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Supporting cardiology patients in the community

I have been a cardiovascular specialist nurse with Northumbria Healthcare NHS Foundation Trust for a year now. After qualifying as a nurse, I worked on a medical cardiology ward in a hospital for 10 years, joined a community cardiology team as a staff nurse, then became a cardiovascular nurse specialist.

I have also completed the British Association for Cardiovascular Prevention and Rehabilitation (BACPR) course, which gave me the expertise to safely and effectively exercise patients with cardiovascular conditions.

BACPR sets out the standards that patients and healthcare professionals should expect from a high-quality cardiac rehabilitation programme. Prevention, behaviour change and education are at the heart of those standards.

In North Tyneside, the community cardiology service provides cardiac rehabilitation for patients post myocardial infarction, post bypass or valve surgery or percutaneous coronary intervention. This is initially in the form of a home visit, helping patients to understand and come to terms with what has happened to them and discussing the anatomy and physiology of their diagnosis. This reinforces the information they have received in hospital and addresses particular concerns.

Time is spent discussing the patient’s medications to ensure concordance and explain the rationale for taking them. This also includes what to do if a patient develops chest pain and the correct way to administer their glyceryl trinitrate (GTN) spray. Advice is also given on titration of medications to their optimal levels.

Medical advances in the treatment of cardiovascular conditions mean that patients are able to go home from hospital quickly. Sometimes they are still processing what has happened and as part of our initial home visit we complete a holistic assessment of their psychosocial needs and make a referral if necessary to health psychology to address any anxiety or depression.

Health education is important to empower patients to be experts in their own condition and prevent further problems. This is in the form of diet, lifestyle and smoking cessation advice where appropriate. Patients are then invited onto an eight-week exercise and educational programme for their cardiac rehabilitation.

The education component covers a relevant topic each week, some of which are presented by the specialist nurses, but also include outside speakers such as dietitians, pharmacists, psychologists and cardiologists to ensure expert and accurate information for the patients and provide them with a valuable opportunity to ask questions.

The cardiac rehabilitation team is made up of specialist nurses, staff nurses, physiotherapists and fitness instructors. As cardiovascular nurses, we lead and manage the sessions and are responsible for the day-to-day running of the programme, as well as overseeing the team.

These sessions are a very important part of the patient’s journey because they help them regain their confidence to believe that they can still lead full and active lives.

Following the eight-week cardiac rehabilitation programme, patients are offered long-term exercise programmes to encourage lifelong exercise. This is in collaboration with local authorities.

My community role builds on my ward experience, and as a cardiovascular nurse, I provide a link between primary and secondary care to ensure a smooth transition for cardiovascular patients and their families. I also provide specialist evidence-based advice for health colleagues in primary care. There is an incredible amount of job satisfaction in this role and feedback indicates patients’ appreciation for this service.