. The good aspect of working in a
team is that you get to discuss and hear other people’s perspectives on a
topic. The only negative aspect of working in a team is mixed opinions can
sometimes cause disagree. However, the team I was in listened and discuss in a
polite and respectful manner. I feel that in the future I will try and continue
this approach in my own personal practice. 

Ethical
and legal aspects of primary care

There are many ethical and
legal aspect to practice nursing. Healthcare providers have a legal obligation
to provide treatment for their patients, if they fail to provide treatment,
they may incur liability under civil law or even criminal law. There are many
more legal aspects that need to be taken into consideration when nursing. For
example, practice nurses need to obtain consent, otherwise, legal action could
be taken if consent is not obtained before treatment, However, Consent can only
be given by a fully informed individual with the capacity to give consent
(Taylor,2013). If an individual does not have capacity then the mental capacity
act (2005) must be followed. In addition, there are also ethical issues that
need to be taken into account. In promoting health, preventing illness,
restoring health and alleviating suffering, the GPN may experience ethical
conflict. The GPN must then apply his or her reasoning abilities and ethics
knowledge to the patient care situation to determine what action ought to be
undertaken (Fry & Johnstone, 2002). 

Health
policies relating to primary care

There are many policies put in
place to maintain safety. Firstly, a practice nurse must keep up to date with
training, such as manual handling. Moving and handling is a key part of the
working day, poor moving and handling practice can lead to accidents, which can
cause injury to both patient and nurse (Trinkoff, 2008). They need to adhere to
health and safety policies and follow procedures if any incident should arise.
Every day over a million NHS patients is cared for by practice staff. Most patients
are treated safely, but unfortunately, sometimes things go wrong. GPN should
always report all patient safety incidents and near misses whether they result
in harm or not. These reports can be used to spot emerging patterns or any
concerns. This is then used to raise awareness of the risks and helps to
protect patients (NHS improvements, 2017).

This also includes adhering to
health policies such as safeguarding patients such as adults who are incapable
of looking after any aspect of their lives, to individuals experiencing a short
period of illness or disability (British Medical Association, 2011) and the
Freedom of Information Act (2000) that gives anyone the right to ask for
recorded information held by public authorities.

Managing
of significant events in general practice

Significant event analysis
(SEA) is an increasingly routine part of general practice. It is a process used
to reflect on and learn from, it is promoted as a team-based approach to
enhancing patient safety and quality of care (McKay, 2009).  Without reflecting on experiences and
questioning ourselves about what it means, learning doesn’t really happen.
Reflection helps to turn an experience into understanding and a tool to learn
from (Ayoubi, 2013). SEA team discussions should be held routinely as part of
the practices quality improvement and is an opportunity for the team to:
discuss each stage in detail, identify any learning needs and identify actions
to be taken. Then changes to be agreed and discussed how these will be
processed. SEA is a process that should be continuous and used as a basis for
improving practice (Bowie, de Wet & Pringle, 2011).

Chronic
illness management

One of the main requirements
of a GPN is to manage a long-term chronic disease. Chronic diseases are a
condition that currently has no cure and need to be managed with drugs or other
treatments. Examples of chronic diseases are diabetes, chronic obstructive
pulmonary disease (COPD), arthritis and hypertension. The role of the practice
nurse includes identification, diagnosis, monitoring and management in the
primary care environment. For example, they would be the person to carry out
diagnostic test such as spirometry, diagnose COPD, prescribe medication as
appropriate (having undertaken a recognized prescribing qualification) and
provide support and advice for that patient. Practice nurses, therefore, play a
significant role in the management of people in relation to both
disease-specific care management and in supporting people care (Carrier, 2016).

Wound
care management

An important aspect of
practice nursing is wound management, wound management can be a complex and
challenging process in nursing, nurses must take responsibility for updating
their knowledge, skills and ongoing competence. The first step of giving the
optimum care of a wound requires an understanding of wound healing (Werdin et
al, 2009). Wound healing is a systematic process, that has four phases:
hemostasis, inflammation, proliferation, and maturation. s (Simon, Meyers &
Romo, 2016).

v Hemostasis
phase – This stage is the initial response to injury and its object is to stop
the bleeding (Maynard, 2015).

v Inflammation
phase – This stage focuses on destroying bacteria and removing debris. It often
shows signs of redness, heat, and pain (Maynard, 2015).

v Proliferation
phase – the wound begins to rebuilt with healthy granulation tissue. The blood
supply to the wound needs to be adequate to provide enough nutrients and
oxygen. It is important to maintain observation of the wound to monitor
changes. For example, a darker tissue is often an indicator of infection or
inadequate delivery of blood to the wound bed. However, a reddish or pinkish
colour normally means that it is healthy (Brown, 2015).

v Maturation
phase- this phase is known as the remodelling stage and can last between 21
days to two years. Epithelial cells from the surrounding areas cover the newly
formed granulation tissue and reducing the size of the wound by contracting and
pulling the edges together (Brown, 2015).

After knowing what is involved
in the wound healing process, nurses would carry out a wound assessment. An
accurate and considered wound assessment is essential to ensure appropriate
patient and wound management is given (Benbow, 2016).  A structured approach to wound assessment is required
to maintain a good standard of care (Ousey, 2012). There are serval factors
that should be recorded when assessing a wound: size of the wound, the edge of
the wound, site of the wound, wound bed, necrotic tissue, slough, and eschar,
Depth, surrounding skin, infection, and pain (Grey, Enoch & Harding, 2006).
Furthermore, a good wound assessment should include patient`s history,
underlying medical conditions, current medication, nutritional state, mobility;
and psychosocial issues. This allows the nurse to make a holistic assessment
(Cornforth, 2013).

After an assessment is done,
treatment is determined from the assessment information obtained, therefore it
is done on an individual basis. The goal of any wound regimen should be to
optimize wound healing by combining basic wound care modalities including
debridement, off-loading, and infection control (Garwood & Steinberg,
2016). Once a holistic patient assessment is completed and evidence-based
treatment plans can commence (Stephen-Haynes & Callaghan, 2015). The final
stage of wound management would be to document the assessment and treatment
regimen to aid monitoring and facilitate communication between caregivers
(Dowsett et al, 2015).

Conclusion

This essay highlights the many
different skills and knowledge needed to became a GPN or to work in the community,
such as teamwork, management and adhering to trust polices.  It shows how flexible and versatile a person
needs to be to become a GPN.  Overall, I
feel that this module, placement and writing this assignment has given me a
better insight into primary and community healthcare and the role a GPN does.
From a personal perspective, it has enhanced my knowledge, confidence, and
skills, which I will be able to continue to work on throughout my training and
as a newly qualified nurse.

Word count: 2002

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