Cardiology Nurse Practitioners Organize Successful Educational Rounds

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An ability to educate new recruits and maintain skill levels of the highly trained cardiology nurses is a key element to the success of Schulich Heart Centre at Sunnybrook and Women’s College Health Sciences Centre.

“In our research and practice we found that nurses had many questions about how to improve their skills,” says, Anita Ytsma, Schulich Heart Centre Nurse Practitioner. “We recognized there was a need for continuing nursing education but we didn’t have a formal setting for our staff to learn and share new ideas.”

So, Anita and her colleague, Charlene Lester, a fellow Nurse Practitioner, developed the idea of Cardiology Nursing Rounds. “As far as we know, we’re one of the few hospitals in Canada to do this. It’s a unique way for nurses to keep abreast of current topics and promote quality patient care,” says Charlene.

To get started on this project, the first thing they did was a learner needs assessment. Nurses were asked to identify topics that interest them. “I think the success of the program is due to the fact that the rounds are strictly driven by nurses, who identify their learning needs and topics.” Recently, the nurses have addressed such topics as breath sounds, congestive heart failure, EKG interpretation, acute coronary syndromes and pre and post cardiac catheterization care.

The purpose of the rounds is to:

  1. address the knowledge gap of new staff to the cardiac patient population
  2. promote evidence-based practice
  3. keep nursing staff abreast of changing medical therapies
  4. promote critical thinking and problem solving
  5. provide leadership and mentorship, particularly for new staff
  6. promote team building amongst staff
  7. provide a safe and comfortable environment for staff to discuss practice issues
  8. promote retention and recruitment

“The rounds are held every Tuesday, twice on each day, to cover both lunch hour shifts,” says Anita. “The same topic is repeated the following week, which gives everyone a chance to attend.” Depending on the topic, Anita and Charlene have made some of the presentations and they have also arranged for guest speakers.

“The rounds have been extremely successful and popular Ñ more so, than we expected,” says Anita. “Ongoing evaluations of the program, have found that 94 per cent of the nurses that have attended felt, that the rounds contributed to their knowledge and improved their nursing practice. Ultimately this improves patient care.” Sunnybrook & Women’s Event Explores Women and Heart Disease Schulich Heart Centre’s Women’s Cardiovascular Health Initiative recentlyheld a special symposium exploring some of the reasons why heart disease is the number one killer of Canadian women.

“Women’s Day Apart” was a special event that featured a wide variety of clinical and psychosocial experts discussing how women can prevent and manage heart disease.

“Many women are still not aware that heart disease is the country’s number one killer. On top of this, women often find it impossible to fit good health habits into an already hectic daily schedule where we have many roles,” says Jennifer Price, Nurse Practitioner. “Stress can affect the body and make the heart work harder. Stress increases a person’s breathing rate and forces the heart to work harder. The reality is that heart disease can sometimes be prevented by exercise, diet and stress management.”

Dr. David Posen, author, physician and lifestyle-counseling consultant, gave a presentation at the session about stress management. He said that more than 40 per cent of Canadians over the age of 30 say they often or almost always feel overwhelmed by stress on the job or with their families or finances. Statistics Canada estimates that the annual cost of work time lost to stress is $12 billion per year.

According to research conducted at Schulich Heart Centre’s Women’s Cardiovascular Health Initiative, women’s risk factors and symptoms differ from those of men. Women need to be educated about the symptoms of heart disease because they tend not to report them to their doctors as often as men.

Six times as many women will die from heart disease than from breast cancer and one in nine women over the age of 45 lives with some form of heart disease. This statistic rises as women age and by the time they reach the age of 65 and older, one in three women will have some form of heart disease.

The Women’s Cardiovascular Health Initiative is dedicated to promoting a heart healthy lifestyle in women of all ages. We are Canada’s first comprehensive health care facility for women with existing or potential heart problems. We assess cardiovascular risk and help women to modify their lifestyles through support, investigation, and management during a three month supervised exercise and education program. For more information on Women’s Cardiovascular Health visit womenshearts@swchsc.on.ca or call (416) 323-6400 (Ext 4883). Fluorescent Dye and Lasers Light up Cardiac SurgeryA medical imaging technique being pioneered in Canada allows cardiac surgeons at Sunnybrook & Women’s to check bypass grafts and look for other blockages while patients undergo surgery.

To perform this new technique, operating room staff inject fluorescent dye into the patient and then aim a laser imaging device directly into the patient’s chest to track the movement of the dye through the arteries and heart. A special camera projects the images of the arteries onto a monitor set up in the operating room. Essentially, this procedure performs a coronary angiogram while the patient is still in the operating room. The angiogram can immediately tell surgeons how well the bypass grafts are working and spot arteries that may have compromised blood flow.

“If we can check the quality of our work during surgery it may eliminate the need for follow-up surgeries and help reduce post-operative complications,” says Dr. Stephen Fremes, head of the Schulich Heart Centre’s division cardiac surgery at Sunnybrook & Women’s. “We’ve been using this system so far for research purposes but the early indications of this technology are showing us that it could become standard practice for cardiac bypass surgery.”

Currently, surgeons have to close up the chest and wheel the patient to a cardiac catheterization lab if they want to perform an angiogram. This can cause logistical problems and can lead to follow-up surgeries.

“Ideally, we don’t want to move patients around too much after they’ve gone through major surgery. Wheeling patients around and trying to get them into a cath lab when they’re hooked up to pumps and other equipment can be a little tricky,” says, Dr. Fremes. “Obviously if we can eliminate the need to move patients and get immediate information on the success of their grafts, before they leave the operating room, then we’ll be improving the quality of patient care.”

Schulich Heart Centre and the Ottawa Heart Institute are testing this technology that will soon be piloted in other parts of North America and Europe. Novadaq, a Winnipeg-based company is a spin off from the National Research Council of Canada’s Institute for Biodiagnostics.