This module and my placements using the Gibbs

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Last updated: February 28, 2019

This assignment willinvestigate the role of a practice/ community nurse and discuss an aspect ofcare, I will be discussing wound management. I choose this subject because as apractice 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 generalpractice nurse (GPN) and reflective on the module and my placements using theGibbs (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 beable to visit the hospital and helps to lower hospital admissions, frees bedsfor patients and helps to prevent long-term admissions (Edwards, 2014).Relevantcompetencies and training as a GPN With the movement of careshifting from hospitals to general practice, it is important that GPN has theskills and knowledge to deliver optimum care. Utilising a wide range ofclinical and diagnostic skills will be an everyday occurrence. An extensiveamount of expertise is required in order to support patients with all types ofconditions (Cooke, 2017).

Relevant training needs to be updated and guidelinesneed to be followed. For example, training on infection control is essentialand guidelines (Nice guideline, 2012) need to be followed (Evans et al,2012).  In addition, there are a numberof competencies that need to be completed to become a GPN. Some of thecompetencies needed are: communication with patients, have an understanding ofthe ethical issues and clinical audit that impinge on general practice, manageclinical risk within consultations and Being able to assist the patient to makedecisions in a style appropriate to their wishes. These competencies and othersare to be signed off before a nurse would be seen as competent and safe topractice (Ruscoe et el, 2012). While on placement in aGeneral practice surgery, I had to complete a set of competencies in my firsttwo weeks before I was deemed competent to take my own clinic. It was anexciting thought to take my own clinic. However, I wasn’t feeling confident indoing this and felt I did not know enough to do so.

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It gave me a chance todevelop and grow as an individual and as a professional. However, I feel theonly downside was the unsure feeling of being on my own. I learned to workwithin a time limit, keeping myself and my patients safe, gaining consent witheverything I did and the importance of documentation. It showed me that I doknow more than what I thought and I always asked for help when unsure.

If I hadthis opportunity again, I would have done more reading on wound care andutilised staffs knowledge and skills a little more. Overall, the experience hasimproved my knowledge, practice, and self-confidence. Teamworkin primary care An essential aspect of generalpractice nursing is teamwork. The importance of teamwork in nursing cannot beoveremphasised, it depends on teams to meet objectives. Effective teamworkmeans less stress and a higher quality of care is provided to patients(Kalisch, Weaver& Eduardo, 2009).GPNs need to communicate andwork as a team alongside doctors, pharmacists, and dieticians, as well as otherspecialists (Cooke, 2017). The NMC (2015) states “nurses should respect theskills, expertise, and contributions of colleagues, referring matters to themwhen appropriate”.

Working in partnership with other professionals andorganisations is vital for general practices to provide effective services forpatients, but it is vital to acknowledge that joint working must adhere toprimary care trust policies. For example, if community nurses and practicenurses set a wound care clinic together, there may already be a primary caretrust policy on wound management that need to be adhered to (Campbell,Longbottom & pooler, 2007). Reflecting back on the modulethere has been activities that have required me to work within a team. I didn’tfeel that this would be a problem as through my training and previous work ithas been essential for me to work in a team.

The good aspect of working in ateam is that you get to discuss and hear other people’s perspectives on atopic. The only negative aspect of working in a team is mixed opinions cansometimes cause disagree. However, the team I was in listened and discuss in apolite and respectful manner. I feel that in the future I will try and continuethis approach in my own personal practice.

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

  Healthpolicies relating to primary care There are many policies put inplace to maintain safety. Firstly, a practice nurse must keep up to date withtraining, such as manual handling. Moving and handling is a key part of theworking day, poor moving and handling practice can lead to accidents, which cancause injury to both patient and nurse (Trinkoff, 2008).

They need to adhere tohealth 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 patientsare treated safely, but unfortunately, sometimes things go wrong. GPN shouldalways report all patient safety incidents and near misses whether they resultin harm or not. These reports can be used to spot emerging patterns or anyconcerns. This is then used to raise awareness of the risks and helps toprotect patients (NHS improvements, 2017). This also includes adhering tohealth policies such as safeguarding patients such as adults who are incapableof looking after any aspect of their lives, to individuals experiencing a shortperiod of illness or disability (British Medical Association, 2011) and theFreedom of Information Act (2000) that gives anyone the right to ask forrecorded information held by public authorities.

Managingof significant events in general practice Significant event analysis(SEA) is an increasingly routine part of general practice. It is a process usedto reflect on and learn from, it is promoted as a team-based approach toenhancing patient safety and quality of care (McKay, 2009).  Without reflecting on experiences andquestioning ourselves about what it means, learning doesn’t really happen.Reflection helps to turn an experience into understanding and a tool to learnfrom (Ayoubi, 2013).

SEA team discussions should be held routinely as part ofthe practices quality improvement and is an opportunity for the team to:discuss each stage in detail, identify any learning needs and identify actionsto be taken. Then changes to be agreed and discussed how these will beprocessed. SEA is a process that should be continuous and used as a basis forimproving practice (Bowie, de Wet & Pringle, 2011). Chronicillness management One of the main requirementsof a GPN is to manage a long-term chronic disease.

Chronic diseases are acondition that currently has no cure and need to be managed with drugs or othertreatments. Examples of chronic diseases are diabetes, chronic obstructivepulmonary disease (COPD), arthritis and hypertension. The role of the practicenurse includes identification, diagnosis, monitoring and management in theprimary care environment. For example, they would be the person to carry outdiagnostic test such as spirometry, diagnose COPD, prescribe medication asappropriate (having undertaken a recognized prescribing qualification) andprovide support and advice for that patient. Practice nurses, therefore, play asignificant role in the management of people in relation to bothdisease-specific care management and in supporting people care (Carrier, 2016).Woundcare management An important aspect ofpractice nursing is wound management, wound management can be a complex andchallenging process in nursing, nurses must take responsibility for updatingtheir knowledge, skills and ongoing competence. The first step of giving theoptimum care of a wound requires an understanding of wound healing (Werdin etal, 2009).

Wound healing is a systematic process, that has four phases:hemostasis, inflammation, proliferation, and maturation. s (Simon, Meyers &Romo, 2016). v Hemostasisphase – This stage is the initial response to injury and its object is to stopthe bleeding (Maynard, 2015). v Inflammationphase – This stage focuses on destroying bacteria and removing debris. It oftenshows signs of redness, heat, and pain (Maynard, 2015). v Proliferationphase – the wound begins to rebuilt with healthy granulation tissue. The bloodsupply to the wound needs to be adequate to provide enough nutrients andoxygen. It is important to maintain observation of the wound to monitorchanges.

For example, a darker tissue is often an indicator of infection orinadequate delivery of blood to the wound bed. However, a reddish or pinkishcolour normally means that it is healthy (Brown, 2015).v Maturationphase- this phase is known as the remodelling stage and can last between 21days to two years.

Epithelial cells from the surrounding areas cover the newlyformed granulation tissue and reducing the size of the wound by contracting andpulling the edges together (Brown, 2015).After knowing what is involvedin the wound healing process, nurses would carry out a wound assessment. Anaccurate and considered wound assessment is essential to ensure appropriatepatient and wound management is given (Benbow, 2016).

  A structured approach to wound assessment is requiredto maintain a good standard of care (Ousey, 2012). There are serval factorsthat should be recorded when assessing a wound: size of the wound, the edge ofthe 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 itis done on an individual basis. The goal of any wound regimen should be tooptimize wound healing by combining basic wound care modalities includingdebridement, off-loading, and infection control (Garwood & Steinberg,2016). Once a holistic patient assessment is completed and evidence-basedtreatment plans can commence (Stephen-Haynes & Callaghan, 2015). The finalstage of wound management would be to document the assessment and treatmentregimen to aid monitoring and facilitate communication between caregivers(Dowsett et al, 2015).

ConclusionThis essay highlights the manydifferent 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 personneeds to be to become a GPN.  Overall, Ifeel that this module, placement and writing this assignment has given me abetter insight into primary and community healthcare and the role a GPN does.From a personal perspective, it has enhanced my knowledge, confidence, andskills, which I will be able to continue to work on throughout my training andas a newly qualified nurse. Word count: 2002

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