Advanced Practitioner

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.

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

Select Guide Rating