July 4th, 2008
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Education for Health, October 1, 2007
As many as 4,498 nurses working with patients with respiratory disease may not be providing appropriate care or treatment for their patients with asthma or COPD 638,000 people with long term respiratory health conditions could be receiving their diagnosis, treatment and on-going care from practice nurses who have not been adequately trained for that role according to the findings of a national survey conducted by the Charity Education for Health published today.
The National Survey into the Roles and Training of Respiratory Nurses in UK General Practice was intended to demonstrate the vital role that practice nurses fulfil in delivering respiratory care. Instead it ended up exposing the fact that, whilst there are a considerable number of respiratory nurses working at an advanced level (making diagnoses, recommending choice of therapy and providing on-going care), significant numbers of them have not been trained to undertake that role. Worse - many nurses reported that they do not even have easy access to a GP should they find themselves with a patient who needs a medical referral.
“Inadequate training and support could result in a misdiagnosis and inappropriate treatment being commenced” commented Samantha Prigmore, Chair of the Association of Respiratory Nurse Specialists (ARNS)
The Survey found:
1. 20% of asthma nurses with an advanced role (autonomously conducting diagnostic and follow-up consultations) had had no accredited asthma training and 41% of these nurses did not have immediate access to a GP should they require one”
2. 52% of COPD nurses with an advanced role had had no accredited COPD training and 45% of these nurses did not have immediate access to a GP should they require one
3. Of the 52% of COPD nurses with an advanced role and no accredited COPD training, 92% of these had obtained no accredited spirometry training (spirometry is the main diagnostic tool for COPD and is an important tool for confirming a diagnosis of asthma)
4. In the 389 practices which took part as many as 14,203 patients with asthma and 9,126 patients with COPD could be receiving care from nurses who have an advanced role but no accredited training to back them up their clinical decisions.
1. 20% of asthma nurses with an advanced role (autonomously conducting diagnostic and follow-up consultations) had had no accredited asthma training and 41% of these nurses did not have immediate access to a GP should they require one”
2. 52% of COPD nurses with an advanced role had had no accredited COPD training and 45% of these nurses did not have immediate access to a GP should they require one
3. Of the 52% of COPD nurses with an advanced role and no accredited COPD training, 92% of these had obtained no accredited spirometry training (spirometry is the main diagnostic tool for COPD and is an important tool for confirming a diagnosis of asthma)
4. In the 389 practices which took part as many as 14,203 patients with asthma and 9,126 patients with COPD could be receiving care from nurses who have an advanced role but no accredited training to back them up their clinical decisions.
The results of the Survey highlight the need to invest in nurse education and support for the survey’s findings is already high: “The delivery of optimum care for patients with respiratory illnesses remains the goal of all of us involved in promoting good practice. Whilst the Quality and Outcomes Framework (QoF) has provided an opportunity to do this, it also carries with it the threat of a minimum standard only culture in primary care. Practice nurses and GP’s managing patients under the current framework should do so with appropriate levels of accredited training and experience.” explained Dr Iain Small, GP in Peterhead, Scotland and incoming Chair of the General Practitioners in Airways Group (GPIAG)
Dame Helena Shovelton, Chief Executive of the British Lung Foundation goes further - “The extensive lack of training amongst nurses providing COPD care is deeply worrying. It’s vital that COPD is identified as early as possible yet this survey suggests 92% of nurses don’t have accredited training in the main diagnostic tool, spirometry. Patients deserve well trained professionals.” Evidence shows that the impact of asthma and COPD on patients and the economy is high.
What is not clear is why the situation continues if so much patient suffering could be prevented through better diagnosis and more effective self management, as is implied by the data.
“Patients’ lives can be transformed through effective nurse education” says Dr Samantha Walker, Director of Education, Development and Research at Education for Health, “The results of our randomised controlled trial published in March this year unequivocally demonstrates that investment made in long term, accredited education does impact favourably on patient health outcomes and quality of life*”.
“Nurses can use this research to present their case for continuing their professional development and enhancing their skills; They need to get better at accessing training and in linking it to the Practice or local health priorities” continues Monica Fletcher, CEO of Education for Health To help nurses do this, Education for Health are launching a new toolkit which will be available to download free of charge from it’s website. (www.educationforhealth.org.uk ) Called ‘How to present and win your case for education’ it will initially focus on asthma and COPD education but will feature additional long term conditions such as Heart Failure and Diabetes over the coming months.”
The news contained in the survey could cause concern amongst patients with other long term conditions too warns David Pink, Chief Executive of The Long Term Conditions Alliance.“ If (the survey) proves to be descriptive of the diagnosis and care for patients with other long term conditions then it would demonstrate the already perceived connection between the numbers of emergency admissions of those with co morbidities which remains high, and with 8.8 million people with a long term illness who say their condition severely limits their day to day activity. Patients who have a full understanding of their condition, and who are able to confidently manage it effectively on a day to day basis, have a better quality of life and are liable to fewer acute episodes and subsequent admissions than patients without such knowledge. How can we as a nation expect patients to develop this confidence and competence if they are being assisted by health professionals who are not given sufficient or appropriate knowledge in the first place?”
Patients must ask for the best care from their health team. Mel, 36, a personal fitness instructor from Twickenham, Middlesex, says that when she was first diagnosed with asthma last winter she made sure that her nurse knew about asthma by asking her what training she had had. “To manage my asthma properly means I have to take the treatment and advice given to me by my nurse. If I’d found that she didn’t know what she was talking about it could have compromised my health and career”.
To help more patients have the confidence to ask the right questions Education for Health is launching a Patient Charter at the House of Lords on 10th October at an event which celebrates their 20th Anniversary of improving the lives of patients with long term conditions through training the health professionals who care for them. The Charter will also be available to download from the Education for Health web site www.educationforhealth.org.uk on 10th October.
David Colin-Thome, Director of Primary Care Nursing at the Department of Health and GP in Runcorn, Cheshire concludes “I am a great admirer of practice nursing’s huge contribution to Primary Care but we must have a well trained workforce and where that entails specialist care an accredited workforce. I am a strong supporter of Education for Health and as such I welcome the toolkit and the Patients Charter. Safety and quality has to underpin all we do in the care of our patients
*Reference: Sheikh A, Khan-Wasti S, Price D, Smeeth L, Fletcher M, Walker S. Standardized training or healthcare professionals and its impact on patients with perennial rhinitis: a multi-centre randomized controlled trial. Clin Exp Allergy 2007; 37(1):90-99
More information on Respiratory Education Programs