The Ever Evolving Cardiac Nurse; Competencies & Pathways

Shirley Ingram Cardiology RANP, RNP, MSc, NFESC

INCA 2018

• Cardiac Nursing is a speciality that works with patients who suffer from various conditions of the cardiovascular (CV) system. (2015) Core curriculum for the CPD of Nurses working in CV settings. CCNAP on behalf of the ESC

• 4 domains

• health promotion,

• cardiac prevention and rehabilitation,

• acute/chronic and episodic care,

• and palliative care (Riley, Bullock, West & Shuldham, 2003).

1985 2013

• History of CV nursing in Ireland

• Milestones in CV health

• Education

• Clinical pathways-experience

• Competencies

History of Nurse education (Condron, 2004)

• 1960s-CCUs

• 1970s- Coronary CARE Certificate Course: 6/12, clinical based in a CCU

• Up to 1993: Nurse education: apprenticeship of 28 weeks education

• 1994-Diploma in Nursing 3 yrs.: 59 weeks education & supernumery

• 1990s- Post Grad Higher Diploma (University based): 1 year, clinical & theoretical aspects

• 1998-Commission on Nursing: Pathways for clinical nursing of CNS/ANP

• 2002-BSc Degree in Nursing 4 yrs

• Masters and Doctorate level courses

Milestones in CV Health in Ireland

• 1960s Development of the Coronary Care Unit

• 1990s-Thrombolysis era

• 1999- Building Healthier Hearts

• 1999-2003- €53 invested in CV health!

• 2001- 41% of all deaths due to CVD/ 21% due to CHD (IHF, 2001)

• 2007-CNS pathway NCNM

• 2008-ANP pathway

• 2010-2019- Changing CV Health Policy

• 2012- PPCI pathway

• 2018 -Review of Cardiac services in Ireland

Pathways

Graduation

1,600 annually

Clinical

SN

CNS

ANP

Research/Education

HEIs

Centres of Nurse Ed

Lecturer/Professor

For undergrad/post grad/CPD

Management

CNM1,11, 111

ADON

DON

Group DON

Chief Nurse

Education is vital / 14 HEI in Ireland

Where do I start????

LEVEL1 – Post Grad Courses

• NMBI website: stand alone modules:• i.e Cardiac Nursing management NUIG

• INMO-

• HSELand –

• e-learning –

• Study Days – INCA

• CCNAP –

CCNAP- A Core Curriculum for the CPD of Nurses working in CV settings (on behalf of ESC)

• Aim that Nurses can reach full potential

• Building understanding, knowledge & Skills

• Learner is at the ‘heart’ of the learning process

• Become an ‘expert learner’

• Co-operative Learning- working together on tasks i.e. Workshops!!

CCNAP Syllabus

Formal education path

• Level 2• Post Grad H diploma / Cert in CV Nursing (UCD/TCD etc)• ‘expand knowledge, understanding, critical analysis, research’

• Level 2a to specialise• Professional certs : i.e Heart Failure (level 9)

• Level 3• Masters programmes i.e Critical Care Nursing• Includes research question

• Level 4• Advanced Practice MSc/Grad. Cert• 500 supervised clinical hours, advanced health assessment, autonomous decision making,

leadership• Demonstration of competence• Dissertation

• Level 5• Doctorate• Clinical (UCD) Research (TCD)

Experiential Learning (Benner 1982)

• Nurse education grounded in clinical practice

• Importance of doing, observing, thinking, reflecting & planning

• Reflective practice

• Be varied

• Push yourself

Coronary Care Unit

Cardiac Cath Lab

Cardiac Surgery

ED/Chest pain assessment

Cardiac Rehabilitation

Heart Failure

Syncope

PVD

Arrhythmia

Risk Prevention

Congenital heart disease

CRY

Experience + Education= Competence

Competence is….. (NMBI)

• The attainment of knowledge, intellectual capacities, practice skills, integrity, and professional and ethical values required for safe, accountable and effective practice

• maintained through CPD and is adaptive to the needs of a changing population profile.

• Competence changes and develops over time.

• influenced by educational preparation, frequency of clinical exposure and the duration of experience, in particular, clinical settings.

• If you identify a competence deficittake appropriate measures to gain competence.

BANCC career pathway competences required (2004) Thompson

• CORE

• Haemodynamic monitoring

• ECG monitoring and interpretation

• Arterial oxygenation management

• Delivery of oxygen therapy – non-invasive

• Auscultation of heart sounds

• Auscultation of breath sound

• Blood sampling and cannulation

• Blood sample analysis

• Chest x-ray interpretation

• Underwater seal chest drains

• Wound healing

• Assessment of cardiac chest pain

• SPECIALISED

• Delivery of oxygen therapy – supportive

• Resuscitation/ life support

• Femoral arterial sheath removal

• Cardiac pacing – temporary.

• Cardiac pacing – permanent

• Intra-aortic counterpulsation

• Elective cardioversion

• Thrombolysis – nurse-initiated

• Exercise tolerance testing

• Tilt-table testing ..

BANCC career pathway competences required 2004

CNS

• Core Competencies of Clinical Nurse Specialist (NCNM 2008)

• Clinical Focus

• Patient/client advocate

• Education and training

• Audit & research

• Consultancy

• NMPDUs approve CNS posts under the authority of the DOH

• Framework form 2008

• Job Description

ANP

Core competencies of Registered Advanced Nurse Practitioner (NCNM 2007) now replaced!

• Autonomy in clinical practice

• Expert practice

• Professional and clinical leadership

• Research

• NMBI

• Portfolio- 2 years of CPD, teaching, KPIs, membership of professional associations (INCA)

• Provide evidence of at least 500 clinical supervised hours in the specialist area of advanced practice

• Demonstrate evidence for the Competences for Advanced Practice Nursing

The Competence JourneyDomain 1-Professional values and conduct of the nurse competences

• Registered Nurse

• Identify with the nursing team personal responsibility, level of authority and lines of accountability within one’s scope of practice

• Take personal and professional accountability for own decisions, actions and for the completion of delegated tasks

• ANP

• Demonstrate accountability for practice as a lead healthcare professional

• Articulate & promote the RANP role in clinical, political and professional contexts

The Competence JourneyDomain 2-Clinical Decision Making Competences

• RGN

• Apply an appropriate framework in a systematic manner when taking a comprehensive nursing history.

• Recognise and interpret signs of normal and changing health care needs and escalate to members of the multidisciplinary team when necessary

• Collate a range of clinical observations, feedback from the person and other sources of information to adjust the plan of nursing care through ongoing evaluation of its effectiveness

• ANP

• Determine diagnosis

• Autonomous advanced nursing care

• Synthesise assessment information to identify normal & subnormal states of health

• Use diagnostic investigations

• Exhibit comprehensive knowledge of pharmacological/non-p interventions

Expanded practice

• Expanded practice’ is understood as a change in the role of an individual to include areas of practice that have not previously been within their scope of practice

• Advanced physical assessment

• intravenous cannulation

• prescribing of medicines and ionising radiation,

• behaviour management,

• nurse and midwifery-led clinics in acute and community settings.

Lifelong Learning/ CPD

• Continuing professional development (CPD) encompasses experiences, activities and processes that contribute towards the development of a nurse or midwife as a health care professional. CPD is, therefore, a lifelong process of both structured and informal learning.

• Formal education programmes,

• Reflective practice,

• Journal clubs, case-conferences,

• Clinical supervision,

• Learning sets, preceptorship, mentorship, workshops,

• Distance learning, blended learning, e-learning, sourcing information

• Self-directed learning

• Evidence based learning

The Future!

Conclusion

• Cardiac nurses play a critical role in the prevention, diagnosis and treatment of heart disease and other cardiovascular conditions.

• Prevention, diagnosis, treatment, care, rehabilitation, palliation

• Era of ‘education’

• Experience & Skills are vital

• Career is a journey