The Advanced Practitioner in Pathophysiology and Diagnostics E-Book
37,99 €
Mehr erfahren.
- Herausgeber: John Wiley & Sons
- Kategorie: Fachliteratur
- Serie: Advanced Clinical Practice
- Sprache: Englisch
An experienced and multi-disciplinary team of authors map out the intricate interplay between pathophysiology and diagnostic decision-making, two pivotal cornerstones of advanced practice in healthcare
The Advanced Practitioner in Pathophysiology and Diagnostics serves as an indispensable resource for practitioners seeking to deepen their understanding and refine their skills, as the mastery of these fundamental concepts becomes ever more crucial in an evolving healthcare landscape.
This authoritative and comprehensive guide provides readers with an evidence-based, person-centred approach to the study of the functional changes that occur within the body due to disease or injury. With this knowledge, advanced practitioners must then build their diagnostic and treatment strategies, synthesising patient history, physical examination, and diagnostic tests. This text supports the advanced practitioner in developing a deeper understanding of both the mechanisms that drive disease and the critical thinking behind the diagnostic process.
The Advanced Practitioner in Pathophysiology and Diagnostics readers will also find:
- Practical guidance on diagnostic strategies, emphasising the importance of evidence-based practice and differential diagnosis
- A multi-disciplinary approach suitable for a range of clinical backgrounds
- Detailed discussion of topics including pathophysiological processes, providing a robust foundation for clinical decision-making
The Advanced Practitioner in Pathophysiology and Diagnostics is ideal for healthcare professionals interested in or undertaking advanced level practice, as well as for students completing the pathophysiology module on their MSc in advanced practice.
Sie lesen das E-Book in den Legimi-Apps auf:
Seitenzahl: 689
Veröffentlichungsjahr: 2024
Ähnliche
Table of Contents
Cover
Table of Contents
Title Page
Copyright Page
Dedication Page
Contributors
Preface
Interlude
CHAPTER 1: An Introduction to Advanced Clinical Practice and Scope of Practice
INTRODUCTION TO ADVANCED PRACTICE
THE MPF FOR ADVANCED CLINICAL PRACTICE
DEFINING SCOPE OF PRACTICE
MULTIPROFESSIONAL REGISTRATIONS AND SCOPE OF PRACTICE
EXPANDING SCOPE AND SCOPE CREEP
THE ROLE OF INDEMNITY INSURANCE AND ORGANISATIONAL RESPONSIBILITY IN ADVANCED PRACTICE
THE ADVANCED PRACTITIONER AND THE PREGNANT PATIENT
CLINICAL INVESTIGATIONS
RESPONSIBILITY AND ACCOUNTABILITY
CONCLUSION
CHAPTER 2: Clinical Decision‐Making and Diagnostic Reasoning
INTRODUCTION
CLINICAL REASONING AND CLINICAL DECISION‐MAKING
THINKING, GROWING, AND EVOLVING
DECISION‐MAKING THEORIES
INTUITION
HYPOTHETICO‐DEDUCTIVE REASONING (ADAPTED FROM ELSTEIN ET AL. 1978 ; ELSTEIN AND BORDAGE 1988 )
THE COGNITIVE PROCESS
BIASES
CONCLUSION
CHAPTER 3: Clinical History Taking
INTRODUCTION
TRIGGERS TO CONSULTATION
TRIGGERS TO CONSULTATION: CONSULTATIONS WITH AN ALTERNATIVE AGENDA
COMMUNICATION
COMMUNICATION: KINESICS INTERVIEWING
COMMUNICATION: THE CONE TECHNIQUE
CONDUCTING THE CONSULTATION: USING A CONSULTATION MODEL
CONDUCTING THE CONSULTATION: CALGARY‐CAMBRIDGE GUIDE TO THE MEDICAL INTERVIEW
HISTORY TAKING IN SPECIAL CIRCUMSTANCES: TIME‐CRITICAL SITUATIONS
THE PATIENT PERSPECTIVE OF CONSULTATION AND THE USE OF IDEAS CONCERNS AND EXPECTATIONS (ICE)
EQUALITY, DIVERSITY, AND INCLUSIVITY CONSIDERATIONS
HISTORY TAKING FOR NEURODIVERSE AND NON‐VERBAL POPULATIONS
HISTORY TAKING FOR ETHNIC MINORITY POPULATIONS
CHAPTER 4: Physical Examination and Diagnostic Reasoning
INTRODUCTION
CLINICAL ASSESSMENT – ASPECTS OF PHYSICAL EXAMINATION
HANDS AND NAILS
UPPER LIMBS
HEAD AND NECK
THORAX
ABDOMEN
LOWER LIMBS
CLOSING THE CONSULTATION
CLINICAL REASONING AND THE CONSULTATION
COGNITIVE AND META‐COGNITIVE PROCESSES
DUAL PROCESS THEORY AND COGNITIVE BIAS IN DIAGNOSTIC REASONING
INTEGRATING THE CLINICAL REASONING PROCESS INTO THE CLINICAL CONSULTATION
EVIDENCE‐BASED DIAGNOSIS
BAYES' THEOREM
2 × 2 CONTINGENCY TABLE
THE INACCURACIES OF DIAGNOSTIC ACCURACY
CHAPTER 5: Interpretation of Clinical Investigations – Blood Tests
INTRODUCTION
CLINICAL AND DIAGNOSTIC REASONING
CHAPTER 6: Interpretation of Clinical Investigations – Radiology
INTRODUCTION
IONISING RADIATION MEDICAL EXPOSURE REGULATIONS (IRMER)
RADIATION DOSES
HEAD AND NECK IMAGING
THORACIC IMAGING
CARDIAC IMAGING
ABDOMINAL IMAGING
MUSCULOSKELETAL IMAGING
IMAGING IN SPECIFIC PATIENT POPULATIONS
CHAPTER 7: Pathophysiology and Diagnostic Decision‐Making in Inflammation and Sepsis
INTRODUCTION
INFLAMMATORY DISORDERS – PATHOPHYSIOLOGY AND RISK FACTORS
CLINICAL REASONING AND DIAGNOSTIC REASONING
IMAGING STUDIES ARE ANOTHER ESSENTIAL COMPONENT OF STRUCTURED SYMPTOM ANALYSIS
CELLULITIS
SEPTIC ARTHRITIS
FIELDS OF PRACTICE – PAEDIATRICS, MENTAL HEALTH, AND LEARNING DISABILITIES
PHARMACOLOGICAL PRINCIPLES
CHAPTER 8: Neurological Disorders
INTRODUCTION
STROKE
ISCHAEMIC STROKE
CLASSIFICATION OF ISCHAEMIC STROKE
HAEMORRHAGIC STROKE
CLINICAL FEATURES OF STROKE
CLINICAL ASSESSMENT AND DIAGNOSTIC DECISION‐MAKING
HAEMORRHAGIC STROKE MANAGEMENT
CAROTID ARTERY DISSECTION AND CENTRAL VENOUS THROMBOSIS MANAGEMENT
GENERAL ONGOING MANAGEMENT
SEIZURES AND STATUS EPILEPTICUS
MENINGITIS AND ENCEPHALITIS
CHAPTER 9: Pathophysiology and Diagnostic Decision‐Making in Ophthalmic and Associated Disorders
INTRODUCTION
PHYSIOLOGY OF THE EYE
EXTRAOCULAR MUSCLES
LIDS AND LASHES
CONJUNCTIVA
CORNEA
ANTERIOR CHAMBER AND IRIS
REFRACTION AND THE LENS
VITREOUS AND RETINA
CLINICAL EXAMINATION AND DIAGNOSTIC DECISION‐MAKING OF THE EYE
COMMON CONDITIONS
DIAGNOSTIC REASONING (SPIN AND SPOUT)
TREATMENT OPTIONS
CHAPTER 10: Pathophysiology and Diagnostic Decision‐Making in ENT Disorders
INTRODUCTION
ENT DISORDERS – PATHOPHYSIOLOGY AND RISK FACTORS
DISORDERS OF THE EAR, NOSE, AND THROAT
CLINICAL DECISION‐MAKING
DIAGNOSTIC REASONING
SINUSITIS (ACUTE)
DIFFERENTIAL DIAGNOSES FOR SINUSITIS
ACUTE SORE THROAT
DIFFERENTIAL DIAGNOSES FOR LARYNGITIS
DIFFERENTIAL DIAGNOSES FOR VERTIGO
CHAPTER 11: Pathophysiology and Diagnostic Decision‐Making in Respiratory Disorders
INTRODUCTION
RESPIRATORY DISORDERS
CLINICAL INVESTIGATION – SPIROMETRY
PHARMACOLOGICAL PRINCIPLES OF ASTHMA AND COPD
CHAPTER 12: Pathophysiology and Diagnostic Decision‐Making in Cardiovascular Disorders
INTRODUCTION
MULTI‐PROFESSIONAL FRAMEWORK FOR ADVANCED CLINICAL PRACTICE (HEE 2017 )
HEART FAILURE
ATRIAL ARRHYTHMIAS: ATRIAL FIBRILLATION (AF) AND ATRIAL FLUTTER (A. FLUTTER)
CLINICAL REASONING AND DIAGNOSTIC REASONING
CLINICAL INVESTIGATIONS
EXAMINATION SCENARIOS
CHAPTER 13: Gastrointestinal Disorders
INTRODUCTION
GASTROINTESTINAL DISORDERS: PATHOPHYSIOLOGY AND RISK FACTORS
COLORECTAL CANCER
CROHN'S AND ULCERATIVE COLITIS (INFLAMMATORY BOWEL DISEASE)
ULCERATIVE COLITIS
UC AND GENETICS
DYSFUNCTION OF THE INTESTINAL EPITHELIAL BARRIER
RISK FACTORS OF CROHN'S AND ULCERATIVE COLITIS (INFLAMMATORY BOWEL DISEASE)
GALLSTONES
PANCREATITIS
JAUNDICE
CHAPTER 14: Pathophysiology and Diagnostic Decision‐Making in Renal Disorders
INTRODUCTION
INFECTIONS: CYSTITIS, ACUTE, AND CHRONIC PYELONEPHRITIS
RENAL IMPAIRMENT: CHRONIC AND ACUTE KIDNEY DISEASE
ADDITIONAL CLINICAL AND DIAGNOSTIC REASONING IN RENAL DISEASE
SPIN/SPOUT AND INTERRELATED RELIABILITY APPLICATION IN RENAL DISORDERS
CHAPTER 15: Endocrine Disorders
INTRODUCTION
COMMON ENDOCRINE PATHOLOGIES
CLINICAL AND DIAGNOSTIC REASONING IN ENDOCRINE PATHOLOGY
PANCREATIC DISORDERS
DIABETIC KETOACIDOSIS (DKA)
HYPEROSMOLAR HYPERGLYCAEMIC STATE (HHS)
THYROID DISORDERS
ADRENAL DISORDERS
PARATHYROID DISORDERS
PITUITARY DISORDERS
CHAPTER 16: Pathophysiology and Diagnostic Decision‐Making in Haematological Disorders
INTRODUCTION
HAEMATOLOGICAL DISORDERS
EXAMINATION SCENARIOS: PATIENT EXAMINATION
CHAPTER 17: Neoplasms
INTRODUCTION
EPIDEMIOLOGY
AETIOLOGY
PATHOPHYSIOLOGY
KEY CONDITIONS
CLINICAL REASONING
HISTORY‐TAKING AND CLINICAL EXAMINATION
CHAPTER 18: Mental Health and Learning Disabilities
INTRODUCTION
CLINICAL REASONING: MENTAL HEALTH CONDITIONS
CASE STUDY REVIEW
CHAPTER 19: Musculoskeletal Disorders
INTRODUCTION
BONE
MUSCLES, TENDONS, AND LIGAMENTS
JOINT PATHOLOGY
LOW BACK PAIN AND CAUDA EQUINA RECOGNITION
CHAPTER 20: Frailty and Care of the Older Person
INTRODUCTION
EPIDEMIOLOGY
THE FRAILTY ASSESSMENT
KEY INTERVENTIONS WHICH MAY REDUCE FRAILTY
APPRAISAL
PLANNING
ACKNOWLEDGEMENT
References
Further Reading
Index
End User License Agreement
List of Tables
Chapter 2
TABLE 2.1 Methods of diagnosis.
TABLE 2.2 Well‐being toolkit.
TABLE 2.3 IMSAFE mnemonic.
TABLE 2.4 HALT mnemonic.
Chapter 3
TABLE 3.1 Alternative agendas and suggested communication tools.
TABLE 3.2 Enhanced Calgary‐Cambridge consultation model.
TABLE 3.3 Components of an adult health history and associated mnemonics.
TABLE 3.4 Specific challenges in taking a history of neurodiverse populatio...
Chapter 4
TABLE 4.1 Clinical findings of the hands and nails and their associated pat...
TABLE 4.2 Arterial pulse examination, abnormal findings, and common patholo...
TABLE 4.3 Clinical findings of the head and neck and their associated patho...
TABLE 4.4 Clinical findings of the thorax and their associated pathological...
TABLE 4.5 Clinical findings of the abdomen and their associated pathologica...
TABLE 4.6 The characteristics of dual process theory.
TABLE 4.7 The clinical reasoning process within a consultation.
TABLE 4.8 Statistical terms pertaining to evidence‐based diagnosis.
Chapter 6
TABLE 6.1 Comparison of common imaging modalities.
TABLE 6.2 Radiation doses in context.
TABLE 6.3 Imaging considerations in special populations.
TABLE 6.4 Summary.
Chapter 7
TABLE 7.1 Function of immunoglobulins (antibodies).
TABLE 7.2 Plasma protein changes during the acute phase response.
TABLE 7.3 Inflammation markers.
TABLE 7.4 Use of imaging in inflammatory disorders.
TABLE 7.5 qSOFA screening tool.
TABLE 7.6 Sepsis 6.
TABLE 7.7 Differential diagnosis of cellulitis.
TABLE 7.8 Cellulitis: assessment of severity and management.
TABLE 7.9 Clinical examination.
TABLE 7.10 Differential diagnoses of systemic vasculitis.
TABLE 7.11 Anti‐neutrophil cytoplasmic antibodies (ANCA).
TABLE 7.12 Prednisolone.
TABLE 7.13 Focussed assessment of acute arthritis.
TABLE 7.14 Urgent investigations for septic arthritis.
TABLE 7.15 Differential diagnosis of septic arthritis.
Chapter 8
TABLE 8.1 Clinical features of stroke.
TABLE 8.2 Risk factors for stroke.
TABLE 8.3 Clinical assessment of suspected stroke.
Chapter 9
TABLE 9.1 Differential diagnosis using anatomical landmarks.
TABLE 9.2 Testing visual acuity.
TABLE 9.3 Differential diagnosis of corneal ulcers.
Chapter 10
TABLE 10.1 Differential diagnoses for otitis media.
TABLE 10.2 Differential diagnoses for sinusitis.
TABLE 10.3 Differential diagnoses for acute sore throat.
TABLE 10.4 FeverPAIN score.
TABLE 10.5 Modified centor criteria.
TABLE 10.6 Differential diagnoses for laryngitis.
TABLE 10.7 Differential diagnoses for vertigo.
TABLE 10.8 Pharmacological principles in ENT.
Chapter 11
TABLE 11.1 Management of acute asthma in adults.
TABLE 11.2 An illustration of class 1–5 dysfunction.
TABLE 11.3 An overview of pharmacological principles of asthma and COPD.
Chapter 12
TABLE 12.1 Risk factors.
TABLE 12.2 Targets for significant atherosclerosis.
TABLE 12.3 Differential diagnosis of chest pain by system.
TABLE 12.4 HEART score.
TABLE 12.5 New York Heart Association.
Chapter 13
TABLE 13.1 Differential diagnosis of diverticulitis.
TABLE 13.2 Differential diagnosis of colorectal cancer.
TABLE 13.3 Differential diagnosis of Crohn's disease.
TABLE 13.4 Differential diagnosis of ulcerative colitis.
TABLE 13.5 Differential diagnosis of gallstones.
TABLE 13.6 Differential diagnosis of pancreatitis.
TABLE 13.7 Some of the causes of patients presenting with jaundice.
Chapter 14
TABLE 14.1 Differential diagnoses of cystitis.
TABLE 14.2 Acute pyelonephritis symptoms.
TABLE 14.3 Risk factors for acute pyelonephritis.
TABLE 14.4 Chronic conditions affecting the kidneys.
TABLE 14.5 Risk factors for chronic pyelonephritis.
TABLE 14.6 Types of AKI.
TABLE 14.7 Identifying underlying causes.
TABLE 14.8 CKD and decline in long‐term kidney function.
TABLE 14.9 PKD differentials.
TABLE 14.10 Differentiating features of kidney conditions.
TABLE 14.11 Causes of urinary frequency.
TABLE 14.12 Investigation findings.
TABLE 14.13 Imaging for renal/urinary disease.
TABLE 14.14 Nephrotoxic drugs.
Chapter 15
TABLE 15.1 Hormone and hormone actions.
Chapter 17
TABLE 17.1 Factors Contributing to Carcinogenesis.
TABLE 17.2 Using your senses in general overview.
TABLE 17.3 Local features of malignant disease. Dark, G (2013) / With permi...
TABLE 17.4 Guidelines on diagnostics for suspected cancer.
TABLE 17.5 Clinical examination.
Chapter 18
TABLE 18.1 The clusters of personality disorders.
Chapter 19
TABLE 19.1 Resisted test findings.
TABLE 19.2 Some common capsular patterns.
Chapter 20
TABLE 20.1 Population percentage of frailty.
TABLE 20.2 Components of the comprehensive geriatric assessment.
TABLE 20.3 Levels of frailty care planning.
List of Illustrations
Chapter 2
FIGURE 2.1 The Roberts & Francis‐Wenger clinical decision‐making tree 2022....
FIGURE 2.2 The four stages of competence.
Chapter 3
FIGURE 3.1 A pictorial representation of the open to closed cone described i...
Chapter 4
FIGURE 4.1 Example physical examination content.
FIGURE 4.2 The elements involved in clinical reasoning, underpinned by a kno...
FIGURE 4.3 Traditional findings versus evidence‐based method of diagnosis....
FIGURE 4.4 A two‐by‐two square.
Chapter 6
FIGURE 6.1 NGT correctly placed (tip below diaphragm).
Chapter 8
FIGURE 8.1 Non‐contrast CT head demonstrating SAH.
FIGURE 8.2 CT scan image demonstrating an intraparenchymal haemorrhage with ...
FIGURE 8.3 This image shows hyperdense SAH in the basal cisterns (white arro...
FIGURE 8.4 This image shows a prior left‐sided ischemic stroke due to an MCA...
FIGURE 8.5 This image shows a pre‐operative CT scan of a patient showing a t...
FIGURE 8.6 This image shows a young man with shotgun injury. Bone window (a)...
Chapter 9
FIGURE 9.1 Glands and ducts.
FIGURE 9.2 Ocular muscles.
FIGURE 9.3 Normal anterior eyelid anatomy.
FIGURE 9.4 Cross section of the cornea.
FIGURE 9.5 Cross section of the eye.
FIGURE 9.6 Weiss ring.
Chapter 10
FIGURE 10.1 The ear.
FIGURE 10.2 The nose.
FIGURE 10.3 The throat.
Chapter 11
FIGURE 11.1 Types of V/Q mismatch.
Chapter 12
FIGURE 12.1 CHA
2
DS
2
‐VASc score.
FIGURE 12.2 ORBIT bleeding risk score.
FIGURE 12.3 Case study ECG.
Chapter 13
FIGURE 13.1 Common presenting symptoms and their associations with GI.
Chapter 14
FIGURE 14.1 Common causes of haematuria.
Chapter 15
FIGURE 15.1 Clinical examination findings and features of common endocrine c...
FIGURE 15.2 Pathogenesis of DKA.
FIGURE 15.3 Clinical features of thyrotoxicosis and the additional features ...
FIGURE 15.4 Severe hypothyroidism and myxoedema coma.
Chapter 16
FIGURE 16.1 Various aetiologies of iron deficiency anaemia.
FIGURE 16.2 Sickle cell disease: acute and chronic clinical complications....
Chapter 17
FIGURE 17.1 A diagram showing the 10 hallmarks of cancer.
FIGURE 17.2 Presenting problems in a patient with cancer.
FIGURE 17.3 Different search patterns of clinical breast examination.
FIGURE 17.4 Digital rectal examination.
Chapter 20
FIGURE 20.1 Frailty deficits.
FIGURE 20.2 Functional ability with frailty and acute illness.
FIGURE 20.3 Frailty assessment cycle.
FIGURE 20.4 Frailty intervention process.
FIGURE 20.5 PRISMA‐7 questionnaire.
FIGURE 20.6 The Clinical Frailty Scale.
Guide
Cover Page
Table of Contents
Title Page
Copyright Page
Dedication Page
Contributors
Preface
Interlude
Begin Reading
References
Further Reading
Index
WILEY END USER LICENSE AGREEMENT
Pages
iii
iv
v
ix
x
xi
xii
xiii
xiv
xv
xvi
xvii
xviii
xix
xx
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72
73
74
75
76
77
78
79
80
81
82
83
84
85
86
87
88
89
90
91
92
93
94
95
96
97
98
99
100
101
102
103
104
105
106
107
108
109
110
111
112
113
114
115
116
117
118
119
120
121
122
123
124
125
126
127
128
129
130
131
132
133
134
135
136
137
138
139
140
141
142
143
144
145
146
147
148
149
150
151
152
153
154
155
156
157
158
159
160
161
162
163
164
165
166
167
168
169
170
171
172
173
174
175
176
177
178
179
180
181
182
183
184
185
186
187
188
189
190
191
192
193
194
195
196
197
198
199
200
201
202
203
204
205
206
207
208
209
210
211
212
213
214
215
216
217
218
219
220
221
222
223
224
225
226
227
228
229
230
231
232
233
234
235
236
237
238
239
240
241
242
243
244
245
246
247
248
249
250
251
252
253
254
255
256
257
258
259
260
261
262
263
264
265
266
267
268
269
270
271
272
273
274
275
276
277
278
279
280
281
282
283
284
285
286
287
288
289
290
291
292
293
294
295
296
297
298
299
300
301
302
303
304
305
306
307
308
309
310
311
312
313
314
315
316
317
318
319
320
321
322
323
324
325
326
327
328
329
330
331
332
333
334
335
336
337
338
339
340
341
342
343
344
345
346
347
348
349
350
351
352
353
354
355
356
357
358
359
360
361
362
363
364
365
366
367
368
369
370
371
372
373
374
375
376
377
378
379
380
381
The Advanced Practitioner in Pathophysiology and Diagnostics
Edited by
Ollie Phipps
Canterbury Christ Church University,
UK
Ian Setchfield
East Kent Hospitals University NHS Foundation Trust,
UK
Barry Hill
Buckinghamshire New University,
UK
Sadie Diamond‐Fox
Northumbria University,
UK
Series Editor:
Ian Peate
This edition first published 2025© 2025 John Wiley & Sons Ltd
All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, except as permitted by law. Advice on how to obtain permission to reuse material from this title is available at http://www.wiley.com/go/permissions.
The right of Ollie Phipps, Ian Setchfield, Barry Hill, and Sadie Diamond‐Fox to be identified as the authors of the editorial material in this work has been asserted in accordance with law.
Registered OfficesJohn Wiley & Sons, Inc., 111 River Street, Hoboken, NJ 07030, USA
John Wiley & Sons Ltd, The Atrium, Southern Gate, Chichester, West Sussex, PO19 8SQ, UK
For details of our global editorial offices, customer services, and more information about Wiley products visit us at www.wiley.com.
Wiley also publishes its books in a variety of electronic formats and by print‐on‐demand. Some content that appears in standard print versions of this book may not be available in other formats.
Trademarks: Wiley and the Wiley logo are trademarks or registered trademarks of John Wiley & Sons, Inc. and/or its affiliates in the United States and other countries and may not be used without written permission. All other trademarks are the property of their respective owners. John Wiley & Sons, Inc. is not associated with any product or vendor mentioned in this book.
Limit of Liability/Disclaimer of WarrantyThe contents of this work are intended to further general scientific research, understanding, and discussion only and are not intended and should not be relied upon as recommending or promoting scientific method, diagnosis, or treatment by physicians for any particular patient. In view of ongoing research, equipment modifications, changes in governmental regulations, and the constant flow of information relating to the use of medicines, equipment, and devices, the reader is urged to review and evaluate the information provided in the package insert or instructions for each medicine, equipment, or device for, among other things, any changes in the instructions or indication of usage and for added warnings and precautions. While the publisher and authors have used their best efforts in preparing this work, they make no representations or warranties with respect to the accuracy or completeness of the contents of this work and specifically disclaim all warranties, including without limitation any implied warranties of merchantability or fitness for a particular purpose. No warranty may be created or extended by sales representatives, written sales materials, or promotional statements for this work. This work is sold with the understanding that the publisher is not engaged in rendering professional services. The advice and strategies contained herein may not be suitable for your situation. You should consult with a specialist where appropriate. The fact that an organization, website, or product is referred to in this work as a citation and/or potential source of further information does not mean that the publisher and authors endorse the information or services the organization, website, or product may provide or recommendations it may make. Further, readers should be aware that websites listed in this work may have changed or disappeared between when this work was written and when it is read. Neither the publisher nor authors shall be liable for any loss of profit or any other commercial damages, including but not limited to special, incidental, consequential, or other damages.
Library of Congress Cataloging‐in‐Publication DataNames: Phipps, Oliver, editor. | Setchfield, Ian, editor. | Hill, Barry (Lecturer in nursing), editor. | Diamond‐Fox, Sadie, editor.Title: The advanced practitioner in pathophysiology and diagnostics / edited by Ollie Phipps, Ian Setchfield, Barry Hill, Sadie Diamond‐Fox.Description: Hoboken, NJ : Wiley‐Blackwell, 2024. | Includes bibliographical references and index.Identifiers: LCCN 2024024183 (print) | LCCN 2024024184 (ebook) | ISBN 9781394206766 (paperback) | ISBN 9781394206773 (adobe pdf) | ISBN 9781394206780 (epub)Subjects: MESH: Clinical Decision‐Making–methods | Diagnostic Techniques and Procedures | Scope of Practice | Advanced Practice Nursing | Allied Health Personnel | United KingdomClassification: LCC RC71.3 (print) | LCC RC71.3 (ebook) | NLM WB 142.5 | DDC 616.07/5–dc23/eng/20240626LC record available at https://lccn.loc.gov/2024024183LC ebook record available at https://lccn.loc.gov/2024024184
Cover Design: WileyCover Image: © SEBASTIAN KAULITZKI/SCIENCE PHOTO LIBRARY/Getty Images
Dedications
“I helped a fellow human climb a mountain and found that I too had reached the top.”
Thank you to the clinical experts who have contributed chapters to this book. We are grateful for the support of our partners, friends, colleagues, and the advanced practice community.
A special thank you to the amazing Wiley publishing team for supporting, developing, and providing opportunities to expand the knowledge and education of both trainees and qualified advanced practitioners. Having this book included in Wiley's Advanced Practice Series is a privilege.
Kindest regards,
Ollie Phipps, Ian Setchfield, Barry Hill, and Sadie Diamond‐Fox
Contributors
Esther ArnoldSenior Lecturer in Advanced Clinical Practiceand Clinical Nurse Specialist in CardiologyCanterbury Christ Church UniversityKent, UK
Jo Amy BaileyLecturer in Adult Nursing (Education)University of PlymouthUK
Nick BrowningTrust Lead for Advanced PracticeAdvanced Clinical PractitionerNorth Bristol NHS TrustUK
Esther CliftChair, Nurses and AHPs Council and aConsultant Physiotherapist specialising in FrailtyBritish Geriatrics SocietyUK
John ClulowConsultant Advanced Clinical Practitioner inEmergency MedicineMaidstone and Tunbridge Wells NHS TrustUK
Rebecca ConnollyConsultant ACP: Adult DeteriorationEmergency and Critical Care MedicineUnited Lincolnshire Hospitals NHS TrustUK
Jo DelréeIndependent Nurse ConsultantEducator and AcademicDelrée Training and ConsultancyUK
Sadie Diamond‐FoxAdvanced Critical Care Practitioner(FICM member), North Cumbria Integrated CareNHS Foundation Trust and Assistant Professorin Advanced Critical Care Practice & AdvancedClinical PracticeNorthumbria UniversityUK
Inmaculada Diaz‐AlonsoLecturer for Advanced Clinical PracticeCanterbury Christ Church UniversityKent, UK
Helen Francis‐WengerAdvanced Clinical PractitionerLecturer in Advanced Clinical PracticeDeputy Chair of the Association of AdvancedPractice Educators (UK) (AAPEUK)UK
Alexandra GatehouseLead Advanced Critical CarePractitioner, Newcastle Hospitals NHSFoundation TrustUK
James HardieConsultant Practitioner FrailtyKent Community Health NHS Foundation TrustUK
Jo HardyAdvanced Practitioner in Critical CarePhysiotherapy, Advanced Practitioner andAdult Therapies Lead for Advancing PracticeThe Leeds Teaching HospitalsUK
Michelle HawesAdvanced Clinical Practitioner at Kent andMedway NHS and Social CarePartnership; Honorary Senior Lecturerfor Advanced Clinical PracticeCanterbury Christ Church UniversityKent, UK
Sarah HenryAdvanced Clinical Practitioner in Acute MedicineHarrogate and District NHS Foundation TrustUK
Dr Barry HillProfessor of Acute and Critical Care NursingHead of School for Nursing and MidwiferyBuckinghamshire New UniversityBuckinghamshire, UK
Dr Mona KhandwalaConsultant Ophthalmic andOculoplastic SurgeonMaidstone and Tunbridge Wells NHS TrustUK
Mark KitchinghamConsultant NurseOlder Adults Mental Health at Kent and MedwayNHS & Social Care Partnership Trust andLecturer in Mental Health Nursing atCanterbury Christ Church UniversityKent, UK
Janine MairConsultant Nurse Acute CareEast Kent Hospitals University NHSFoundation TrustUK
Sandra Marti‐NavarreteAdvanced Clinical Practitioner, EmergencyDepartmentMaidstone and Tunbridge WellsHospital NHS TrustUK
Tracey MaxfieldAdvanced Clinical Practitioner inAcute MedicineAiredale NHS Foundation TrustUK
Caroline McCreaAdvanced Critical Care PractitionerPortsmouth Hospitals NHS TrustUK
Valentino OrioloConsultant Nurse PractitionerAssessment and Supervision Lead for AcuteInternal Medicine (AIM), South West Faculty ofAdvancing PracticeHeath Education England, UK
Jaime PhippsAdvanced Nurse PractitionerSnodland Medical PracticeKent, UK
Ollie PhippsSenior Lecturer Advanced Practice &Non‐Medical Prescribing, Professional Leadfor Advanced Clinical Practice & IndependentPrescribing, Course Director MSc AdvancedClinical PracticeCanterbury Christchurch UniversityKent, UK
Dr Claire Anne PryorProfessorSalford University;RCN Foundation Chair in Adult SocialCare Nursing,UK
Alex RickettConsultant Nurse in Liaison Psychiatry at Kentand Medway NHS and Social Care PartnershipTrust; Honorary Lecturer for AdvancedClinical PracticeCanterbury Christ Church UniversityKent, UK
Amanda RileyACP in the Urgent Care Service at KCHFTSoutheast Training Programme Lead for AHPsin Advancing Practice, NHS EnglandUK
Angela RobertsAdvanced Nurse PractitionerSouthern Health NHS TrustUK
Dr Colin RobertsAssociate Professor of Advanced PracticeUniversity of Plymouth and Registered General Practitioner (GP)
Ian SetchfieldAssociate Director‐Workforce Development andEducation for Nursing, Midwifery and AlliedHealth Professionals and Advance Practice LeadEast Kent Hospitals University NHSFoundation Trust
Sonya StoneAssociate Professor of AdvancedClinical Practice;Director of Postgraduate Taught Educationand CPD (School of Health Sciences); FacultyDirector for Higher Degree Apprenticeships(Medicine & Health Sciences;ACP, Cardiac Intensive Care UnitNottingham University Hospitals NHS TrustUK
Holly TantRadiotherapy Physics Education andTraining OfficerMaidstone and Tunbridge Wells NHS TrustUK
Katy TaylorMacmillan Consultant Therapy Radiographer(Palliative)Maidstone and Tunbridge Wells NHS TrustUK
Dr John WilkinsonAnaesthetics RegistrarNHS England North East andNorth Cumbria Deanery
Nick WorthAdvanced Clinical PractitionerSports Performance Physiotherapist andPhysiotherapy Expert WitnessThe Physiotherapy Clinic, Chair for the Society ofMusculoskeletal Medicine (SOMM)UK
Preface
Pathophysiology and diagnostic decision‐making are fundamental to healthcare, enabling advanced practitioners to provide high‐quality, evidence‐based care. In today's evolving healthcare landscape, a deep understanding of these concepts is increasingly vital. This book aims to enhance practitioners' knowledge and skills in these critical areas.
Pathophysiology involves studying functional changes in the body due to disease or injury, forming the foundation for diagnostic and treatment strategies. Recognising subtle signs and symptoms of diseases allows practitioners to make accurate diagnoses and implement effective, evidence‐based treatment plans, directly impacting patient care quality and safety.
Diagnostic decision‐making synthesises information from patient history, physical examinations, and diagnostic tests to reach a diagnosis. This skill requires a solid foundation in pathophysiology, critical evaluation of information, and effective communication of findings to patients and healthcare professionals.
As healthcare systems evolve, advanced practitioners play an increasingly crucial role. The shift towards patient‐centred care and preventive medicine necessitates a deeper understanding of pathophysiological processes. The rise of multidisciplinary teams demands accurate and timely diagnoses from practitioners, making mastery of these skills essential.
In the UK, the role of advanced practitioners has expanded to address workforce shortages and provide high‐quality care in diverse settings. This book supports practitioners in navigating modern healthcare complexities by offering comprehensive insights into pathophysiology and diagnostic decision‐making.
Throughout the book, we explore the pathophysiological basis of various diseases, their clinical manifestations, and diagnostic criteria. Practical guidance on the diagnostic process, emphasising critical thinking, pattern recognition, and differential diagnosis, is provided. Real‐world case studies illustrate key concepts and offer tangible contexts for application.
In conclusion, pathophysiology and diagnostic decision‐making are essential for advanced practitioners to deliver high‐quality, evidence‐based care. This book aims to empower practitioners to master these concepts, enhancing their ability to provide exceptional patient care, navigate healthcare complexities confidently, and collaborate effectively with colleagues. By engaging with this content, you will deepen your knowledge, refine your diagnostic skills, and embark on a fulfilling and impactful healthcare career.
Interlude
Mapping of Advanced Clinical Practice Chapters to National Frameworks and Specialist Curricula
Chapter
Multi‐Professional Framework (MPF) Statements
Specialist Curricula and Capabilities
1. Introduction to Advanced Clinical Practice and Scope of Practice
1.1; 1.2; 3.1; 3.2; 3.8; 4.6
Acute Medicine: Generic CiPs 1 * Autism: Domain A – Capability 1 * Community Rehabilitation: Area‐specific capabilities: 1.1.2 * Critical Care: 2.1 * Emergency Medicine: SLO 1‐2 * Learning Disabilities: Domain A – Capability 1 & 2 * Rehabilitation & Long‐term Conditions: Generic capabilities: 1.1 * Neurological Rehabilitation: Domain A – 1.1 * Mental Health: Domain A: Person‐centred therapeutic alliance * Older People: Generic Clinical CiPs: 1, 2, 3, 4 * Specialist Clinical CiPs: 3
2. Clinical Decision‐Making and Diagnostic Reasoning
1.1‐1.11; 2.3‐2.4; 3.1‐3.2; 4.2
Acute Medicine: Generic CiPs 1‐4; Speciality Clinical CiPs: 3‐4 * Autism: Domain A – Capability 1, Domain B – Capability 4 * Community Rehabilitation: Area‐specific capabilities: 1.1.2; Generic Capabilities: 1.1, 2.1, 2.3, 3.3 * Critical Care: 2.2; 3.1‐3.2; 4.2 * Emergency Medicine: SLO 1‐2 * Learning Disabilities: Domain A – Capability 1 & 2 * Rehabilitation & Long‐term Conditions: Area‐specific capabilities: 1.1; Generic capabilities: 1.1, 1.3, 2.1‐2.3 * Neurological Rehabilitation: Domain A – 1.1; Domain B – 2.1‐2.2; Domain C – 3.1‐3.2 * Mental Health: Domain A: Person‐centred therapeutic alliance; Domain B: Assessment and investigations; Domain C: Formulation * Older People: Generic Clinical CiPs: 1‐4; Specialist Clinical CiPs: 3, 3.3
3. Clinical History Taking
1.1‐1.7; 2.1‐2.3; 2.9; 3.1‐3.2; 3.4; 4.1
Acute Medicine: Generic CiPs 1 * Autism: Domain A – Capability 1, Domain B – Capability 4 * Community Rehabilitation: ASC 2.1 * Critical Care: 2.1‐2.2; 3.1‐3.2; 4.2 * Emergency Medicine: SLO1‐4; SLO7; SLO11; SLO12 * Learning Disabilities: Domain A – Capability 1 & 2 * Rehabilitation & Long‐term Conditions: Area‐specific capabilities: 1.1; Generic capabilities: 1.1, 1.3, 2.1‐2.3 * Neurological Rehabilitation: Domain A – 1.1; Domain B – 2.1‐2.2; Domain C – 3.1‐3.2; Domain D – 4.1 * Mental Health: Domain A: Person‐centred therapeutic alliance; Domain B: Assessment and investigations; Domain C: Formulation * Older People: Generic Clinical CiPs: 1‐4; Specialist Clinical CiPs: 3, 3.3
4. Physical Examination
1.1‐1.7; 2.1‐2.3; 2.9; 3.1‐3.2; 3.4; 4.1
Acute Medicine: Generic CiPs 1 * Autism: Domain A – Capability 1, Domain B – Capability 4 * Community Rehabilitation: ASC 2.1 * Critical Care: 2.1‐2.2; 3.1‐3.2; 4.2 * Emergency Medicine: SLO1‐4; SLO7; SLO11; SLO12 * Learning Disabilities: Domain A – Capability 1 & 2 * Rehabilitation & Long‐term Conditions: Area‐specific capabilities: 1.1; Generic capabilities: 1.1, 1.3, 2.1‐2.3 * Neurological Rehabilitation: Domain A – 1.1; Domain B – 2.1‐2.2; Domain C – 3.1‐3.2; Domain D – 4.1 * Mental Health: Domain A: Person‐centred therapeutic alliance; Domain B: Assessment and investigations; Domain C: Formulation * Older People: Generic Clinical CiPs: 1‐4; Specialist Clinical CiPs: 3, 3.3
5. Interpretation of Clinical Investigations – Blood Tests
1.1‐1.7; 2.1‐2.3; 2.9; 3.1‐3.2; 3.4; 4.1
Acute Medicine: Generic CiPs 1‐3; Specialty Clinical CiPs: 3 * Autism: Domain B – Capability 4 * Community Rehabilitation: Area‐specific capabilities: 1.1.2; Generic Capabilities: 1.1, 2.1, 2.3, 3.3 * Critical Care: 2.2; 2.4; 2.5; 3.1‐3.2; 4.2 * Emergency Medicine: SLO 1‐2 * Learning Disabilities: Domain A – Capability 1 & 2 * Rehabilitation & Long‐term Conditions: Generic capabilities: 1.3, 2.1‐2.3 * Neurological Rehabilitation: Domain A – 1.1 * Mental Health: Domain B: Assessment and investigations * Older People: Generic Clinical CiPs: 1‐4; Specialist Clinical CiPs: 3, 3.3
6. Interpretation of Clinical Investigations – Radiology
1.1‐1.7; 2.1‐2.3; 2.9; 3.1‐3.2; 3.4; 4.1
Acute Medicine: Core CiPs: 2‐4; General Clinical CiPs: 2, 4 * Autism: Domain B – Capability 4 * Community Rehabilitation: Area‐specific capabilities: 1.1.2; Generic Capabilities: 1.1, 2.1, 2.3, 3.3 * Critical Care: 2.3; 2.5; 3.2; 3.5; 4.3 * Emergency Medicine: GP 1‐10; GC 1‐8; SuP 1‐7; SuC 2, 4, & 12 * Learning Disabilities: Domain A – Capability 1 & 2 * Rehabilitation & Long‐term Conditions: Generic capabilities: 1.3, 2.1‐2.3 * Neurological Rehabilitation: Domain A – 1.1 * Mental Health: Domain B: Assessment and investigations * Older People: Generic Clinical CiPs: 1‐4; Specialist Clinical CiPs: 3, 3.3
7. Inflammation and Sepsis
1.2; 1.4; 1.6‐1.7; 2.5; 3.1
Acute Medicine: Generic Clinical CiPs: 1; Presentations and Conditions: Infectious diseases, Oncology * Autism: Domain A – Capability 1, Domain B – Capability 4 * Community Rehabilitation: ASC 2.1 * Critical Care: 2.4; 2.5; 3.2; 3.5; 4.3 * Emergency Medicine: SLO1‐4; SLO7; SLO11; IP1‐3 * Learning Disabilities: Domain A – Capability 1 & 2 * Rehabilitation & Long‐term Conditions: Area‐specific capabilities: 1.1; Generic capabilities: 1.1, 1.3, 2.1‐2.3 * Neurological Rehabilitation: Domain A – 1.1 * Mental Health: Domain B: Assessment and investigations; Domain C: Formulation * Older People: Generic Clinical CiPs: 1‐4; Specialist Clinical CiPs: 3, 3.3
8. Neurological Disorders
1.2; 1.4; 1.6‐1.8; 3.1‐3.2
Acute Medicine: Generic CiPs: 1‐4; Speciality Clinical CiPs: 3‐4; Presentations and Conditions: Endocrinology and diabetes mellitus, Neurology * Autism: Domain A – Capability 1, Domain B – Capability 4 * Community Rehabilitation: ASC 2.6 * Critical Care: 2.2; 2.4‐2.6; 3.1‐3.3; 3.5; 3.6‐3.7; 3.9‐3.11 * Emergency Medicine: SLO1‐2; NeuP1‐9 * Learning Disabilities: Domain A – Capability 1 & 2 * Rehabilitation & Long‐term Conditions: Generic capabilities: 1.1, 1.3, 2.1‐2.3 * Neurological Rehabilitation: Domain A – 1.1‐1.2; Domain B – 2.1‐2.2; Domain C – 3.1‐3.2; Domain D – 4.1 * Mental Health: Domain B: Assessment and investigations; Domain C: Formulation * Older People: Generic Clinical CiPs: 1‐4; Specialist Clinical CiPs: 3, 3.3
9. Ophthalmology and associated Disorders
1.1‐1.7; 2.1‐2.3; 2.9; 3.1‐3.2; 3.4; 4.1
Acute Medicine: Generic CiPs: 1‐4; Speciality Clinical CiPs: 3‐4 * Autism: Domain A – Capability 1, Domain B – Capability 4 * Community Rehabilitation: Area‐specific capabilities: 1.1.2; Generic Capabilities: 1.1, 2.1, 2.3, 3.3 * Critical Care: 2.1‐2.2; 3.1‐3.2; 3.5 * Emergency Medicine: SLO1‐2; OptP1‐5 * Learning Disabilities: Domain A – Capability 1 & 2 * Rehabilitation & Long‐term Conditions: Generic capabilities: 1.3, 2.1‐2.3; Area‐specific capabilities: 1.1 * Neurological Rehabilitation: Domain A – 1.1‐1.2; Domain B – 2.1‐2.2; Domain C – 3.1‐3.2; Domain D – 4.1 * Mental Health: Domain B: Assessment and investigations; Domain C: Formulation * Older People: Generic Clinical CiPs: 1‐4; Specialist Clinical CiPs: 3, 3.3
10. Ear, Nose, and Throat Disorders
1.1‐1.7; 2.1‐2.3; 2.9; 3.1‐3.2; 3.4; 4.1
Acute Medicine: Generic CiPs: 1‐4; Speciality Clinical CiPs: 3‐4 * Autism: Domain A – Capability 1, Domain B – Capability 4 * Community Rehabilitation: Area‐specific capabilities: 1.1.2; Generic Capabilities: 1.1, 2.1, 2.3, 3.3 * Critical Care: 2.1‐2.2; 3.1‐3.2; 3.5 * Emergency Medicine: SLO 1‐2 * Learning Disabilities: Domain A – Capability 1 & 2 * Rehabilitation & Long‐term Conditions: Generic capabilities: 1.3, 2.1‐2.3; Area‐specific capabilities: 1.1 * Neurological Rehabilitation: Domain B – 2.1 * Mental Health: Domain B: Assessment and investigations; Domain C: Formulation * Older People: Generic Clinical CiPs: 1‐4; Specialist Clinical CiPs: 3, 3.3
11. Respiratory Disorders
1.1‐1.7; 2.1‐2.3; 2.9; 3.1‐3.2; 3.4; 4.1
Acute Medicine: Generic CiPs: 1‐4; Speciality Clinical CiPs: 3‐4; Presentations and Conditions: Respiratory * Autism: Domain A – Capability 1, Domain B – Capability 4 * Community Rehabilitation: ASC 2.3; Area‐specific capabilities: 1.1.2; Generic Capabilities: 1.1, 2.1, 2.3, 3.3 * Critical Care: 2.1‐2.2; 3.1‐3.2; 3.5 * Emergency Medicine: SLO 1‐2; ResP1‐4 * Learning Disabilities: Domain A – Capability 1 & 2 * Rehabilitation & Long‐term Conditions: Generic capabilities: 1.3, 2.1‐2.3; Area‐specific capabilities: 1.1 * Neurological Rehabilitation: Domain B – 2.1 * Mental Health: Domain B: Assessment and investigations; Domain C: Formulation * Older People: Generic Clinical CiPs: 1‐4; Specialist Clinical CiPs: 3, 3.3
12. Cardiovascular Disorders
1.1‐1.7; 2.1‐2.3; 2.9; 3.1‐3.2; 3.4; 4.1
Acute Medicine: Generic CiPs: 1‐4; Speciality Clinical CiPs: 3‐4; Presentations and Conditions: Cardiology * Autism: Domain A – Capability 1, Domain B – Capability 4 * Community Rehabilitation: ASC 2.4; Area‐specific capabilities: 1.1.2; Generic Capabilities: 1.1, 2.1, 2.3, 3.3 * Critical Care: 2.1‐2.2; 3.1‐3.2; 3.5 * Emergency Medicine: SLO 1‐2; CP1‐4 * Learning Disabilities: Domain A – Capability 1 & 2 * Rehabilitation & Long‐term Conditions: Generic capabilities: 1.3, 2.1‐2.3; Area‐specific capabilities: 1.1 * Neurological Rehabilitation: Domain B – 2.1 * Mental Health: Domain B: Assessment and investigations; Domain C: Formulation * Older People: Generic Clinical CiPs: 1‐4; Specialist Clinical CiPs: 3, 3.3
13. Gastrointestinal Disorders
1.1‐1.7; 2.1‐2.3; 2.9; 3.1‐3.2; 3.4; 4.1
Acute Medicine: Generic CiPs: 1‐4; Speciality Clinical CiPs: 3‐4; Presentations and Conditions: Gastroenterology and hepatology * Autism: Domain A – Capability 1, Domain B – Capability 4 * Community Rehabilitation: Area‐specific capabilities: 1.1.2; Generic Capabilities: 1.1, 2.1, 2.3, 3.3 * Critical Care: 2.1‐2.2; 3.1‐3.2; 3.5 * Emergency Medicine: SLO 1‐2; GP1‐10 * Learning Disabilities: Domain A – Capability 1 & 2 * Rehabilitation & Long‐term Conditions: Generic capabilities: 1.3, 2.1‐2.3; Area‐specific capabilities: 1.1 * Neurological Rehabilitation: Domain B – 2.1 * Mental Health: Domain B: Assessment and investigations; Domain C: Formulation * Older People: Generic Clinical CiPs: 1‐4; Specialist Clinical CiPs: 3, 3.3
14. Renal Disorders
1.1‐1.7; 2.1‐2.3; 2.9; 3.1‐3.2; 3.4; 4.1
Acute Medicine: Generic CiPs: 1‐4; Speciality Clinical CiPs: 3‐4; Presentations and Conditions: Renal medicine * Autism: Domain A – Capability 1, Domain B – Capability 4 * Community Rehabilitation: Area‐specific capabilities: 1.1.2; Generic Capabilities: 1.1, 2.1, 2.3, 3.3 * Critical Care: 2.1‐2.2; 3.1‐3.2; 3.5 * Emergency Medicine: SLO 1‐2; NepP1‐2 * Learning Disabilities: Domain A – Capability 1 & 2 * Rehabilitation & Long‐term Conditions: Generic capabilities: 1.3, 2.1‐2.3; Area‐specific capabilities: 1.1 * Neurological Rehabilitation: Domain B – 2.1 * Mental Health: Domain B: Assessment and investigations; Domain C: Formulation * Older People: Generic Clinical CiPs: 1‐4; Specialist Clinical CiPs: 3, 3.3
15. Endocrine Disorders
1.1‐1.7; 2.1‐2.3; 2.9; 3.1‐3.2; 3.4; 4.1
Acute Medicine: Generic CiPs: 1‐4; Speciality Clinical CiPs: 3‐4; Presentations and Conditions: Endocrinology and diabetes mellitus, Neurology * Autism: Domain A – Capability 1, Domain B – Capability 4 * Community Rehabilitation: ASC 2.5; Area‐specific capabilities: 1.1.2; Generic Capabilities: 1.1, 2.1, 2.3, 3.3 * Critical Care: 2.1‐2.2; 3.1‐3.2; 3.5 * Emergency Medicine: SLO 1‐2; RP8; CP3; EnP2‐3; EnC2, 4, 6; PhP1; PhC1; TP1 * Learning Disabilities: Domain A – Capability 1 & 2 * Rehabilitation & Long‐term Conditions: Generic capabilities: 1.3, 2.1‐2.3; Area‐specific capabilities: 1.1 * Neurological Rehabilitation: Domain A – 1.1; Domain B – 2.1‐2.2; 3.2 * Mental Health: Domain B: Assessment and investigations; Domain C: Formulation * Older People: Generic Clinical CiPs: 1‐4; Specialist Clinical CiPs: 3, 3.3
16. Haematological Disorders
1.1‐1.7; 2.1‐2.3; 2.9; 3.1‐3.2; 3.4; 4.1
Acute Medicine: Generic CiPs: 1‐4; Speciality Clinical CiPs: 3‐4; Presentations and Conditions: Haematology, Oncology * Autism: Domain A – Capability 1, Domain B – Capability 4 * Community Rehabilitation: Area‐specific capabilities: 1.1.2; Generic Capabilities: 1.1, 2.1, 2.3, 3.3 * Critical Care: 2.1‐2.2; 3.1‐3.2; 3.5 * Emergency Medicine: SLO 1‐2; HP1‐3 * Learning Disabilities: Domain A – Capability 1 & 2 * Rehabilitation & Long‐term Conditions: Generic capabilities: 1.3, 2.1‐2.3; Area‐specific capabilities: 1.1 * Neurological Rehabilitation: Domain B – 2.1 * Mental Health: Domain B: Assessment and investigations; Domain C: Formulation * Older People: Generic Clinical CiPs: 1‐4; Specialist Clinical CiPs: 3, 3.3
17. Neoplasms
1.1‐1.7; 2.1‐2.3; 2.9; 3.1‐3.2; 3.4; 4.1
Acute Medicine: Generic CiPs: 1‐4; Speciality Clinical CiPs: 3‐4; Presentations and Conditions: Oncology * Autism: Domain B – Capability 4 * Community Rehabilitation: Area‐specific capabilities: 1.1.2; Generic Capabilities: 1.1, 2.1, 2.3, 3.3 * Critical Care: 2.1‐2.2; 3.1‐3.2; 3.5 * Emergency Medicine: SLO 1‐2 * Learning Disabilities: Domain A – Capability 1 & 2 * Rehabilitation & Long‐term Conditions: Generic capabilities: 1.3, 2.1‐2.3; Area‐specific capabilities: 1.1 * Neurological Rehabilitation: Domain B – 2.1 * Mental Health: Domain B: Assessment and investigations; Domain C: Formulation * Older People: Generic Clinical CiPs: 1‐4; Specialist Clinical CiPs: 3, 3.3
18. Mental Health
1.1‐1.7; 2.1‐2.3; 2.9; 3.1‐3.2; 3.4; 4.1
Acute Medicine: Generic CiPs: 1‐4; Speciality Clinical CiPs: 3‐4 * Autism: Domain A – Capability 1 * Community Rehabilitation: ASC 2.8 * Critical Care: 2.1‐2.2; 3.1‐3.2; 3.5 * Emergency Medicine: SLO1‐2; MHC2‐8 * Learning Disabilities: Domain A – Capability 1 & 2 * Rehabilitation & Long‐term Conditions: Generic capabilities: 1.3, 2.1‐2.3; Area‐specific capabilities: 1.1 * Neurological Rehabilitation: Domain B – 2.1 * Mental Health: All domains * Older People: Generic Clinical CiPs: 1‐4; Specialist Clinical CiPs: 3, 3.3
19. Musculoskeletal Disorders
1.1‐1.7; 2.1‐2.3; 2.9; 3.1‐3.2; 3.4; 4.1
Acute Medicine: Generic CiPs: 1‐4; Speciality Clinical CiPs: 3‐4 * Autism: Domain B – Capability 4 * Community Rehabilitation: ASC 2.7 * Critical Care: 2.1‐2.2; 3.1‐3.2; 3.5 * Emergency Medicine: SLO1‐2; MuP 1‐4 * Learning Disabilities: Domain A – Capability 1 & 2 * Rehabilitation & Long‐term Conditions: Generic capabilities: 1.3, 2.1‐2.3; Area‐specific capabilities: 1.1 * Neurological Rehabilitation: Domain B – 2.1 * Mental Health: Domain B: Assessment and investigations; Domain C: Formulation * Older People: Generic Clinical CiPs: 1‐4; Specialist Clinical CiPs: 3, 3.3
20. Frailty and Care of the Older Person
1.1‐1.7; 2.1‐2.3; 2.9; 3.1‐3.2; 3.4; 4.1
Acute Medicine: Generic CiPs: 1‐4; Speciality Clinical CiPs: 3‐4; Presentations and Conditions: Geriatric medicine * Autism: Domain A – Capability 1 * Community Rehabilitation: All capability outcomes * Critical Care: 2.1‐2.2; 3.1‐3.2; 3.5 * Emergency Medicine: SLO1‐2; EIC1‐4, EIC8 * Learning Disabilities: Domain A – Capability 1 & 2 * Rehabilitation & Long‐term Conditions: Area‐specific capabilities: 1.1; Generic capabilities: 1.1, 1.3, 2.1‐2.3, 3.1‐3.2 * Neurological Rehabilitation: Domain B – 2.1 * Mental Health: Domain B: Assessment and investigations; Domain C: Formulation * Older People: Generic Clinical CiPs: 1‐4; Specialist Clinical CiPs: 3, 3.3
CHAPTER 1An Introduction to Advanced Clinical Practice and Scope of Practice
Ollie Phipps and Ian Setchfield
Aim
The aim of this chapter is to introduce advanced clinical practice, explore the governance required to support advanced clinical practice, how to develop an advanced practitioner's scope of practice, and the associated legalities.
LEARNING OUTCOMES
After reading this chapter, the reader will:
Gain an overview of advanced practice.
Understand the need of governance within advanced practice.
Be aware of their own scope of professional practice and how to they should develop and grow it safely, within the law.
How own scope of practice should be supported by an appropriate governance framework.
INTRODUCTION TO ADVANCED PRACTICE
The evolution of advanced clinical practice in the United Kingdom (UK), beginning in the 1980s, has seen significant development with the NHS Long Term Plan and the multiprofessional framework (MPF) by Health Education England (HEE) acting as recent key drivers. These roles, designed to complement rather than replace existing medical models, have expanded due to several factors including increased life expectancy and medical staff shortages. Efforts from professional bodies and HEE have led to substantial investments in workforce development, highlighting the crucial role of advanced clinical practitioners (ACPs) in transforming healthcare services to meet future needs (HEE 2017 ). The role of an ACP is increasingly recognised as crucial for the future development of the workforce, as emphasised in the NHS Long Term Plan (NHS 2019 ) and reiterated in the recent NHS Long Term Workforce Plan, which highlights the necessity for an experienced and capable advanced practice workforce (NHS 2023 ). The NHS Multiprofessional Framework (2017 ) outlines the need for a unified approach to ACP role development, ensuring quality, safety, and governance. It is vital for advanced practitioners to be aware of the professional, legal, and ethical challenges they might encounter.
THE MPF FOR ADVANCED CLINICAL PRACTICE
The MPF expands the definition of advanced clinical practice in England (HEE 2017 ). The framework is designed to enable a consistent understanding of advanced clinical practice, building on work previously carried out across England, Scotland, Wales, and Northern Ireland. The core capabilities of advanced clinical practice are articulated in this framework, and these will apply across all advanced clinical practice roles, regardless of the health and care professional's setting, subject area, and job role (HEE 2017 ). The MPF requires that health and care professionals working at the level of advanced clinical practice should have developed and can evidence the underpinning competencies (knowledge, skills, and behaviours) applicable to their specialty or subject area (HEE 2017 ). It must be recognised that every practitioner is responsible and accountable for their actions and omissions, as reflected within each healthcare professional's code of conduct (HCPC 2016 ; Nursing and Midwifery Council 2018).
DEFINING SCOPE OF PRACTICE
For healthcare professionals, acknowledging one's scope of professional practice is important, as it defines the limits of their knowledge, skills, and experience. This scope, supported by professional activities undertaken in their working role, requires that essential boundaries be identified, acknowledged, and maintained. It is recognised that a professional's scope will evolve over time as their knowledge, skills, and experience develop. Furthermore, no single profession can encompass all the expertise needed to treat and care for patients; not one definition will perfectly fit all advanced practitioners or some work environments. Advanced practice is occasionally described as a blurring of traditional role boundaries among registered healthcare professionals. Yet, this ‘blurring’ of boundaries, implying the assumption of aspects of a variety of roles, is necessary to provide better, more holistic care to all, which can be seen as a positive evolution of healthcare.
Each advanced practitioner must possess the correct knowledge, skills, and behaviours to undertake their role and demonstrate competence, both professionally and educationally. While embracing the four pillars of advanced practice, as experts, advanced practitioners must be professionally mature and have significant practice experience. They must always work within their scope of professional practice and acknowledge their professional limitations and restrictions.
MULTIPROFESSIONAL REGISTRATIONS AND SCOPE OF PRACTICE
Advanced clinical practice is multiprofessional, differentiating it from other health and care provisions by registered professionals (HEE 2021 ). It must be acknowledged that there is no single underpinning, pre‐registration professional training for those developing to work at an advanced level. The scope of practice for different registered professions varies, and not all professional registrations extend to independent or supplementary prescribing (HEE 2021 ).
EXPANDING SCOPE AND SCOPE CREEP
Those training and working at an advanced level must be aware of their competence and capability. With various curricula and capability frameworks being developed and implemented, advanced practitioners receive guidance on where their knowledge, skills, and professional behaviour should align. However, those beginning their journey as advanced practitioners must recognise that it will take years to acquire the necessary knowledge, skills, and experience. While advanced practice may encompass traditional knowledge and skills associated with medicine, the development of a multiprofessional workforce brings a unique set of knowledge and skills, making the advanced practitioner ‘value‐added’ rather than a role substitute.
THE ROLE OF INDEMNITY INSURANCE AND ORGANISATIONAL RESPONSIBILITY IN ADVANCED PRACTICE
Healthcare professionals, by law, must have in place an appropriate indemnity arrangement to practise and provide care in the UK. The NHS insures its employees for work carried out on their behalf, meaning that you will be covered if a successful claim is made against you in that employment. Outside the NHS, many employers likely have professional indemnity arrangements that provide appropriate cover for all relevant risks related to your job and scope of practice. Each employer carries responsibility and vicarious liability for practitioners and must ensure that all advanced clinical practice roles, both existing and future, do not compromise safety (HEE 2017 ). Policies will need to be developed and processes introduced to reflect this. Without these, there is a significant risk of ‘unconscious incompetence’, compromising safe person‐centred care, as well as the reputation of advanced clinical practice (HEE 2017 ).
THE ADVANCED PRACTITIONER AND THE PREGNANT PATIENT
The Royal College of Nursing (RCN) issued guidance in 2021 regarding advanced practitioners treating pregnant women. It must be highlighted that the care of the pregnant woman is primarily the domain of midwives and medical practitioners, as outlined in legislation. However, this does not exclude other healthcare professionals, including advanced level practitioners. It is imperative that all healthcare professionals understand their own roles, limits, and boundaries of practice, always considering their registration and working within their scope/competence (RCN 2021 ). Non‐midwife and non‐medical practitioners should advise all pregnant women to seek advice from their named midwife at the earliest convenience, even if the condition appears unrelated to the pregnancy.
CLINICAL INVESTIGATIONS
Laboratory Investigations
Clinicians requesting blood investigations must acknowledge that the responsibility for ensuring results is acted upon rests with the person requesting the test. This responsibility can only be transferred by prior agreement, including when discharging patients before results are back and forwarding to primary care colleagues (BMA 2020 ). Patients should be informed sensitively and appropriately about investigation results, actions taken, and in accordance with the principles of Duty of Candour (RCEM 2020 ).
Radiology
In 2021, the Royal College of Emergency Medicine introduced a protocol titled ‘Radiology Requesting Protocol for Extended and Advanced Clinical Practitioners in the Emergency Department’ (RCEM 2021 ), setting clear standards for advanced practitioners supported by the Clinical Radiology Faculty of the Royal College of Radiologists. The Ionising Radiation (Medical Exposures) Regulations 2017 (IR(ME)R) outline measures for patient protection from unnecessary or excessive exposure to medical X‐rays and provide specific guidance for Employers, Practitioners, Operators, and Referrers regarding their responsibilities. Employers are responsible for implementing policies, protocols, and procedures to govern referrals, ensure justification of exposures, and record a clinical evaluation of all radiographs. The aim is to ensure that radiation doses to patients are as low as reasonably practicable, with diagnostic findings and clinical evaluations recorded in the patient's notes.
Fields of Practice – Paediatrics
Those working and treating children must ensure that they are competent to undertake such a role. The individual must possess the correct knowledge, have the right skills, and demonstrate professional behaviours. Those working with children must ensure that they have the appropriate indemnity and insurance to cover paediatric practice. At the time of writing, an ACP Paediatric curriculum is being developed. HEE, working with the Royal College of Paediatrics and Child Health (RCPCH), are creating a curricular framework consisting of key capabilities and learning outcomes across 11 domains, which map across five patient groups: non‐hospital paediatrics, hospital paediatrics, neonatal, critical care, and child with complex needs. This curricular framework encompasses the four pillars that underpin ACP practice.
Source: Adapted from RCPCH (2022 ).
Fields of Practice – Mental Health
The field of mental health is a specialist area (HEE 2020a ). A minimal standard of practice has been established. This curriculum allows the Advanced Practitioner in Mental Health to deliver high‐quality, effective care for individuals experiencing mental health illnesses/conditions. It enables regulated healthcare professionals to develop theoretical knowledge and clinical skills to practice in the specialist areas of mental health.
Fields of Practice – Learning Disabilities
Those working with individuals with learning disabilities and autism must ensure that they are competent for such roles. HEE launched frameworks for Advanced Clinical Practice for those working with people with learning disabilities (HEE 2022e ) and autism (HEE 2023 ). These frameworks define advanced clinical practice for allied health professionals and nursing staff in these services. The focus on the learning disabilities and autism workforce, intensified by initiatives like the Transforming Care Programme and the Learning Disabilities Mortality Review (LeDeR) Programme, aims to address preventable health inequalities and significantly improve life expectancy and independence for people with learning disabilities.
Learning Events
A patient presents with shortness of breath and later dies. An advanced practitioner had reviewed the patient's chest X‐ray and noted it as ‘unremarkable ‐ nothing abnormal detected’. The coroner asks the advanced practitioner to demonstrate their competence in interpreting a chest X‐ray. How would you respond in this situation?
You are tasked with reviewing a patient whose condition tests the boundaries of your clinical knowledge and acumen. Despite your supervisor's confidence in your abilities and encouragement to proceed with the assessment and management, how would you safeguard the patient's well‐being and appropriately seek assistance?
RESPONSIBILITY AND ACCOUNTABILITY
All healthcare practitioners working either at their base registration or at an advanced level must understand that they are both responsible and accountable for the decisions they make. Expanding one's scope of practice should follow correct preparation, education, and experience. The concepts of accountability and responsibility are closely linked and are central to the codes of conduct for those professionally regulated by the Nursing and Midwifery Council NMC (2018) and the Health and Care Professions Council (HCPC 2016 ). Advanced Practitioners have an obligation to undertake their role and associated tasks using sound professional judgement. As their level of practice expands, so does their level of responsibility. Regulated healthcare professionals are responsible for maintaining their competence in practice. They are answerable for their decisions made within their professional practice and the consequences of those decisions. Advanced practitioners should be able to justify their decision‐making and understand the associated legislation, ethical principles, professional standards, guidelines, and evidence‐based practice.
Case Study 1.1
A newly appointed advanced practitioner is undertaking their MSc ACP and working through their capability framework. They have several years clinical experience in their area of speciality and as such have a depth of knowledge and skills related to the patient group. However, they have never been responsible for making diagnosis and planning patient management.
What would be the first steps for the trainee to achieve the required capabilities in practice of their advanced role for which they are training?
What are the responsibilities of their supervisor, and how might they support the trainee to achieve the capabilities in practice?
What is the role of university tutor in facilitating the trainee to achieve the competencies for their advanced role?
An ACP has recently been signed off as competent to perform Level One Ultrasound scans within your department. They have started using the skill within their clinical practice.
What should be required to deem someone capable and competent to undertake a procedure?
Who should be able to assess this?
What governance framework should be in place?
CONCLUSION
The development of advanced practice in the UK has altered traditional professional boundaries, necessitating multiprofessional advanced practitioners to be cognisant of professional, legal, and ethical considerations. It is crucial for both trainees and practicing advanced practitioners to understand their competencies, manage scope creep, and adhere to governance. Guidance is provided through various curricula and frameworks. Acknowledging the time needed to acquire necessary skills and knowledge is essential. Advanced practice, often augmenting traditional medical knowledge, adds value to a pressured health service by ensuring that patients see the right person with the right skills.
Take Home Points
Advanced practitioners must embody the requisite knowledge, skills, and professional behaviours to effectively fulfil their roles within their professional registration.
They should critically acknowledge their practice limitations and the expanded level of responsibility and autonomy their roles entail.
Awareness and management of scope creep and its associated legal implications are crucial for maintaining ethical and effective practice.
CHAPTER 2Clinical Decision‐Making and Diagnostic Reasoning
Helen Francis‐Wenger, Colin Roberts, and Jo Amy Bailey
Aim
The aim of this chapter is to raise awareness and facilitate an approach to clinical decision‐making and reasoning through a process of exploring critical thinking and analytical skills when applied to clinical encounters with a recognition and appreciation of human factors.
LEARNING OUTCOMES
After reading this chapter, the reader will be able to:
Understand and apply a range of thought processes and approaches to decision‐making and human factors that advanced level practitioners can use to nurture, foster, and develop clinical skills to become sound, confident, decisive clinicians.
Enhance existing practice with the aim of providing best quality patient care.
Promote an appreciation of lifelong learning in practice, exploring the dynamic recognition that underpins curiosity and reflexive attention to advanced practitioners' well‐being and individual learning needs.
Facilitate means to promote practitioner well‐being by utilising a range of methods of self‐care strategies.
INTRODUCTION
Clinical decision‐making is the integration of experience, intuition, knowledge, wisdom, clinical skills, and problem‐solving capabilities to guide patients through diagnosis and management of health‐related issues. Although initially daunting in advanced practice, this skill is often inherently developed over years of experience. Practitioners in their respective fields naturally acquire unconscious pattern recognition, utilising robust communication and analytical skills to identify various conditions and assess their severity.
CLINICAL REASONING AND CLINICAL DECISION‐MAKING
Higgs and Jensen (2019 ) provide clear definitions of clinical reasoning and clinical decision‐making, terms often used synonymously. Clinical reasoning involves the overarching ‘thinking’ process in clinical practice, while clinical decision‐making applies this ‘thinking’ to determine the outcomes of the clinical encounter. These terms will be used interchangeably to highlight that both ‘thinking’ and ‘decision‐making’ must occur synonymously in practice. The Roberts & Francis‐Wenger Model (Figure 2.1) illustrates the journey of a decision‐maker, emphasising the central and challenging role of clinical reasoning in practice, with Higgs and Jensen (2019 ) advocating a three‐factor approach to all patients in a clinical setting. These include:
FIGURE 2.1 The Roberts & Francis‐Wenger clinical decision‐making tree 2022.
Wise action
– based on a specific context, taking the best judged action.
Professional action
– ensuring that we adopt and include an ethical, accountable, and self‐regulatory decisions and conduct.
Person‐centred action
– demonstrating and upholding respect for, and collaboration with clients, carers, and colleagues.
Clinical reasoning can be complex, multi‐faceted and frequently leads to uncertainty. Developing advanced skills in autonomous diagnostic practice demands the acknowledgement, acceptance, and tolerance of uncertainty. Such is the complexity in contemporary clinical practice; there cannot, ever, be a single, solitary method to manage the case. Our ability to manage uncertainty evolves over time as we gain both generic‐ and role‐specific experience. Exposure to clinical scenarios and developing trust in ourselves as clinicians occurs as we build upon this experience. When managing these complexities, the clinician must be prepared to adopt a high tolerance level of ambiguity, reflexive understanding, practice artistry, and collaboration. Herein lie some of the issues and concerns faced by clinicians on a case‐by‐case basis. Our clinical practice is founded on a dynamic, multifactorial, human interaction. Therefore, the diagnostic and clinical aspect of a patient encounter is one set of factors to consider; however, no two human beings are the same; present the same way; tell their story the same way; demonstrate their concerns in the same way; and, indeed, do not react the same way to treatments and our management plans.
THINKING, GROWING, AND EVOLVING
Human evolution has led to the development of both instinctive decision‐making and complex problem‐solving ability, which stands us apart as a species. Kahneman (2012
