The Practice Nurse
The Practice Nurse THEORY AND PRACTICE Second edition Pauline J efl'ree Elm House Surgery Beckenham UK SPRINGER-SCIENCE+BUSINESS MEDIA, B.V.
First edition 1990 Second edition 1995 1990, 1995 Pauline Jeffree Originally published by Chapman & Hall in 1995 Typeset in 10/12 Times by Best-set Typesetter Ltd., Hong Kong ISBN 978-0-412-56640-0 DOI 10.1007/978-1-4899-6874-6 ISBN 978-1-4899-6874-6 (ebook) Apart from any fair dealing for the purposes of research or private study, or criticism or review, as permitted under the UK Copyright Designs and Patents Act, 1988, this publication may not be reproduced, stored, or transmitted, in any form or by any me ans, without the prior permission in writing of the publishers, or in the case of reprographic reproduction only in accordance with the terms of the licences issued by the Copyright Licensing Agency in the UK, or in accordance with the terms of licences issued by the appropriate Reproduction Rights Organization outside the UK. Enquiries concerning reproduction outside the terms stated here should be se nt to the publishers at the London address printed on this page. The publisher makes no representation, express or implied, with regard to the accuracy of the information contained in this book and cannot accept any legal responsibility or liability for any errors or omissions that may be made. A catalogue record for this book is available from the British Library Library of Congress Catalog Card Number: 94 71060 i Printed on permanent acid-free text paper, manufactured in accordance with ANSIINISO Z39.48-1992 and ANSIINISO Z39.48-1984 (Permanence of Paper).
Ta My colleagues at Elm House Surgery
Contents Foreword by Professor P. Jarvis ix Foreword by Dr K. Scott xi Preface xiii Acknowledgements xv Part One CLINICAL CARE IN GENERAL PRACTICE 1 1 Ethics 3 2 The Data Protection Act 1984 6 3 Health and safety 9 4 The treatment room 19 5 Nursing models 24 6 Control of infection 39 7 Laboratory reports and units of measurement 50 8 Laboratory specimens and their interpretation 54 9 Immunization and primary prevention 82 10 Wound management 103 11 Resuscitation and basic life support 115 12 Sudden infant death syndrome 119 13 Child abuse and child protection under the Children Act 1989 125 14 Domestic violence and the nursing team 141 15 Communication in the primary care setting 144 16 Counselling theory and practice 156 Part Two LIFESTYLE AND HEALTH 169 17 Asthma 171 18 Diabetes mellitus 196 19 Care of the normally ageing elderly 206 20 Care of the elderly at risk of abuse 227
viii 1 1 CONTENTS ~ 21 Care of the elderly with Alzheimer's disease 231 22 Coronary heart disease and stroke 239 23 The young adult, including the well man 260 24 The well woman 264 25 Alcohol and drug abuse 290 26 Stress 322 27 Depression 329 28 Suicide 333 29 Travellers' health 335 30 Human immunodeficiency virus (HIV) and AIDS 347 31 Research in general practice 368 Appendix A - Standard abbreviations 380 Appendix B - Laboratory tests in nutritional assessment 385 Index 387
Foreword by Professor P. J arvis It gives me great pleasure to write the Foreword to this edition of Pauline Jeffree's The Practice Nurse. 1 have been privileged to work with her for many years now, as she has developed her own understanding of the education of adults. lndeed, 1 was also able to help her start the very first course in England for the training of practice nurses at the University of Surrey. The book that Pauline Jeffree has written is a practicat book, and that it should be, because the work of the practice nurse is practicat. Underlying every practice, however, is theory and it is increasingly important in this complex. world that our theory is well developed. The old maxim 'nothing is as practicat as good theory' is true.lt is for this reason that we started the training courses. As government policy is emphasizing the place of the General Practice in health care rather than the hospital, so the work of the practice nurse is developing and becoming even more complex. Not only is it about healing patients of their bodily ills, it is also about listening, counselling and supporting. It is about the young and the not so young - many of whom will need the practice nurse's expert knowledge, skill and all the support that can be offered. lndeed, in this modern society, when some people feel at a loss and unsure of themselves, people may turn increasingly to the General Practice for help of all types. The practice nurse is playing an increasingly important role in the care of people and 1 am sure that this book will be used extensively by practice nurses in the process of their own work, helping them develop the practicat knowledge of the expert. In a world of commercialism and the market, when everything is costed at the market price, the dedicated care that the expert practice nurse offers cannot be costed and so 1 commend this book to you as a useful tool in
X 1 ~1 F_O_R_E_W_O_R_D ~ furthering your work to the greater benefit of the patients who seek your help. Professor Peter J arvis Head of Department and Professor of Continuing Education University of Surrey Guildford U.K.
Foreword by Dr K. Scott The past two decades has seen nursing develop in the United Kingdom into a highly skilled professional body. During this time a new brand of nursing has emerged - the Practice Nurse. This book is designed specifically for the Practice Nurse to equip herlhim to undertake skills that are expected in the development of Primary Care linked with the training to fulfil this role. The Author has spent many years of her nursing career committed to the education and training of the Practice Nurse. She was responsible for the first approved Practice Nurse Training Course in the UK which was established at the University of Surrey. Miss Jeffree has undertaken extensive research into practice nursing and has been able to refine the needs ofthe Practice Nurse. This, associated with her vast clinical experience as a Senior Practice Nurse, has enabled her to become an authority in this field and in this book she is able to share her knowledge and experience. The Practice Nurse is emminently placed to be a practitioner in her/his own right and should be recognised as such. The missing link in securing this concept is the provision of appropriate levels of training, a gap which this excellent book will go a long way to fill. Kenneth Scott, OBE, MB, BS, FRCGP, DRCOG Senior Partner, General Practice, Beckenham, Kent.
Preface Nursing has made, over the years, a unique contribution to patient care and the introduction of practice nursing has had a signficant ro le to fulfil in the development of primary care. The focus of primary care is changing, many people are living longer and many have disabilities and/or chronic diseases. There are more risk factors which can be identified and modified by improving lifestyle or preventing illness. There is also a growing awareness of the need not only to respond to illness, but also to prevent disease and to promote health. The Practice Nurse and Practice Nursing does have a key role to play in these changes. Indeed, practice nurses are in a position, both opportunistically and through planned intervention, to inftuence the health status of the estimated 98% of the general population who are registered with a general practitioner. There is a need for the utilization of nursing and health visiting skills for the greater effectiveness of primary health care. The sharing of responsibilities with not only the nursing profession but also with the patient/client and his/her carers or supporters, challenges the traditional role of the nurse, because a higher profite is given to the unique role of the nurse in assessing, diagnosing and prescribing the nursing care programmes, monitoring and evaluating that programme and the subsequent outcomes of nursing care. The aim of these changes is to bring together the range of professional skills available in the community so that the utilization of resources are maximized for the benefit of patients/clients, carers and supporters and society as a whole. The challenges before us are considerable. It is hoped that this book will provide some support as future challenges are faced.
Acknowledgements In my acknowledgements for tbis second edition of The Practice Nurse 1 would like to make special mention and express my tbanks to Dr Kennetb Scott wbo over tbe years bas constantly encouraged and supported tbe various developments and initiatives associated witb Practice Nursing and Practice Nurses. Dr Scott's sound counsel and foresigbt bave contributed to and enricbed tbe developments wbicb bave taken place in primary care. Dr Peter J arvis, wbo inspired and encouraged tbe writing of tbe first edition and wbo bas equaliy supported me during tbe writing of tbe second edition. Tbis book could not ba ve been written witbout tbe inspiration of practice nurse colieagues wbom 1 bave bad tbe pleasure to meet or work alongside over the years and 1 am indebted to each and everyone of tbem. 1 am also indebted to Saliy Crawford, wbo copy-edited tbis text and to the otbers involved at Chapman and Hali, ali of wbom have been very patient. 1 am grateful to tbose wbo bave been kind enougb to give permission to reproduce from otber sources. Lastly, but by no means least, 1 remember very specialiy the sbaring of tbe progress of the first edition of tbis book with Dr Jobn Fry and also talking tbrougb some of tbe contents of tbis edition. He always gave generously of his time and expertise until bis untimely deatb tbis year. In tbe final analysis, bowever, the ultimate responsibility for the contents of this book bas to remain witb the autbor.