The Role of the Nurse in The Role of the Nurse in Implementing CVD Implementing CVD Prevention GuidelinesPrevention Guidelines

Noeleen Fallon

Clinical Nurse Specialist in Cardiac Rehabilitation AMNCH, Tallaght, Dublin 24

BackgroundBackground

CVD accounts for almost half of all deaths in Europe

CVD costs the EU economy approximately 169 billion euro a year

CVD remains the single biggest killer in Europe and is responsible for more death than all cancers combined

The European Heart Health Charter demands PREVENTION in practice at both European and National level in order to protect health and improve quality of life (June 2007)

www.heartcharter.eu

Prevention in PracticePrevention in Practice

NICE (2010) public health guidance on prevention of CVD suggests that small changes in diet and smoking and activity in the population can have an enormous impact on the nations overall health and could prevent around 40,000 early cardiovascular deaths in people under 75 years each year.

National Institute for Clinical Excellence 2010

Implementing StrategiesImplementing Strategies

What would make the practice of CVD prevention easier?

Guidelines simple clear credible

Time Government policies

Salt and fat reduction in food industry Resources (MDT) Remuneration for prevention not just

treatment Education for patients to foster understanding

(ESC Guidelines 2007)

Barriers to Implementing GuidelinesBarriers to Implementing Guidelines

Patients – Soccio-ecconomic status, Social isolation, Stress levels

Professionals – perception, opinion, clinical knowledge, competence, relationship to patient

Practice – financial constraints, lack of re-imbursement

Organisation – time, staff, referral pathways Education – overload, journals

Audit – feedback from patients, other practices, conference results

(Kaufman, 2002)

Nurses RoleNurses Role

Responsibility of all nurses to incorporate health promotional and health education activities into their professional roles.

Nurses in primary healthcare are in a unique position and have a responsibility for pioneering a universal acceptance and adoption of health-promoting practice.

Nurse/patient relationship – developed and nurtured over many years.

(Whitehead, 2000 Gott 2004)

Health of a NationHealth of a Nation

Role of the nurse: Providing education for the patient Clinical practice: Identify high risk patients and

monitoring low risk patientsand identifying patients for primary prevention.

Register Review & Record (Assessment) Recall Research (Audit)

Qualities & Skills required for the Qualities & Skills required for the RoleRole Knowledge & Education Leadership Communication Skills Clinical Assessment Skills Counselling Advice (Simple and Explicit)

Motivational interviewing Power of persuasion Empathy Intuition Respect for patient

EducationEducation

Historically nurses have taught patients how to manage their illness

Advanced education for nurses to empower them to deliver knowledge

Future focus must be teaching people to remain healthy Motivational interviewing Behavioural change Alliance with patient in order for

understanding (Chiverton, 2003)

Clinical PracticeClinical Practice

Baseline patient assessment Risk assessment charts Scoring systems Risk factor management Physical activity counselling Nutritional counselling Psychosocial management Vocational counselling Optimised medical therapy

Record and Review (Monitor)Record and Review (Monitor)

History Pulse check (ECG) Blood pressure (ABPM) Pedal pulses (ABI) Lipid profile Blood sugar levels Weight, BMI and Waist circumference Smoking status Alcohol intake Physical activity/Exercise levels Diet and portion size

Record and Review (Monitor)Record and Review (Monitor)

Sleep pattern Anxiety and depression Social support Vocational status Medication adherence

Recall and Research (Audit)Recall and Research (Audit)

Computer database Flag according to Dx, Meds, RF’s Recall for follow up visit Audit figures annually for remuneration

and resources

Health PromotionHealth Promotion

Nurses must have evidence-based understanding of the significant effect that can be made through health promotion interventions and communicate this understanding with the public at large

As more people grow in their awareness of activities that lead to good health and become knowledgeable about their own health status and that of their families, the overall health of the population will improve (Chiverton et al, 2003)

Remember the number for a healthy person is 0 3 5 140 5 3 0

Nurses as professionalswithin the primary care team and secondary prevention programs can be champions for cardiovascular disease prevention

Encourage patients to“Move a little more and eat a little less!”

““An ounce of prevention is An ounce of prevention is worth a pound of cure”worth a pound of cure”

(Benjamin Franklin)(Benjamin Franklin)