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 (

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.