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