Роля, обучение и интервенции на респираторните медицински специалисти в Англия. Домашни посещения и предотвратяването на хоспитализиране.

Anelia Chevrakova-Mihaylova

100103422

Nurse specialist role- Respiratory specialist nurse

In accordance with The Nursing and Midwifery Council (2015) Code of Conduct, nurses must respect patient’s right to confidentiality at all time. Therefore, for this reflection all names or identifiable information of the patients discussed, are changed to protect their privacy and dignity.

For this reflection, I will be using a Gibbs Model of reflection (Gibbs G.,1988).

Description: As part of my Respiratory medicine placement I had the opportunity to spent time with Respiratory specialist nurses. I knew very little about their role, however it turns up to be much broader and their role involves home visits for patients with Chronic obstructive pulmonary disease (COPD) or patients on Oxygen therapy, leading the pulmonary rehabilitation, supporting patients and working towards quick discharge from the hospital by education how to manage their symptoms (www.brit-thoracic.org.uk,2017). COPD describes a group of conditions that includes emphysema and chronic bronchitis (Dictionary of Nursing, 2015).

Feelings: I found a study which suggests that preventing the spread of infection in a ward with elderly or respiratory compromised patient is very important, as they are at higher risk developing more serious symptoms than younger patients (Niederman,2001). When discussed with the respiratory specialist nurse this fact all of them confirmed that their role is very much to prevent hospitalisation but helping patients managing their disease at home. In my experience, I found that respiratory nurses were the preferred point of contact for people with respiratory long- term conditions. Literature says as well that respiratory patients value that flexible access to a professional they can trust and who can provide care and support (Worth et al., 2010).

Evaluation: The good experience was that I learned very quick from my mentors and specialist nurses about COPD and treatment methods. I have realised that shortness of breath is one of the most disabling symptoms and cause a lot of stress to patients with COPD. Over time breathless is associated with lower functions of the lungs. Broncho-dilators are very often first treatment, however very often patients come to hospital with exacerbations, which basically is worsening of the symptoms. In this case there is increase of the treatment with bronchodilators, antibiotics and corticosteroids (Renard and MacNee,2009). When I was on my spoke placement with the specialist nurses I have observed clinic, home visits and patients on long term oxygen therapy which showed me how with some support patients can avoid admission to hospital and be in control of their symptoms and treatment (Cox et al., 2017). I found that their role is very important for patients as they need someone to be closely related, can answer all questions and support them. I found a study which confirms that patients benefit from specialist nurses and build trust in health care professionals (Thygesen et al., 2012). I spent a day observing pulmonary rehabilitation programme, which is provided by NHS for people with long term lung conditions, helping them with exercise and education. Pulmonary rehabilitation helps to build more muscle strength, so they can do more in their day to day life (British Lung Foundation, 2017).

Analysis: I found that there are many personal skills and experience needed to become a specialist respiratory nurse. Most of the literature says that good networking and being part of the team is the most important personal skill, being compassionate and empathetic and being really experience in respiratory care (Darmody, 2010). Another study says that specialist respiratory nurses who can prescribe are more independent which can enable them to overcome some common problems like convenience and patients have more access to treatment, therefore nurse prescribers can manage more complex patients and support them (Carey, Stenner and Courtenay, 2014). In my experience, I found that all those skills are relevant and can be found, however all specialist nurses I spent time with were having passion and motivation for the role.

Conclusion: I could have spent more time with respiratory specialist nurses as I was going to gain more knowledge in respiratory medicine and person-centred care. I found that respiratory medicine is complicated and many patients have multiple co-morbidities and that’s why all specialist nurses look holistically at the patients and relay on the person-centred care (Philippa et al., 2005). Information which patients share with them is very important, so they can assess the situation and find the most appropriate way to help them deal with their long-term condition and improve their quality of life (Arnold and Boggs, 2015). I could have learned more about spirometry and how to read it so I can understand better patients notes, diagnosis and treatment (www.brit-thoracic.org.uk,2017). Spirometry measures the total amount of air breathe in, blow out and the capacity and function of the lungs (British Lung Foundation, 2017). Being able to read and understand the results could help when caring for patients and answer their questions.

Action plan: When I have a chance to spent time with specialist nurse will try to ask as many question as possible, look up at information relevant to the speciality and discuss with the nurse. Will check for relevant literature and will look for rational behind decisions, and will ask how treatments are changed over time and why. Overall my experience was satisfying, however it was going to be more beneficial if it was longer and I had time to look up at information and then discuss with specialist nurse.

References

A Dictionary of Nursing (6th edition)2015 182 Tanya McFerran Elizabeth A. Martin A Dictionary of Nursing (6th edition) Oxford Oxford University Press 2014 viii + 632 pp. 9780199666379 £8.99. (2015). Reference Reviews, 29(5), pp.35-36.

Arnold, E. and Boggs, K. (n.d.). Interpersonal relationships. 1st ed.

British Lung Foundation. (2017). Home. [online] Available at: http://www.blf.org.uk [Accessed 28 Oct. 2017].

Carey, N., Stenner, K. and Courtenay, M. (2014). An exploration of how nurse prescribing is being used for patients with respiratory conditions across the east of England. BMC Health Services Research, 14(1).

Cox, K., Macleod, S., Sim, C., Jones, A. and Trueman, J. (2017). Avoiding hospital admission in COPD: impact of a specialist nursing team. British Journal of Nursing, 26(3), pp.152-158.

Darmody, J. (2010). Clinical Nurse Specialist and Administrator Perceptions of Clinical Nurse Specialist Practice. Clinical Nurse Specialist, 24(2), p.90.

Gibbs, G. (1988) Learning by doing: A guide to teaching and learning methods. London: FEU.

MacNee, W., Rennard, S. and MacNee, W. (2009). Fast facts. 1st ed. Oxford: Health Press.

Niederman, M. (2001). Respiratory infections. 1st ed. Philadelphia: Saunders.

Nmc.org.uk. (2017). The Nursing & Midwifery Council. [online] Available at: http://www.nmc.org.uk [Accessed 26 March 2017].

Phillipa, J.D., Sully, P., Dallas, J. and Nicol, M. (2005) Essential communication skills for nursing practice (essential). Edinburgh: Elsevier Mosby.

Society, B. (2017). Home | British Thoracic Society | Better lung health for all. [online] Brit-thoracic.org.uk. Available at: https://www.brit-thoracic.org.uk [Accessed 18 Oct. 2017].

Worth, A., Pinnock, H., Fletcher, M., Hoskins, G., Levy, M. and Sheikh, A. (2010). Systems for the management of respiratory disease in primary care — an international series: United Kingdom. Primary Care Respiratory Journal, 20(1), pp.23-32.