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The community heart nurse: forming local support groups

Carole Twells
RGN ON DN BSc(Hons) NP
Community Heart Nurse
E:carole.twells@nottinghamcity-pct.nhs.uk

Jacqui Radford
RGN RM RHV NP MSc
Research Nurse
4H Project Nottingham City PCT

In Nottingham the new role of community heart nurse (CHN) is being developed to meet health needs in a deprived inner city area that has high rates of ­coronary heart disease (CHD) and poor uptake of existing cardiac rehabilitation and secondary prevention services.(1-3) As part of a three-year research project known as 4H (Happy, Healthy, Holistic Hearts), the CHN provides a community-based cardiac rehabilitation service to patients and their families. The holistic approach of the CHN role emphasises both individual care and the importance of building social capital(*) related to health needs.(4-6) This means that in addition to working with patients in the home to develop and implement individual cardiac rehabilitation programmes, the CHN utilises specialist community nursing skills to build up resources in the local community to meet the needs of cardiac patients. Community nurses are well placed to work in partnership with a range of professionals and agencies to meet identified need.(7) The CHN has been able to form links with many local agencies, sharing learning, acting as a resource and assisting with strategic developments. The points below highlight the community- focused role of the CHN:

  • Involvement with multiagency groups targeting CHD.
  • Taking part in local health events.
  • Involvement with local CHD collaborative work.
  • Provision of locality-focused education for staff and practice populations.
  • Development of new services to address need.
  • Building networks and partnerships to develop ­initiatives.

The development of the heart support group came about in response to comments from patients involved in the 4H research. Patients who were interviewed as part of the exploratory study felt there was a need for support groups; indeed one or two had attended the Nottingham Cardiac Support Group, a citywide group already in existence. However, some felt excluded from this group because of the distance they would have to travel and because the meetings are held in the evening when some prefer not to go out.(8) Having a network of additional smaller supp-ort groups within local communities, tailored to local need was seen as way of overcoming these issues. It was also felt that local support groups could be used as a way of increasing social capital for those taking part.
The first local support group to be established was the Clifton Area Heart Support Group, Clifton being one of the geographical areas within Nottingham City PCT. Individual patients there had expressed an interest in being involved, with one patient in particular volunteering to help organise it. With the CHN acting as facilitator, the group has developed as a self-help group affiliated to both the Nottingham Self-Help Team and the British Heart Foundation. Both of these liaisons provides the group with independent advice and opportunities to bid for small grants to assist with trips, running costs and room rental. The group meets fortnightly on a Tuesday afternoon in one of the local community centres and is very informal. Anybody who has been affected by any kind of heart problem is welcome to attend, including carers or family members. A programme of speakers is arranged by the CHN in response to requests from the group. Speakers attend once every fourth week and cover a broad range of subjects, not always related to heart disease or health but sometimes just aiming to raise people's awareness of other things that are happening in Clifton and to encourage engagement in them.
The group has continued to show a keen interest in taking part in other activities to benefit their cardiac health. In collaboration with the cardiac rehabilitation nurses based in secondary care the CHN was involved in the establishment of the local "Walking Your Way to Health" initiative known as "Trent Tickers". This scheme provides trained volunteers who lead weekly short walks for cardiac patients. Those members of the support group who are able enjoy participating in this. The next step is to pilot some community-based exercise sessions at the local leisure centre and several of the heart support group are looking forward to joining in with this also.
The people who regularly attend the meetings say that they gain a lot from the group, they have a sense of belonging and ownership, that it is "theirs". One lady said that she would miss not coming to the group - that "we are all friends now". It has given some an opportunity to gain health advice and information they had not previously received. One lady commented: "As somebody with angina I've been able to find out how to help myself after 2 years of being in the dark".
As the CHN I have certainly seen a change in the group over the last 18 months. Confidence has grown. There has been a willingness to share experiences with visiting guests in order to shape the health services they want to receive. This is not something they would volunteer to do individually but as a collective they have a real "voice" and a sense of empowerment.
The 4H project has enabled the CHN to work in new and innovative ways and has demonstrated how being able to work in this way has started to make a difference to the patient experience. Primary care nursing is changing and benefits will be maximised if nurses feel less constrained and are able to respond appropriately to the needs of patients and communities.(9)

*Social capital is a theory that seeks to explain how social factors within a person's home environment can influence general wellbeing and health. It comprises several elements such as participation in the local community, trust (of those living nearby), availability and use of local community resources, reciprocity (doing favours for others in the knowledge that you will get something in return), and proactivity (actively doing something for yourself). These five elements come together to form the concept of social capital. The idea is that if social capital can be improved then it will have the knock-on effect of improving health and wellbeing, especially in areas of deprivation. For more information see references 4-6 or go to the Health Development Agency website - www.hda-online.org.uk

The authors would like to thank Dr Ken Brown, GP, City PCT 4H Project Lead, Linda East, Lecturer, School of Nursing, Nottingham University, and all the 4H Project Team for their help

References

  1. Director of Public Health. Annual report - action on heart disease. Nottingham: Nottingham Health District; 2001.
  2. Health Development Agency. Health update - coronary heart disease and stroke. London: HDA; 2000.
  3. Melville MR, Packham C, Brown N, Weston C, Gray D. Cardiac rehabilitation; socially deprived patients are less likely to attend but patients ineligible for thrombolysis are less likely to be invited. Heart 1999;82:373-7.
  4. Campbell C, Wood R, Kelly M. Social capital and health. London: HEA; 1999.
  5. Social Action Research Project. Available from URL: http://www.social-action.org.uk/sarp/
  6. Morgan A. Developing a new set of social indicators. London: HDA; 2001.
  7. Royal College of Nursing. Primary care trusts in England: the knowledge and skills nurses need to make them a real success. London: RCN; 2001.
  8. Brown K, East L, Twells C. 4H exploratory study report. Nottingham: Nottingham City PCT; 2001.
  9. Department of Health. Liberating the talents. London: DoH; 2002.

Resources
Health Development Agency
W:hda-online. org.uk

Walking Your Way to Health
W:www.whi.org.uk

NSF for CHD Chapter on cardiac ­rehabilitation
W:www.doh.gov.uk/heart/index.htm