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The latest evidence for practice

Una Adderley
Specialist Nurse
Team Leader

What are patients' attitudes to the expanded role of general
practice nurses?
In recent years, the role of registered nurses working in general practice has expanded considerably to take on many of the tasks that were previously the responsibility of doctors. There has been considerable debate about this in both the clinical and general press but there is relatively little research evidence that investigates this phenomenon.

This literature review used an extensive search to seek research evidence about the expanded role of UK practice nurses. A total of 164 potential studies were identified but only eight met the inclusion criteria. The outcomes from these studies were synthesised into three themes; the impact on patients, nurse competence and NHS policy. The author identified that the nursing role had been driven by general practice and that the delegation of what had been traditionally GP roles had reduced consumer choice about which health professional patients were able to see. The review concluded that there was little evidence about the role of nurses working in general practice and identified the need for patients' views to be included in future research.

A commentary notes that as this review only included studies after 2004, the focus was relatively narrow. Furthermore, it was not clear how the reported themes had been derived. The commentary suggests that this study highlights the paucity of research into the expanding role of practice nursing and calls for further research to evaluate the existing and emerging models of primary care.

Reference
Rashid C. Benefits and limitations of nurses taking on aspects of the clinical role of
doctors in primary care: integrative literature review. J Adv Nurs 2010;66:1658-70.

Commentary
Halcomb EJ. Evid-Based Nurs 2011;14(1):28.

What is the best method for managing excessive earwax?
For most people, the production of earwax (cerumen) is a self-regulating and balanced natural function where the generation of wax roughly equates to the amount that is naturally degraded. However, in some people, earwax is retained where it can harden to block the ear canal and reduce hearing. Earwax blockages can also be associated with pain, itching, cough, dizziness and tinnitus. There are many potential remedies for managing hardened earwax but it is unclear which of these are the most effective and safe.

This systematic review sought to identify the most clinically and cost-effective methods for managing hardened earwax. An extensive search of 11 electronic databases sought relevant clinical trials. Twenty-six clinical trials were included in the review: these covered a wide range of interventions in a range of patients and used a variety of methodological approaches. It was difficult to draw robust conclusions but it did appear that cerumenolytics (which included cerumol, olive oil and sodium bicarbonate) are more effective than no treatment. Sodium bicarbonate drops followed by irrigation by a nurse seems to be more effective than drops followed by self-irrigation. The authors concluded that some treatment seemed to be better than no treatment and that adverse effects were mainly minor and self-limiting.

A commentary notes that any attempt at removing earwax should be preceded by earwax softening therapy. Furthermore, removal should be attempted cautiously
by qualified and trained clinicians to
minimise the risk of tympanic membrane injury or infection.

Reference
Clegg AJ, Loveman E, Gospodarevskaya E et al. The safety and effectiveness of different methods of earwax removal: a systematic review and economic evaluation. Health Technology Assessment 2010;14:1-192.

Commentary
Roth Y, Oron Y, Goldfarb A. Evid-Based Nurs 2011;14(2):60.