Transcript The role of the nurse in implementing CVD prevention

The Role of the Nurse in
Implementing CVD
Prevention Guidelines
Noeleen Fallon
Clinical Nurse Specialist in Cardiac Rehabilitation
AMNCH, Tallaght, Dublin 24
Background
 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 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 Strategies
What would make the practice of CVD
prevention easier?
 Guidelines
simple clear credible
 Time
 Government policies
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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 Guidelines
 Patients – Soccio-ecconomic status, Social
isolation, Stress levels
 Professionals – perception, opinion, clinical
knowledge, competence, relationship to patient
 Practice – financial constraints, lack of reimbursement
 Organisation – time, staff, referral pathways
 Education – overload, journals
 Audit – feedback from patients, other practices, conference
results
(Kaufman, 2002)
Nurses 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 Nation
Role of the nurse:
 Providing education for the patient
 Clinical practice: Identify high risk patients and
monitoring low risk patients
and identifying patients for
primary prevention.
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Register
Review & Record (Assessment)
Recall
Research (Audit)
Qualities & Skills required for the Role
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Knowledge & Education
Leadership
Communication Skills
Clinical Assessment Skills
Counselling
Advice (Simple and Explicit)
Motivational interviewing
Power of persuasion
Empathy
Intuition
Respect for patient
Education
 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
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Motivational interviewing
Behavioural change
Alliance with patient in order for
understanding
(Chiverton, 2003)
Clinical Practice
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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)
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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)
 Sleep pattern
 Anxiety and depression
 Social support
 Vocational status
 Medication adherence
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 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 professionals
within 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
worth a pound of cure”
(Benjamin Franklin)