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N040 A Systematic Intervention to Improve Patient Care in Cardiac Surgery
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N038 AN ACTION LEARNING GROUP APPROACH TO SUPPORT NURSING PRACTICE IN ETHICAL SITUATIONS WITH PATIENTS UNDER VENTRICULAR ASSIST DEVICE FOR DESTINATION THERAPY V Harris, S Cossette, M Ouimette Montréal Heart Institute, Montréal, QC
In Canada, ventricular assist device (VAD) (a mechanical cardiac support system) for destination therapy (DT) is a treatment that is newly offered to advanced heart failure patients. In response to this situation, a new nursing role has emerged to help these patients before and after its surgical implementation. However, nurses, as other professionals, are often challenged in their own values about VAD for DT. This can be due to different perceptions held by the patients, their families, and the care team about the benefits of the treatment versus the human costs. To help nurses better manage these situations, an Action Learning Group (ALG) based on Payette and Champagn’s (2010) approach was implemented in a cardiac center. Its aim is to promote co-learning in a group setting among professionals, and to promote the implementation of solutions identified. The purpose of the present project was to apply an ALG to support nurses in developing abilities in ethical thinking and competencies. In the present project, the central concerns emerged from the nurses own lived experiences regarding VAD for DT. Five sessions were conducted, each one exploring one ethical clinical experience to promote co-learning and identifying possible solutions. An ALG can support nurses in developing abilities in ethical thinking, can guide nurses in their practice, and may facilitate nurses in finding solutions to ethical concerns encountered. The presentation will illustrate the core concerns and the solutions that emerged during the ALG and the applicability of ALG in other clinical contexts.
N039 CARDIOVASCULAR NURSES: THE KEY FACTOR IN THE SUCCESS OF THE FIRST CANADIAN HEART FAILURE REMOTE MONITORING CLINIC R Grant, E Estrella-Holder, K Lewington, K Liebrecht, A Malik, S Zieroth, F Cordova Perez St. Boniface Hospital, Winnipeg, MB
Heart failure is a common, debilitating, and costly chronic disease condition. The rising cost of health care is forcing health care providers to be more accountable in offering a more efficient and economical systems with regards to providing care. Health Care providers are pursuing innovative approaches that are clinically and financially more proficient. Remote monitoring of heart failure patients is made possible through telemonitoring of the physiologic data derived from devices combined with a structured telephone support. The remote monitoring alerts care providers of impending decompensation, allows interventions with decreased clinic visits, averts hospitalization, therefore reducing health care costs. This presentation will describe the first Canadian center’s ex-
Canadian Journal of Cardiology Volume 28 2012
perience in using a model of care that utilizes remote monitoring by cardiovascular nurses with expertise in heart failure. The evaluation of the first phase of this model of care yielded a low rate of all-cause patient admission and reduced admissions for heart failure decompensation among a population of 25 monitored patients. Most treatments for prognosticators of heart failure decompensation were implemented over the phone and avoided medical visits. Furthermore, the regular interaction of nurses with patients, especially those with prognosticators of decompensation, promoted treatment compliance and increased patient satisfaction as evidenced by patient feedback. Remote monitoring can potentially reduce health care cost, enhance clinic resources and increase patient satisfaction. The Cardiovascular nurses’ impeccable ability to assess and manage these complex patients in various settings, including remote monitoring, and their positive relationships with these patients, are the key factors in the effectiveness of this model of care.
N040 A SYSTEMATIC INTERVENTION TO IMPROVE PATIENT CARE IN CARDIAC SURGERY D Brault, D Taddeo, V Vandal, M Bérubé Jewish General Hospital, Montréal, QC
Our hospital offers cardiac surgery services to the patient population who come from diverse areas of Quebec. The preparation for cardiac surgery and the type of services available in the community differs greatly which impacts the patient transition during the hospitalization. The goal of this innovative project was to implement a systematic follow up in cardiac surgery in order to improve the quality of care and services offered to the patients. In the context of this project, a nurse meets the patient during his pre operative visit. She also conducts telephone interviews while the patient is on the waiting list for surgery as well as after the surgery once the patient returned home. She works in partnership with the interdisciplinary team members and the community. Moreover, she collects data on the patients she follows including frequency of contacts, issues she found and her interventions. This project brought us a better understanding of the challenges the patient/encounter during various transitional phases of care in cardiac surgery and has helped to avert serious complications. In addition, the patient satisfaction was measured and demonstrated a marked improvement in comparison with a previous patient satisfaction survey done in our department. This initiation brought to light the difficulties specific to the pre operative phase such as anxiety, sadness and increase in serious symptoms. In the post operative phase, pain, incision drainage and the omission to book a follow up appointment are frequent. This data will allow us to improve our care to this population.
N038 AN ACTION LEARNING GROUP APPROACH TO SUPPORT NURSING PRACTICE IN ETHICAL SITUATIONS WITH PATIENTS UNDER VENTRICULAR ASSIST DEVICE FOR DESTINATION THERAPY V Harris, S Cossette, M Ouimette Montréal Heart Institute, Montréal, QC
In Canada, ventricular assist device (VAD) (a mechanical cardiac support system) for destination therapy (DT) is a treatment that is newly offered to advanced heart failure patients. In response to this situation, a new nursing role has emerged to help these patients before and after its surgical implementation. However, nurses, as other professionals, are often challenged in their own values about VAD for DT. This can be due to different perceptions held by the patients, their families, and the care team about the benefits of the treatment versus the human costs. To help nurses better manage these situations, an Action Learning Group (ALG) based on Payette and Champagn’s (2010) approach was implemented in a cardiac center. Its aim is to promote co-learning in a group setting among professionals, and to promote the implementation of solutions identified. The purpose of the present project was to apply an ALG to support nurses in developing abilities in ethical thinking and competencies. In the present project, the central concerns emerged from the nurses own lived experiences regarding VAD for DT. Five sessions were conducted, each one exploring one ethical clinical experience to promote co-learning and identifying possible solutions. An ALG can support nurses in developing abilities in ethical thinking, can guide nurses in their practice, and may facilitate nurses in finding solutions to ethical concerns encountered. The presentation will illustrate the core concerns and the solutions that emerged during the ALG and the applicability of ALG in other clinical contexts.
N039 CARDIOVASCULAR NURSES: THE KEY FACTOR IN THE SUCCESS OF THE FIRST CANADIAN HEART FAILURE REMOTE MONITORING CLINIC R Grant, E Estrella-Holder, K Lewington, K Liebrecht, A Malik, S Zieroth, F Cordova Perez St. Boniface Hospital, Winnipeg, MB
Heart failure is a common, debilitating, and costly chronic disease condition. The rising cost of health care is forcing health care providers to be more accountable in offering a more efficient and economical systems with regards to providing care. Health Care providers are pursuing innovative approaches that are clinically and financially more proficient. Remote monitoring of heart failure patients is made possible through telemonitoring of the physiologic data derived from devices combined with a structured telephone support. The remote monitoring alerts care providers of impending decompensation, allows interventions with decreased clinic visits, averts hospitalization, therefore reducing health care costs. This presentation will describe the first Canadian center’s ex-
Canadian Journal of Cardiology Volume 28 2012
perience in using a model of care that utilizes remote monitoring by cardiovascular nurses with expertise in heart failure. The evaluation of the first phase of this model of care yielded a low rate of all-cause patient admission and reduced admissions for heart failure decompensation among a population of 25 monitored patients. Most treatments for prognosticators of heart failure decompensation were implemented over the phone and avoided medical visits. Furthermore, the regular interaction of nurses with patients, especially those with prognosticators of decompensation, promoted treatment compliance and increased patient satisfaction as evidenced by patient feedback. Remote monitoring can potentially reduce health care cost, enhance clinic resources and increase patient satisfaction. The Cardiovascular nurses’ impeccable ability to assess and manage these complex patients in various settings, including remote monitoring, and their positive relationships with these patients, are the key factors in the effectiveness of this model of care.
N040 A SYSTEMATIC INTERVENTION TO IMPROVE PATIENT CARE IN CARDIAC SURGERY D Brault, D Taddeo, V Vandal, M Bérubé Jewish General Hospital, Montréal, QC
Our hospital offers cardiac surgery services to the patient population who come from diverse areas of Quebec. The preparation for cardiac surgery and the type of services available in the community differs greatly which impacts the patient transition during the hospitalization. The goal of this innovative project was to implement a systematic follow up in cardiac surgery in order to improve the quality of care and services offered to the patients. In the context of this project, a nurse meets the patient during his pre operative visit. She also conducts telephone interviews while the patient is on the waiting list for surgery as well as after the surgery once the patient returned home. She works in partnership with the interdisciplinary team members and the community. Moreover, she collects data on the patients she follows including frequency of contacts, issues she found and her interventions. This project brought us a better understanding of the challenges the patient/encounter during various transitional phases of care in cardiac surgery and has helped to avert serious complications. In addition, the patient satisfaction was measured and demonstrated a marked improvement in comparison with a previous patient satisfaction survey done in our department. This initiation brought to light the difficulties specific to the pre operative phase such as anxiety, sadness and increase in serious symptoms. In the post operative phase, pain, incision drainage and the omission to book a follow up appointment are frequent. This data will allow us to improve our care to this population.