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Role of the Specialist Nurse HEART FAILURE

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Growing incidence- ageing population, increased survival from AMI. ... self-monitor their weight, balance exercise and rest, adopt smoking cessation ... – PowerPoint PPT presentation

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Title: Role of the Specialist Nurse HEART FAILURE


1
Role of the Specialist NurseHEART FAILURE
  • Usha Rajkoomar
  • Project Manager
  • CHD Collaborative
  • East and North Herts
  • 14/01/03

2
Heart Failure
  • Growing incidence- ageing population, increased
    survival from AMI.
  • Recent study, more than one third of patients
    have died within 12 months of diagnosis, Cowie et
    al(2000).
  • High admission rates, re-admission rates, lengthy
    hospital stays, high financial burden.

3
Why do we need specialist nurses?
  • Patients are frail and vulnerable
  • Devastating effect on quality of life
  • Patient group that often has inadequate access to
    help and advice.
  • Patients are often on suboptimal treatments and
    are not receiving the best management, thus
    creating a huge potential for care to be
    improved.

4
  • Often lack of patient education and support-
  • Knock-on effect in terms of non-adherence
  • both pharmacological and non-pharmacological.
  • 54 of re-admission to hospital are preventable,
  • Michaelsen et al (1998).
  • Need for health professional to coordinate what
  • can be a complicated map of care.
  • Nurse led approaches to HF management have
  • Shown to be cost effective.
  • Promote collaborative working not only between
  • primary and secondary care but also incorporating
  • A multidisciplinary approach in both areas.

5
Meeting the NSF targets
  • Standard 11 of the NSF states doctors should
    arrange for people with suspected HF to be
    offered appropriate investigations that will
    confirm or refute diagnosis. For those HF is
    confirmed , its cause should be identified and
    the treatments most likely to both relieve
    symptoms and reduce the risk of death should be
    offered.

6
3 possible service delivery
  • are proposed
  • Outreach follow-up of HF patients following
    discharge from hospital
  • Multidisciplinary support in the community for
    those with established HF
  • Heart failure clinics for investigations and/or
    follow up.

7
What are the needs of a HF patient?
  • Pharmacological needs (initiation and titration)
  • Multiple drug treatments
  • Little or no understanding of their medications,
    risk of developing side-effects and possible drug
    interactions
  • Patient compliance
  • Biochemical observation (diuretics, ACE,
    spironolactone)
  • Influenza and pneumococcal immunisations.

8
Non-pharmacological needs
  • Education and support
  • Need of be aware of their condition, its
    implications on their lives
  • Symptoms and when these are deteriorating
  • Aim self-monitoring and self management
  • Know when and how to contact healthcare
    professionals.

9
Contd.
  • Lifestyles changes/adjustments.
  • Changes in diet/fluid intake, need to
    self-monitor their weight, balance exercise and
    rest, adopt smoking cessation and moderate
    alcohol intake
  • Financial and Psychosocial implications, change
    of occupations or may not be able to work at all
  • HF places a great deal of stress on all forms of
    relationships creating psychological issues.

10
  • Support and counselling
  • Palliative care. It is now recognised that the
  • terminal phase of heart failure may be as bad
  • as cancer, both in terms of symptoms and
    distress.
  • The aim of palliative care is to improve quality
    of
  • Life, quality of dying and to ameliorate the
  • devastating effect of dying on family and carers.
  • Ongoing care management is optimised

11
Role of the Heart Failure Nurse
  • Majority of these needs can be met and
    coordinated by a HF nurse, further interventions
    from other disciplines is required, need for
    multi-disciplinary approach.
  • Ongoing follow-up care
  • Support and counselling, acting as patients
    advocate

12
Contd.
  • Promote communication between prim and sec
  • care and also within multi-disciplinary team.
  • The HF Nurse should be considered a resource to
  • other professionals, assisting professional
  • Education and development

13
Benefits of the HF Nurse Service
  • Improved care and management
  • Rapid response to patient problems
  • Providing follow-up, lead to reduction in medical
    time
  • Reduce hospital admissions, length of stay,
    financial burden, bed pressures
  • Specialist resource- consistency of care
  • Provision of professional education and meeting
    clinical governance requirements.

14
Benefits
  • Optimal treatment that can be flexible and
    tailored
  • to individual needs
  • Promotes patient empowerment
  • Provides patients with easy access to a
  • professional who knows them and who is able to
  • provide consistent care.
  • Regular follow-up and monitoring whether it be
  • clinic based, home based or by telephone contact.
  • Improved functional status and quality of life
    for
  • patients.
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