The role of a practice/community healthcare nurse
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 crucial role in helping the NHS, meet the needs of patients who may not be able to easily visit the hospital and helps to lower hospital admissions, frees beds for critical patients and helps to prevent long-term admissions (Edwards, 2014).

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).
Hemostasis phase – This stage is the initial response to injury and its object is to stop the bleeding (Maynard, 2015).
Inflammation phase – This stage focuses on destroying bacteria and removing debris. It often shows signs of redness, heat, and pain (Maynard, 2015).
Proliferation phase – the wound begins to rebuilt with healthy granulation tissue. The blood supply to the wound needs to be sufficient 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).

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.
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