The advanced practitioner: a framework for practice / edited by Ian Peate, Sadie Diamond-Fox, Barry Hill

Contributor(s): Peate, Ian [editor] | Diamond-Fox, Sadie [editor.] | Hill, Barry [editor.]
Language: English Series: Advanced clinical practicePublisher: Chichester, West Sussex : Wiley Blackwell, 2024Description: xxvii, 426 pages : illustrations; 26 cmContent type: text Media type: unmediated Carrier type: volumeISBN: 9781119882039Subject(s): Allied health personnel | Medical personnelDDC classification: 610.69/53
Contents:
Table of Contents Contributors xviii Preface xxv Acknowledgements xxvii Chapter 1 Advanced Clinical Practice 1 Sadie Diamond-Fox and Vikki-Jo Scott Learning Outcomes 1 Introduction 1 The Concept and History of Advanced-Level Practice 3 Frameworks and Toolkits for Advanced Clinical Practice 3 Ensuring Quality and Governance in Advanced Practice 3 How to Use this Book 5 Conclusion 5 References 7 Further Reading 8 Self-Assessment Questions 8 Glossary 8 Chapter 2 The Advanced Clinical Practice Curriculum 10 Rachael Daw and Ollie Phipps Learning Outcomes 10 Introduction 10 Curriculum Development 12 Understanding the Context of ACP 14 The Clinical Practice Curriculum 14 The Leadership and Management Curriculum 15 The Education Curriculum 15 The Research Curriculum 16 Assessment for ACP 16 Specialist Curriculums, Credentials and Capability Frameworks 18 First Contact Practitioners and Advanced Practitioners – Roadmaps to Practice 19 Supervision and CPD Strategies 19 Conclusion 21 References 22 Further Reading 23 Self-Assessment Questions 24 Glossary 24 Chapter 3 Scope of Practice and Management of Patient Care 25 Ollie Phipps Learning Outcomes 25 Introduction 25 The Multi-Professional Framework (MPFFACP) 26 Governance 27 Legal Issues 27 Regulation Statements of Standards and Code of Conducts 28 Nursing and Midwifery Council (NMC) 28 Health and Care Professions Council (HCPC) 28 General Pharmaceutical Council (GPhC) 28 Scope and Capability 28 Defining Scope of Practice 28 Competency vs Capability 29 Knowledge, Skills and Behaviours 29 Competence 29 Multiprofessional Registrations and Scope of Practice 30 Expanding Scope and Scope Creep 30 Responsibility and Accountability 30 Dunning–Kruger Effect 31 Imposter Syndrome 31 Professional Issues 31 Indemnity 33 Indemnity Insurance 33 Negligence 34 Duty of Care 34 Breach of Duty 34 Causation 34 Mental Health Act 1983 and Sections 35 Mental Capacity Act 36 Ethics 37 Autonomy 37 Non-maleficence 38 Beneficence 38 Justice 38 The Right to Life and the Right to Dignity 38 Consent 39 Gillick Competence 39 Confidentiality 39 Development and Regulation 39 Conclusion 40 References 40 Further Reading 42 Self-Assessment Questions 42 Glossary 43 Chapter 4 Principles of Physiology for Advanced Practice 44 Colin Chandler, Alison Wood, and Robin Hyde Learning Outcomes 44 Introduction 45 How the Body Adapts to Different Situations 47 Key Concepts of the Cell 52 Contents vii Control – How the Body Allows us to Achieve Action and Participation in Society 55 Changes to Physiology Through the Life Course 57 Microbiome/Microbiota and Interactions with the Microbiological Environment 61 Conclusion 62 References 63 Further Reading 64 Self-Assessment Questions 64 Glossary 64 Chapter 5 Principles of Pathophysiology 66 Sarah Ashelford and Vanessa Taylor Learning Outcomes 66 Introduction 67 The Main Disease Mechanisms 68 Cancer 69 Aetiology and Pathogenesis of Cancer 70 Clinical Investigations 72 Learning Events 72 Clinical Effects of Cancer 72 Learning Event 72 Cardiovascular Disease and Stroke 73 Investigations 73 Pathogenesis of Atherosclerosis 73 Pharmacological Principles 76 Investigations 76 Diabetes 76 Clinical Presentation 76 Learning Event 77 Aetiology and Pathogenesis of Type 1 Diabetes 77 Aetiology and Pathogenesis of Type 2 Diabetes 78 Acute Complications of Diabetes 79 Respiratory Disease 81 Asthma 81 Aetiology and Pathogenesis of Asthma 81 Pharmacological Principles 83 Learning event 83 Chronic Obstructive Pulmonary Disease 83 Aetiology and Pathogenesis of COPD 83 Conclusion 86 References 86 Further Reading 89 Self-Assessment Questions 89 Glossary 89 Chapter 6 Principles of Pharmacology 90 Ihab Ali and Phil Broadhurst Learning Outcomes 90 Introduction 90 Pharmacotherapy 91 Pharmacokinetics (PK) 91 VIII Contents Pharmacodynamics (pd) 93 Pharmacodynamics: Drug–Receptor Interactions 94 Pharmacodynamics: Drug Concentration 94 Therapeutic Drug Monitoring (TDM) 96 Plasma Protein Binding 98 Drug-induced Adverse Effects 100 Drug Interactions 103 Contraindications 103 Excipients 104 Adherence 104 Conclusion 107 References 107 Further Reading 111 Self-Assessment Questions 111 Glossary 111 Chapter 7 Supplementary and Independent Prescribing 113 Brigitta Fazzini, Esther Clift, and Jill Bentley Learning Outcomes 113 Introduction 113 Education 115 General Pharmacological Principles 115 Prescribing in Paediatrics 115 Prescribing in Mental Health 116 Prescribing in Critical Care 117 Absorption 117 Distribution 117 Metabolism 118 Excretion 119 Assessing Drug Therapy in Critical Illness 119 Prescribing in Older People 120 Medication Reviews 120 Pharmacokinetics 121 Guidelines on Drug Prescription for Older People 122 Antibiotics Stewardship 123 Authorisation of Blood Components and Products 125 Legal Aspects and Governance 125 Patient Consent 126 Clinical Decision Making 126 De-Prescribing 127 Health Promotion 127 Why is This Important to Us as Prescribers? 128 So What Can We Do? 128 Social Prescribing 129 Conclusion 130 References 130 Further Reading 131 Self-Assessment Questions 131 Glossary 131 Chapter 8 Core Procedural Skills 132 Mark Cannan, Kirstin Geer, and Stuart Cox Learning Outcomes 132 Introduction 132 Consent/Assent 133 Clinical Competence for Procedures 134 Preparation: Positioning 135 Core Procedural Skills 137 Airway: Basic Manoeuvres and Adjuncts 137 Airway: Supraglottic Airway Devices 137 Breathing: Intercostal Drain Insertion 137 Preprocedure Set-up and Equipment for ICD Insertion 137 Procedure for ICD Insertion (Seldinger) – Small Bore 139 Procedure for ICD Insertion – Large Bore (Lloyd 2019) 141 Postprocedure Checks 141 Pearls and Pitfalls 141 Circulation: Venepuncture 142 Practitioner Safety 142 Technique 143 Postprocedure Checks 144 Pearls and Pitfalls 144 Circulation: Peripheral Intravenous Cannulation 144 Technique 145 Postprocedure Checks 146 Pearls and Pitfalls 146 Circulation: Arterial Puncture and Cannulation 147 Technique 148 Postprocedure Checks 149 Pearls and Pitfalls 149 Circulation: Central Venous Access Via Central Venous Catheter 149 Technique 150 Pearls and Pitfalls 151 Circulation: Intraosseous Needle Insertion 152 Preprocedure Considerations 152 Pearls and Pitfalls 152 Disability: Lumbar Puncture 153 Technique 154 Pearls and Pitfalls 155 Exposure: Nasogastric Tube Insertion 156 Technique – Awake Patient 156 Technique - Unconscious/Anaesthetised/Intubated Patient 157 Postprocedure Checks 157 Pearls and Pitfalls 157 Learning From Patient Safety Events 158 Conclusion 158 References 159 Further Reading 161 Self-Assessment Questions 161 Glossary 161 Chapter 9 Clinical History Taking and Physical Examination 162 Sadie Diamond-Fox, Rebecca Connolly, Alexandra Gatehouse, and John Wilkinson Learning Outcomes 162 Introduction 162 The Consultation as a Diagnostic Tool 163 Communication 164 The Cone Technique 164 Ideas, Concerns and Expectations (ICE) 165 Triggers to Consultation 165 Consultation Models 165 Calgary-Cambridge Guide to the Medical Interview 167 Patient Perspective of Consultation 168 Kinesics Interviewing 168 Aspects of Obtaining a Medical History 169 History Taking in Special Circumstances: Time-Critical Situations 171 History Taking for Neurodiverse and Non-verbal Populations 172 History Taking for Ethnic Minority Populations 173 History Taking for LGBTQIA+ Populations 173 Clinical Assessment – Aspects of Physical Examination 175 Introduction 175 General Inspection 176 Vital Signs 176 Physical Examination Techniques 177 Hands and Nails 177 Upper Limbs 181 Head and Neck 181 Thorax 185 Abdomen 188 Lower Limbs 190 Closing the Consultation 190 Conclusion 191 References 191 Further Reading 194 Self-Assessment Questions 194 Glossary 194 Chapter 10 Clinical Decision Making and Diagnostic Reasoning 195 Helen Francis-Wenger and Colin Roberts Learning Outcomes 195 Introduction 195 Clinical Reasoning and Clinical Decision Making 197 Recognition 200 Probability 200 Reasoning 200 Watching and Waiting 200 Selective Doubting 201 Iteration and Reiteration 201 Thinking, Growing and Evolving 201 Contents xi Decision-Making Theories 203 Normative, Prescriptive and Descriptive Interactions 203 Descriptive Approach 203 Normative Approach 203 Prescriptive Approach 204 Intuition 204 Hypothetico-Deductive Reasoning 205 Cue Acquisition Stage 205 Hypothesis Generation 205 Cue Interpretation 206 Hypothesis Evaluation 206 The Cognitive Process 206 Biases 207 Assistive Tools and Concepts: Risk Assessments/Probability Scores/Risk Stratification 210 Odds Ratios 210 Numbers Needed to Treat 210 Bayes’ Theorem: Sensitive (Rule Out) and Specific (Rule In) 210 Risk Stratification 211 Conclusion 211 References 211 Further Reading 213 Self-Assessment Questions 213 Glossary 213 Chapter 11 Diagnostic Interpretation 214 Colin Roberts, Christine Eade, and Helen Francis-Wenger Learning Outcomes 214 Introduction 214 Principles to Follow 216 Principles of Ordering and Interpretation 216 Reference Ranges 217 Patient and Clinician Factors to Consider When Interpreting Results: Context 217 The Full Blood Count 217 Haemoglobin 217 A Stepwise Approach 218 White Cells (Leucocytes) 219 Platelets (Thrombocytes) 219 Raised Platelets (>400) 219 Low Platelets (<150) 219 Inflammatory Markers 220 C-Reactive Protein 220 Plasma Viscosity 220 Renal Function 220 Range 220 Creatinine (Cr) 221 Urea (U) 221 Acute Kidney Injury 221 Chronic Kidney Injury 221 Electrolytes: Sodium and Potassium 221 Electrolytes: Calcium and Magnesium 223 Liver Function Tests 225 Alanine Aminotransferase (ALT) 225 Alkaline Phosphatase (ALP) 225 Bilirubin (Br) 225 Patterns of Liver Disease 225 Thyroid Function Tests 226 Hypothyroidism (Underfunctioning) 226 Hyperthyroidism (Overfunctioning) 226 Subclinical Hypothyroidism and Hyperthyroidism 227 Diagnostic Interpretation: Imaging 228 Fundamental Principles 228 The Essentials of Each Imaging Modality are Considered Below 229 Plain Film 229 Ultrasound 232 Lung Ultrasound 232 FAST Scan 233 Echo 233 Computed Tomography 233 Imaging Summary 234 References 235 Further Reading 236 Self-Assessment Questions 236 Glossary 236 Chapter 12 Public Health: Prevention, Promotion and Empowerment 238 Joanna Lavery and Sharon Riverol Learning Outcomes 238 Introduction 238 Accreditation Considerations 240 Clinical Examination 242 Leg assessment 244 Clinical investigation – point-of care (POC) D-dimer testing 244 Diagnosis – Class 1 Cellulitis 245 Pharmacology 245 Follow-up Plan 246 Clinical Examination 248 Results 249 Management 249 Pharmacology 249 Clinical Examination 251 NEWS2 – 0 But Blood Pressure Found to Be Hypotensive 251 Neuro assessment 251 Management 253 Reflections 255 Admission Avoidance 255 Advanced Care Practitioner and Patient Empowerment 255 References 256 Further Reading 261 Self-Assessment Questions 261 Glossary 262 Chapter 13 Managing Complexity 263 Jaclyn Proctor and Sadie Diamond-Fox Learning Outcomes 263 Introductions 263 Medical Complexity 265 Measuring Complexity in a Healthcare Context 266 Situational Complexity 269 Systems Complexity 270 NHS Long Term Plan (2019) 270 Advanced Clinical Practice 272 Conclusion 275 References 276 Further Reading 277 Self-Assessment Questions 277 Glossary 277 Chapter 14 Frailty: Principles of Rehabilitation and Reablement, Palliative Care and Organ Donation 278 Esther Clift and Stevie Park Learning Outcomes 278 Introduction 278 Discharge Planning 279 Intermediate Care 280 Rehabilitation 281 Reablement 282 Pathways 282 Technology 282 Home-based Care 282 Virtual Wards 283 Urgent Community Response 283 Palliative or End-of-Life Care 284 Gold Standard Framework 285 Care Plans 285 Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) 286 Pain and Symptom Control 286 Verifying Death 287 Organ Donation 287 Diagnosing Death by Neurological Criteria (Brainstem Death Testing) 287 Role of the SN-OD and Referral Process 288 Tissue Donation 288 Clinical Frailty 288 Diagnosis Tools for Diagnosis and CGA 288 Exercise 290 Nutrition 290 Social Isolation and Loneliness 291 Conclusion 293 References 293 Further Reading 295 Self-Assessment Questions 295 Chapter 15 Mental Health, Learning Disability and Autism 296 Clare Allabyrne and Jo Delrée Learning Outcomes 296 Introduction 297 Parity of Esteem 297 Diagnostic Overshadowing and Unconscious Bias 297 Mental Health and Ethnicity 298 Communication 298 Therapeutic Communication 298 Fundamental Principles of Therapeutic Communication 298 Specific Issues in Communication Clients with ASD/LD 299 Clinical Investigations 299 Mental Health Screening Tools 299 Holistic Mental Health Assessment 299 Ten-point Guide to Mental State Examination 301 Risk Assessment in Mental Health 301 Assessing Different Groups 302 Assessing Children and Young People 302 Assessing People with Autism 303 Assessing People with Learning Disability 304 A Note on Challenging Behaviour 307 Pharmacological Principles 307 Resources 309 Learning Disability Learning Event 309 Mental Health Learning Event 309 Mental Health UK states 309 Conclusion 310 References 310 Further Reading 313 Self-Assessment Questions 313 Glossary 313 Chapter 16 Education and Learning 315 Joe Wood and Elizabeth Midwinter Learning Outcomes 315 Introduction 316 Principles of Teaching and Learning 316 Understanding How We Learn 316 Recognising Adult Learners 317 Dual Coding Theory 317 Evidence-based Practice 318 Contents xv Self-directed Learning 318 Supporting Others to Develop Knowledge and Skills 318 Feedback 318 Appraisal Processes and Continuing Professional Development 319 Learning From Mistakes: Safety I and Safety II 319 Coaching, Mentoring and Role Modelling 319 Creating an Effective Learning Environment 320 Optimise the Space 320 Physial 320 Virtual 321 Ensure Learner-centredness 321 Get to Know the Learner 322 Plan the Process 322 Create Psychological Safety 323 Promote Continual Improvement Via Reflection 324 Simulation and Technological Advances in Healthcare Education 324 Simulation 324 Teaching Practical Skills – Reflections from Clinical Experience 325 Human Factors 325 Interprofessional Education 326 Types of Simulation 327 The Concept of Fidelity 328 In Situ Simulation 329 Designing Simulated Learning 329 Scenario Writing 330 Practical Considerations 330 Introductions and Orientation 330 Pre-brief 330 Programmed vs On the Fly 331 Debrief 331 Technology-enhanced Learning 333 Conclusion 334 References 334 Further Reading 338 Self-Assessment Questions 338 Glossary 338 Chapter 17 The Advanced Practitioner as Educator 339 Phil Broadhurst Learning Outcomes 339 Introduction 339 Providing Feedback 342 Feeding Back and Feeding Forward 343 The One-Minute Preceptor 345 Conclusion 347 References 347 Further Reading 349 Self-Assessment Questions 350 Glossary 350 Chapter 18 Research Principles 351 Brigitta Fazzini and Roberta Borg Learning Outcomes 351 Why Research Is Important 351 The Research Process 352 Critical Appraisal and the Hierarchy of Evidence 353 Designing a Research Project 354 Every Research Project Starts with a Question 354 Research Methods 355 Scientific Hypothesis 355 Quantitative versus Qualitative Research Methods 356 Quantitative Research Method 357 Qualitative Research Method 359 Healthcare Research Ethics 360 Quality Improvement 362 Conclusion 364 References 364 Further Reading 365 Self-Assessment Questions 366 Glossary 366 Chapter 19 Leading Research in Advanced Practice 367 Leanne Dolman, Joanna De Souza, and Sara Stevenson-Baker Learning Outcomes 368 Introduction 368 Enabling Evidence-Based Practice 369 Using Local Procedures and Protocols – Role Modelling and Ensuring Continuity of Practice 370 Auditing Current Practice 370 Utilising Clinical Audit 371 Setting Standards and Developing New Protocols 371 Setting Intended Outcomes 371 Patient-reported Outcome Measures 372 Reviewing your Protocol (Quality Control) 372 Developing Guidelines at a National/International Level 373 Developing New Evidence for Practice 373 Leading on Quality Improvement 374 Dissemination of Existing and New Knowledge 377 Local Dissemination 377 Presenting at an External Conference 377 Developing a Conference Abstract 378 Developing a Poster 378 Developing an Oral Presentation 378 Writing for Publication 378 Joining a National Forum or Guideline Development Group 378 Developing the Advanced Practitioner as a Clinical Academic 379 Creating A Research Culture at Organisational Level to Improve Person-Centred Healthcare 380 Conclusion 381 References 382 Further Reading 384 Self-Assessment Questions 384 Glossary 384 Chapter 20 Innovations in Practice 386 Vanessa Taylor and Sarah Ashelford Learning Outcomes 386 Introduction 386 Innovation, Practice Development and Service Improvement 388 Innovation and Advanced-level Practice and the Advanced Practitioner Role 392 Advanced-level Practice and Workforce Transformation: An Example of Healthcare Service Innovation 392 Advanced Practitioner as Clinical (Practice Development/ Improvement) and Professional (Service/System Development) Innovator 394 Conclusion 400 References 401 Self-Assessment Questions 403 Glossary 403 Chapter 21 Professional Development and Transition 404 Vikki-Jo Scott and Esther Clift Learning Outcomes 404 Introduction 405 Personal Professional Development 405 Continuing Professional Development and Role Transition 410 Supporting Professional Development Within a Team 412 Contribution to Broader Development of Advanced Practice 415 What Next? 416 Conclusion 416 References 417 Further Reading 417 Self-Assessment Questions 418 Glossary 418 Index 419
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Table of Contents
Contributors xviii

Preface xxv

Acknowledgements xxvii

Chapter 1 Advanced Clinical Practice 1
Sadie Diamond-Fox and Vikki-Jo Scott

Learning Outcomes 1

Introduction 1

The Concept and History of Advanced-Level Practice 3

Frameworks and Toolkits for Advanced Clinical Practice 3

Ensuring Quality and Governance in Advanced Practice 3

How to Use this Book 5

Conclusion 5

References 7

Further Reading 8

Self-Assessment Questions 8

Glossary 8

Chapter 2 The Advanced Clinical Practice Curriculum 10
Rachael Daw and Ollie Phipps

Learning Outcomes 10

Introduction 10

Curriculum Development 12

Understanding the Context of ACP 14

The Clinical Practice Curriculum 14

The Leadership and Management Curriculum 15

The Education Curriculum 15

The Research Curriculum 16

Assessment for ACP 16

Specialist Curriculums, Credentials and Capability Frameworks 18

First Contact Practitioners and Advanced Practitioners – Roadmaps to Practice 19

Supervision and CPD Strategies 19

Conclusion 21

References 22

Further Reading 23

Self-Assessment Questions 24

Glossary 24

Chapter 3 Scope of Practice and Management of Patient Care 25
Ollie Phipps

Learning Outcomes 25

Introduction 25

The Multi-Professional Framework (MPFFACP) 26

Governance 27

Legal Issues 27

Regulation Statements of Standards and Code of Conducts 28

Nursing and Midwifery Council (NMC) 28

Health and Care Professions Council (HCPC) 28

General Pharmaceutical Council (GPhC) 28

Scope and Capability 28

Defining Scope of Practice 28

Competency vs Capability 29

Knowledge, Skills and Behaviours 29

Competence 29

Multiprofessional Registrations and Scope of Practice 30

Expanding Scope and Scope Creep 30

Responsibility and Accountability 30

Dunning–Kruger Effect 31

Imposter Syndrome 31

Professional Issues 31

Indemnity 33

Indemnity Insurance 33

Negligence 34

Duty of Care 34

Breach of Duty 34

Causation 34

Mental Health Act 1983 and Sections 35

Mental Capacity Act 36

Ethics 37

Autonomy 37

Non-maleficence 38

Beneficence 38

Justice 38

The Right to Life and the Right to Dignity 38

Consent 39

Gillick Competence 39

Confidentiality 39

Development and Regulation 39

Conclusion 40

References 40

Further Reading 42

Self-Assessment Questions 42

Glossary 43

Chapter 4 Principles of Physiology for Advanced Practice 44
Colin Chandler, Alison Wood, and Robin Hyde

Learning Outcomes 44

Introduction 45

How the Body Adapts to Different Situations 47

Key Concepts of the Cell 52

Contents vii

Control – How the Body Allows us to Achieve Action and Participation in Society 55

Changes to Physiology Through the Life Course 57

Microbiome/Microbiota and Interactions with the Microbiological Environment 61

Conclusion 62

References 63

Further Reading 64

Self-Assessment Questions 64

Glossary 64

Chapter 5 Principles of Pathophysiology 66
Sarah Ashelford and Vanessa Taylor

Learning Outcomes 66

Introduction 67

The Main Disease Mechanisms 68

Cancer 69

Aetiology and Pathogenesis of Cancer 70

Clinical Investigations 72

Learning Events 72

Clinical Effects of Cancer 72

Learning Event 72

Cardiovascular Disease and Stroke 73

Investigations 73

Pathogenesis of Atherosclerosis 73

Pharmacological Principles 76

Investigations 76

Diabetes 76

Clinical Presentation 76

Learning Event 77

Aetiology and Pathogenesis of Type 1 Diabetes 77

Aetiology and Pathogenesis of Type 2 Diabetes 78

Acute Complications of Diabetes 79

Respiratory Disease 81

Asthma 81

Aetiology and Pathogenesis of Asthma 81

Pharmacological Principles 83

Learning event 83

Chronic Obstructive Pulmonary Disease 83

Aetiology and Pathogenesis of COPD 83

Conclusion 86

References 86

Further Reading 89

Self-Assessment Questions 89

Glossary 89

Chapter 6 Principles of Pharmacology 90
Ihab Ali and Phil Broadhurst

Learning Outcomes 90

Introduction 90

Pharmacotherapy 91

Pharmacokinetics (PK) 91

VIII Contents Pharmacodynamics (pd) 93

Pharmacodynamics: Drug–Receptor Interactions 94

Pharmacodynamics: Drug Concentration 94

Therapeutic Drug Monitoring (TDM) 96

Plasma Protein Binding 98

Drug-induced Adverse Effects 100

Drug Interactions 103

Contraindications 103

Excipients 104

Adherence 104

Conclusion 107

References 107

Further Reading 111

Self-Assessment Questions 111

Glossary 111

Chapter 7 Supplementary and Independent Prescribing 113
Brigitta Fazzini, Esther Clift, and Jill Bentley

Learning Outcomes 113

Introduction 113

Education 115

General Pharmacological Principles 115

Prescribing in Paediatrics 115

Prescribing in Mental Health 116

Prescribing in Critical Care 117

Absorption 117

Distribution 117

Metabolism 118

Excretion 119

Assessing Drug Therapy in Critical Illness 119

Prescribing in Older People 120

Medication Reviews 120

Pharmacokinetics 121

Guidelines on Drug Prescription for Older People 122

Antibiotics Stewardship 123

Authorisation of Blood Components and Products 125

Legal Aspects and Governance 125

Patient Consent 126

Clinical Decision Making 126

De-Prescribing 127

Health Promotion 127

Why is This Important to Us as Prescribers? 128

So What Can We Do? 128

Social Prescribing 129

Conclusion 130

References 130

Further Reading 131

Self-Assessment Questions 131

Glossary 131

Chapter 8 Core Procedural Skills 132
Mark Cannan, Kirstin Geer, and Stuart Cox

Learning Outcomes 132

Introduction 132

Consent/Assent 133

Clinical Competence for Procedures 134

Preparation: Positioning 135

Core Procedural Skills 137

Airway: Basic Manoeuvres and Adjuncts 137

Airway: Supraglottic Airway Devices 137

Breathing: Intercostal Drain Insertion 137

Preprocedure Set-up and Equipment for ICD Insertion 137

Procedure for ICD Insertion (Seldinger) – Small Bore 139

Procedure for ICD Insertion – Large Bore (Lloyd 2019) 141

Postprocedure Checks 141

Pearls and Pitfalls 141

Circulation: Venepuncture 142

Practitioner Safety 142

Technique 143

Postprocedure Checks 144

Pearls and Pitfalls 144

Circulation: Peripheral Intravenous Cannulation 144

Technique 145

Postprocedure Checks 146

Pearls and Pitfalls 146

Circulation: Arterial Puncture and Cannulation 147

Technique 148

Postprocedure Checks 149

Pearls and Pitfalls 149

Circulation: Central Venous Access Via Central Venous Catheter 149

Technique 150

Pearls and Pitfalls 151

Circulation: Intraosseous Needle Insertion 152

Preprocedure Considerations 152

Pearls and Pitfalls 152

Disability: Lumbar Puncture 153

Technique 154

Pearls and Pitfalls 155

Exposure: Nasogastric Tube Insertion 156

Technique – Awake Patient 156

Technique - Unconscious/Anaesthetised/Intubated Patient 157

Postprocedure Checks 157

Pearls and Pitfalls 157

Learning From Patient Safety Events 158

Conclusion 158

References 159

Further Reading 161

Self-Assessment Questions 161

Glossary 161

Chapter 9 Clinical History Taking and Physical Examination 162
Sadie Diamond-Fox, Rebecca Connolly, Alexandra Gatehouse, and John Wilkinson

Learning Outcomes 162

Introduction 162

The Consultation as a Diagnostic Tool 163

Communication 164

The Cone Technique 164

Ideas, Concerns and Expectations (ICE) 165

Triggers to Consultation 165

Consultation Models 165

Calgary-Cambridge Guide to the Medical Interview 167

Patient Perspective of Consultation 168

Kinesics Interviewing 168

Aspects of Obtaining a Medical History 169

History Taking in Special Circumstances: Time-Critical Situations 171

History Taking for Neurodiverse and Non-verbal Populations 172

History Taking for Ethnic Minority Populations 173

History Taking for LGBTQIA+ Populations 173

Clinical Assessment – Aspects of Physical Examination 175

Introduction 175

General Inspection 176

Vital Signs 176

Physical Examination Techniques 177

Hands and Nails 177

Upper Limbs 181

Head and Neck 181

Thorax 185

Abdomen 188

Lower Limbs 190

Closing the Consultation 190

Conclusion 191

References 191

Further Reading 194

Self-Assessment Questions 194

Glossary 194

Chapter 10 Clinical Decision Making and Diagnostic Reasoning 195
Helen Francis-Wenger and Colin Roberts

Learning Outcomes 195

Introduction 195

Clinical Reasoning and Clinical Decision Making 197

Recognition 200

Probability 200

Reasoning 200

Watching and Waiting 200

Selective Doubting 201

Iteration and Reiteration 201

Thinking, Growing and Evolving 201

Contents xi

Decision-Making Theories 203

Normative, Prescriptive and Descriptive Interactions 203

Descriptive Approach 203

Normative Approach 203

Prescriptive Approach 204

Intuition 204

Hypothetico-Deductive Reasoning 205

Cue Acquisition Stage 205

Hypothesis Generation 205

Cue Interpretation 206

Hypothesis Evaluation 206

The Cognitive Process 206

Biases 207

Assistive Tools and Concepts: Risk Assessments/Probability Scores/Risk Stratification 210

Odds Ratios 210

Numbers Needed to Treat 210

Bayes’ Theorem: Sensitive (Rule Out) and Specific (Rule In) 210

Risk Stratification 211

Conclusion 211

References 211

Further Reading 213

Self-Assessment Questions 213

Glossary 213

Chapter 11 Diagnostic Interpretation 214
Colin Roberts, Christine Eade, and Helen Francis-Wenger

Learning Outcomes 214

Introduction 214

Principles to Follow 216

Principles of Ordering and Interpretation 216

Reference Ranges 217

Patient and Clinician Factors to Consider When Interpreting Results: Context 217

The Full Blood Count 217

Haemoglobin 217

A Stepwise Approach 218

White Cells (Leucocytes) 219

Platelets (Thrombocytes) 219

Raised Platelets (>400) 219

Low Platelets (<150) 219

Inflammatory Markers 220

C-Reactive Protein 220

Plasma Viscosity 220

Renal Function 220

Range 220

Creatinine (Cr) 221

Urea (U) 221

Acute Kidney Injury 221

Chronic Kidney Injury 221

Electrolytes: Sodium and Potassium 221

Electrolytes: Calcium and Magnesium 223

Liver Function Tests 225

Alanine Aminotransferase (ALT) 225

Alkaline Phosphatase (ALP) 225

Bilirubin (Br) 225

Patterns of Liver Disease 225

Thyroid Function Tests 226

Hypothyroidism (Underfunctioning) 226

Hyperthyroidism (Overfunctioning) 226

Subclinical Hypothyroidism and Hyperthyroidism 227

Diagnostic Interpretation: Imaging 228

Fundamental Principles 228

The Essentials of Each Imaging Modality are Considered Below 229

Plain Film 229

Ultrasound 232

Lung Ultrasound 232

FAST Scan 233

Echo 233

Computed Tomography 233

Imaging Summary 234

References 235

Further Reading 236

Self-Assessment Questions 236

Glossary 236

Chapter 12 Public Health: Prevention, Promotion and Empowerment 238
Joanna Lavery and Sharon Riverol

Learning Outcomes 238

Introduction 238

Accreditation Considerations 240

Clinical Examination 242

Leg assessment 244

Clinical investigation – point-of care (POC) D-dimer testing 244

Diagnosis – Class 1 Cellulitis 245

Pharmacology 245

Follow-up Plan 246

Clinical Examination 248

Results 249

Management 249

Pharmacology 249

Clinical Examination 251

NEWS2 – 0 But Blood Pressure Found to Be Hypotensive 251

Neuro assessment 251

Management 253

Reflections 255

Admission Avoidance 255

Advanced Care Practitioner and Patient Empowerment 255

References 256

Further Reading 261

Self-Assessment Questions 261

Glossary 262

Chapter 13 Managing Complexity 263
Jaclyn Proctor and Sadie Diamond-Fox

Learning Outcomes 263

Introductions 263

Medical Complexity 265

Measuring Complexity in a Healthcare Context 266

Situational Complexity 269

Systems Complexity 270

NHS Long Term Plan (2019) 270

Advanced Clinical Practice 272

Conclusion 275

References 276

Further Reading 277

Self-Assessment Questions 277

Glossary 277

Chapter 14 Frailty: Principles of Rehabilitation and Reablement, Palliative Care and Organ Donation 278
Esther Clift and Stevie Park

Learning Outcomes 278

Introduction 278

Discharge Planning 279

Intermediate Care 280

Rehabilitation 281

Reablement 282

Pathways 282

Technology 282

Home-based Care 282

Virtual Wards 283

Urgent Community Response 283

Palliative or End-of-Life Care 284

Gold Standard Framework 285

Care Plans 285

Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) 286

Pain and Symptom Control 286

Verifying Death 287

Organ Donation 287

Diagnosing Death by Neurological Criteria (Brainstem Death Testing) 287

Role of the SN-OD and Referral Process 288

Tissue Donation 288

Clinical Frailty 288

Diagnosis Tools for Diagnosis and CGA 288

Exercise 290

Nutrition 290

Social Isolation and Loneliness 291

Conclusion 293

References 293

Further Reading 295

Self-Assessment Questions 295

Chapter 15 Mental Health, Learning Disability and Autism 296
Clare Allabyrne and Jo Delrée

Learning Outcomes 296

Introduction 297

Parity of Esteem 297

Diagnostic Overshadowing and Unconscious Bias 297

Mental Health and Ethnicity 298

Communication 298

Therapeutic Communication 298

Fundamental Principles of Therapeutic Communication 298

Specific Issues in Communication Clients with ASD/LD 299

Clinical Investigations 299

Mental Health Screening Tools 299

Holistic Mental Health Assessment 299

Ten-point Guide to Mental State Examination 301

Risk Assessment in Mental Health 301

Assessing Different Groups 302

Assessing Children and Young People 302

Assessing People with Autism 303

Assessing People with Learning Disability 304

A Note on Challenging Behaviour 307

Pharmacological Principles 307

Resources 309

Learning Disability Learning Event 309

Mental Health Learning Event 309

Mental Health UK states 309

Conclusion 310

References 310

Further Reading 313

Self-Assessment Questions 313

Glossary 313

Chapter 16 Education and Learning 315
Joe Wood and Elizabeth Midwinter

Learning Outcomes 315

Introduction 316

Principles of Teaching and Learning 316

Understanding How We Learn 316

Recognising Adult Learners 317

Dual Coding Theory 317

Evidence-based Practice 318

Contents xv

Self-directed Learning 318

Supporting Others to Develop Knowledge and Skills 318

Feedback 318

Appraisal Processes and Continuing Professional Development 319

Learning From Mistakes: Safety I and Safety II 319

Coaching, Mentoring and Role Modelling 319

Creating an Effective Learning Environment 320

Optimise the Space 320

Physial 320

Virtual 321

Ensure Learner-centredness 321

Get to Know the Learner 322

Plan the Process 322

Create Psychological Safety 323

Promote Continual Improvement Via Reflection 324

Simulation and Technological Advances in Healthcare Education 324

Simulation 324

Teaching Practical Skills – Reflections from Clinical Experience 325

Human Factors 325

Interprofessional Education 326

Types of Simulation 327

The Concept of Fidelity 328

In Situ Simulation 329

Designing Simulated Learning 329

Scenario Writing 330

Practical Considerations 330

Introductions and Orientation 330

Pre-brief 330

Programmed vs On the Fly 331

Debrief 331

Technology-enhanced Learning 333

Conclusion 334

References 334

Further Reading 338

Self-Assessment Questions 338

Glossary 338

Chapter 17 The Advanced Practitioner as Educator 339
Phil Broadhurst

Learning Outcomes 339

Introduction 339

Providing Feedback 342

Feeding Back and Feeding Forward 343

The One-Minute Preceptor 345

Conclusion 347

References 347

Further Reading 349

Self-Assessment Questions 350

Glossary 350

Chapter 18 Research Principles 351
Brigitta Fazzini and Roberta Borg

Learning Outcomes 351

Why Research Is Important 351

The Research Process 352

Critical Appraisal and the Hierarchy of Evidence 353

Designing a Research Project 354

Every Research Project Starts with a Question 354

Research Methods 355

Scientific Hypothesis 355

Quantitative versus Qualitative Research Methods 356

Quantitative Research Method 357

Qualitative Research Method 359

Healthcare Research Ethics 360

Quality Improvement 362

Conclusion 364

References 364

Further Reading 365

Self-Assessment Questions 366

Glossary 366

Chapter 19 Leading Research in Advanced Practice 367
Leanne Dolman, Joanna De Souza, and Sara Stevenson-Baker

Learning Outcomes 368

Introduction 368

Enabling Evidence-Based Practice 369

Using Local Procedures and Protocols – Role Modelling and Ensuring Continuity of Practice 370

Auditing Current Practice 370

Utilising Clinical Audit 371

Setting Standards and Developing New Protocols 371

Setting Intended Outcomes 371

Patient-reported Outcome Measures 372

Reviewing your Protocol (Quality Control) 372

Developing Guidelines at a National/International Level 373

Developing New Evidence for Practice 373

Leading on Quality Improvement 374

Dissemination of Existing and New Knowledge 377

Local Dissemination 377

Presenting at an External Conference 377

Developing a Conference Abstract 378

Developing a Poster 378

Developing an Oral Presentation 378

Writing for Publication 378

Joining a National Forum or Guideline Development Group 378

Developing the Advanced Practitioner as a Clinical Academic 379

Creating A Research Culture at Organisational Level to Improve Person-Centred Healthcare 380

Conclusion 381

References 382

Further Reading 384

Self-Assessment Questions 384

Glossary 384

Chapter 20 Innovations in Practice 386
Vanessa Taylor and Sarah Ashelford

Learning Outcomes 386

Introduction 386

Innovation, Practice Development and Service Improvement 388

Innovation and Advanced-level Practice and the Advanced Practitioner Role 392

Advanced-level Practice and Workforce Transformation: An Example of Healthcare Service Innovation 392

Advanced Practitioner as Clinical (Practice Development/ Improvement) and Professional (Service/System Development) Innovator 394

Conclusion 400

References 401

Self-Assessment Questions 403

Glossary 403

Chapter 21 Professional Development and Transition 404
Vikki-Jo Scott and Esther Clift

Learning Outcomes 404

Introduction 405

Personal Professional Development 405

Continuing Professional Development and Role Transition 410

Supporting Professional Development Within a Team 412

Contribution to Broader Development of Advanced Practice 415

What Next? 416

Conclusion 416

References 417

Further Reading 417

Self-Assessment Questions 418

Glossary 418

Index 419

About the Author
The Editors

Ian Peate is Visiting Professor of Nursing at St George’s University of London and Kingston University London; Visiting Professor, Northumbria University; Senior Clinical Fellow, University of Hertfordshire; Professorial Fellow, University of Roehampton; Editor-in-Chief of the British Journal of Nursing, Consultant Editor of the Journal of Paramedic Practice, and Consultant Editor of the International Journal of Advancing Practice.

Sadie Diamond-Fox is an Advanced Critical Care Practitioner (FICM member) at Newcastle upon Tyne Hospitals and Strategic Lead for Advanced Practice Programmes, Assistant Professor in Advanced Critical Care Practice (Fellow - HEA) and a PhD Candidate (‘ImpACCPt’ Study) at Northumbria University, UK. She is also a Training Programme Director for Critical Care within Health Education England’s Advancing Practice Faculty in the North East & Yorkshire, UK and an Honorary Assistant Professor in Advanced Clinical Practice at Nottingham University, UK and External Examiner for Advanced Clinical Practice programmes at Southampton University. Sadie is also a council member and education committee member of the Intensive Care Society.

Barry Hill is an Associate Professor of Nursing Science and Critical Care at Northumbria University, UK. Barry has been a Registered Nurse for almost 20 years and is skilled in clinical settings and Higher Education in the area of acute and critical care, and advanced practice. He worked in general, cardiac and neuro trauma Intensive Care Units at Imperial College NHS Trust and progressed from staff nurse to charge nurse, senior charge nurse, to surgical and ENT matron. He is a certified Advanced Practitioner (MSc), Independent Prescriber (v300), and Senior Fellow with AdvanceHE. Barry is a Commissioning Editor for the British Journal of Nursing, and a Consultant Editor for the International Journal for Advancing Practice.

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