- Email: [email protected]
CARDIAC SURGERY NURSE PRACTITIONER PROGRAM EVALUATION
CCCN Abstracts
N035 AN INTEGRATIVE REVIEW OF THE ROLE OF NURSING IN SHARED DECISION-MAKING IN ARRHYTHMIA MANAGEMENT K Lewis1, R Starzomski2, L Young2 1 University of Ottawa Heart Institute, Ottawa, ON, 2 School of Nursing, University of Victoria, BC
As advances in cardiac arrhythmia management progress, an increasing number of treatment options are available to improve patient’s quality of life and survival. In some instances, clinical equipoise exists, meaning there is no decisive evidence supporting one intervention over another. Examples of such decisions include the many options of new oral anticoagulants for stroke prevention in patients with atrial fibrillation and the option of anti-arrhythmic medications versus catheter ablation for ventricular tachycardia in the setting of structural heart disease. Other decisions are considered preference-sensitive, whereby a patient’s values and preferences about a treatment may legitimately override the best evidence. Implantable-cardioverter defibrillator implantation or deactivation is an example of a preference-sensitive decision. In these particular instances, adopting a shared decision-making (SDM) approach can positively impact patient and healthcare outcomes. To date, the majority of the SDM literature has focused on the physician-patient dyad. Nurses should have distinct roles and responsibilities in these processes given their proximity in the assessment and care management of patients with complex cardiac conditions. The purpose of our integrative review was to identify the role of the nurse in SDM to recommend ways in which nurses can be involved in SDM. Seventeen articles were included. Our analysis revealed four themes: knowledge as a basis for SDM, sharing power in the nurse-patient relationship, utilization of decisional support strategies, and communication. Our findings strongly support the participation of nurses in SDM. Nursing implications for practice, education, and research will be offered, to best support decision-making for patients with cardiac arrhythmias.
N036 CARDIAC SURGERY NURSE PRACTITIONER PROGRAM EVALUATION J Watters, N Aaronson, R Sobolyeva, C Galte Royal Columbian Hospital, New Westminster, BC
The purpose of this project is to evaluate the impact of the newly implemented Cardiac Surgery Nurse Practitioner Program (CSNPP) within the cardiac program at Royal Columbian Hospital in New Westminster, British Columbia, Canada. The Fraser Health Authority (FHA) Cardiac Services Program identified a need to address the impending gaps in health care delivery to meet the increasing demands of the postoperative cardiac surgery patients at Royal Columbian
S359
Hospital. The complementary nature of the nurse practitioner (NP) role was seen as a potential asset in cardiac surgery postoperative management. Initial role definition was created and potential impacts were defined. A post-licensure fellowship model was designed to assist with preparation of the NPs for the clinical role. One year following implementation, a formal comprehensive evaluation of the cardiac surgery NP role was completed. Data was obtained from chart review, FHA Health & Business Analytics, Cardiac Services BC and patient and multidisciplinary team surveys. When a comparator group was needed, pre-post methodology was implemented. Outcome measures were developed with guidance from the Canadian Nurse Practitioner Initiative (CNIP) toolkit and focused on role integration, alignment with FHA strategic imperatives and key clinical outcomes for the cardiac surgery population. Findings of the evaluation demonstrate successful integration and a high level of acceptance by patients and other care providers. Clinical measures reflect a highly effective and efficient model of care. These findings align with current research supporting the successful utilization of NP led care in the provision of postoperative cardiac surgery patients.
N037 CARING FOR PATIENTS WITH COCAINE INDUCED MYOCARDIAL INFARCTION C Middleton, M Leung, K Murfitt University of Ottawa Heart Institute, Ottawa, ON
Alongside traditional diagnostic tests, nurses can play a pivotal role in the assessment, monitoring, counseling and care in the recovery process of patients who suffer from cocaine induced myocardial infarction. Cocaine has become the most frequently used illicit drug among patients presenting to emergency departments worldwide. The literature suggests that patients presenting with chest pain following cocaine use require more specialized assessment and diagnostic testing in order to provide the appropriate treatment. The nursing implications in caring for these patients will be discussed along with the additional challenges of possible neurological complications, impaired mental functioning, as well as psychosocial issues that may accompany this patient population. Awareness and enhanced nursing knowledge as well as amendments to the standard treatment of patients presenting with acute coronary syndrome can increase the ability to effectively assess, create nursing diagnoses and care plans, and provide nursing interventions that aid in the recovery process of these patients. The use of a case study will help demonstrate the complex multifaceted nursing approach and treatment plan necessary for nursing care in an acute care environment.
N035 AN INTEGRATIVE REVIEW OF THE ROLE OF NURSING IN SHARED DECISION-MAKING IN ARRHYTHMIA MANAGEMENT K Lewis1, R Starzomski2, L Young2 1 University of Ottawa Heart Institute, Ottawa, ON, 2 School of Nursing, University of Victoria, BC
As advances in cardiac arrhythmia management progress, an increasing number of treatment options are available to improve patient’s quality of life and survival. In some instances, clinical equipoise exists, meaning there is no decisive evidence supporting one intervention over another. Examples of such decisions include the many options of new oral anticoagulants for stroke prevention in patients with atrial fibrillation and the option of anti-arrhythmic medications versus catheter ablation for ventricular tachycardia in the setting of structural heart disease. Other decisions are considered preference-sensitive, whereby a patient’s values and preferences about a treatment may legitimately override the best evidence. Implantable-cardioverter defibrillator implantation or deactivation is an example of a preference-sensitive decision. In these particular instances, adopting a shared decision-making (SDM) approach can positively impact patient and healthcare outcomes. To date, the majority of the SDM literature has focused on the physician-patient dyad. Nurses should have distinct roles and responsibilities in these processes given their proximity in the assessment and care management of patients with complex cardiac conditions. The purpose of our integrative review was to identify the role of the nurse in SDM to recommend ways in which nurses can be involved in SDM. Seventeen articles were included. Our analysis revealed four themes: knowledge as a basis for SDM, sharing power in the nurse-patient relationship, utilization of decisional support strategies, and communication. Our findings strongly support the participation of nurses in SDM. Nursing implications for practice, education, and research will be offered, to best support decision-making for patients with cardiac arrhythmias.
N036 CARDIAC SURGERY NURSE PRACTITIONER PROGRAM EVALUATION J Watters, N Aaronson, R Sobolyeva, C Galte Royal Columbian Hospital, New Westminster, BC
The purpose of this project is to evaluate the impact of the newly implemented Cardiac Surgery Nurse Practitioner Program (CSNPP) within the cardiac program at Royal Columbian Hospital in New Westminster, British Columbia, Canada. The Fraser Health Authority (FHA) Cardiac Services Program identified a need to address the impending gaps in health care delivery to meet the increasing demands of the postoperative cardiac surgery patients at Royal Columbian
S359
Hospital. The complementary nature of the nurse practitioner (NP) role was seen as a potential asset in cardiac surgery postoperative management. Initial role definition was created and potential impacts were defined. A post-licensure fellowship model was designed to assist with preparation of the NPs for the clinical role. One year following implementation, a formal comprehensive evaluation of the cardiac surgery NP role was completed. Data was obtained from chart review, FHA Health & Business Analytics, Cardiac Services BC and patient and multidisciplinary team surveys. When a comparator group was needed, pre-post methodology was implemented. Outcome measures were developed with guidance from the Canadian Nurse Practitioner Initiative (CNIP) toolkit and focused on role integration, alignment with FHA strategic imperatives and key clinical outcomes for the cardiac surgery population. Findings of the evaluation demonstrate successful integration and a high level of acceptance by patients and other care providers. Clinical measures reflect a highly effective and efficient model of care. These findings align with current research supporting the successful utilization of NP led care in the provision of postoperative cardiac surgery patients.
N037 CARING FOR PATIENTS WITH COCAINE INDUCED MYOCARDIAL INFARCTION C Middleton, M Leung, K Murfitt University of Ottawa Heart Institute, Ottawa, ON
Alongside traditional diagnostic tests, nurses can play a pivotal role in the assessment, monitoring, counseling and care in the recovery process of patients who suffer from cocaine induced myocardial infarction. Cocaine has become the most frequently used illicit drug among patients presenting to emergency departments worldwide. The literature suggests that patients presenting with chest pain following cocaine use require more specialized assessment and diagnostic testing in order to provide the appropriate treatment. The nursing implications in caring for these patients will be discussed along with the additional challenges of possible neurological complications, impaired mental functioning, as well as psychosocial issues that may accompany this patient population. Awareness and enhanced nursing knowledge as well as amendments to the standard treatment of patients presenting with acute coronary syndrome can increase the ability to effectively assess, create nursing diagnoses and care plans, and provide nursing interventions that aid in the recovery process of these patients. The use of a case study will help demonstrate the complex multifaceted nursing approach and treatment plan necessary for nursing care in an acute care environment.