Role of the Specialist Nurse HEART FAILURE

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Role of the Specialist NurseHEART FAILURE

• Usha Rajkoomar
• Project Manager
• CHD Collaborative
• East and North Herts
• 14/01/03

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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.

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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.

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• 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.

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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.

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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.

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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.

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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.

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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.

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• 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

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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

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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

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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.

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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.