1. The Role of the Nurse in Implementing CVD Prevention Guidelines Noeleen Fallon Clinical Nurse Specialist in Cardiac Rehabilitation AMNCH, Tallaght, Dublin 24

2. Background CVD accounts for almost half of all deaths in Europe CVD costs the EU economy approximately 169 billion euro a year CVD remains the single biggest killer in Europe and is responsible for more death than all cancers combined The European Heart Health Charter demands PREVENTION in practice at both European and National level in order to protect health and improve quality of life (June 2007) www.heartcharter.eu

3. Prevention in Practice NICE (2010) public health guidance on prevention of CVD suggests that small changes in diet and smoking and activity in the population can have an enormous impact on the nations overall health and could prevent around 40,000 early cardiovascular deaths in people under 75 years each year. National Institute for Clinical Excellence 2010

4. Implementing Strategies What would make the practice of CVD prevention easier? Guidelines simple clear credible Time Government policies Salt and fat reduction in food industry Resources (MDT) Remuneration for prevention not just treatment Education for patients to foster understanding (ESC Guidelines 2007)

5. Barriers to Implementing Guidelines Patients – Soccio-ecconomic status, Social isolation, Stress levels Professionals – perception, opinion, clinical knowledge, competence, relationship to patient Practice – financial constraints, lack of re- imbursement Organisation – time, staff, referral pathways Education – overload, journals Audit – feedback from patients, other practices, conference results (Kaufman, 2002)

6. Nurses Role Responsibility of all nurses to incorporate health promotional and health education activities into their professional roles. Nurses in primary healthcare are in a unique position and have a responsibility for pioneering a universal acceptance and adoption of health-promoting practice. Nurse/patient relationship – developed and nurtured over many years. (Whitehead, 2000 Gott 2004)

7. Health of a Nation Role of the nurse: Providing education for the patient Clinical practice: Identify high risk patients and monitoring low risk patients and identifying patients for primary prevention. Register Review & Record (Assessment) Recall Research (Audit)

8. Qualities & Skills required for the Role Knowledge & Education Leadership Communication Skills Clinical Assessment Skills Counselling Advice ( Simple and Explicit) Motivational interviewing Power of persuasion Empathy Intuition Respect for patient

9. Education Historically nurses have taught patients how to manage their illness Advanced education for nurses to empower them to deliver knowledge Future focus must be teaching people to remain healthy Motivational interviewing Behavioural change Alliance with patient in order for understanding (Chiverton, 2003)

10. Clinical Practice Baseline patient assessment Risk assessment charts Scoring systems Risk factor management Physical activity counselling Nutritional counselling Psychosocial management Vocational counselling Optimised medical therapy

11. Record and Review (Monitor) History Pulse check (ECG) Blood pressure (ABPM) Pedal pulses (ABI) Lipid profile Blood sugar levels Weight, BMI and Waist circumference Smoking status Alcohol intake Physical activity/Exercise levels Diet and portion size

12. Record and Review (Monitor) Sleep pattern Anxiety and depression Social support Vocational status Medication adherence

13. Recall and Research (Audit) Computer database Flag according to Dx, Meds, RF’s Recall for follow up visit Audit figures annually for remuneration and resources

14. Health Promotion Nurses must have evidence-based understanding of the significant effect that can be made through health promotion interventions and communicate this understanding with the public at large As more people grow in their awareness of activities that lead to good health and become knowledgeable about their own health status and that of their families, the overall health of the population will improve (Chiverton et al, 2003) Remember the number for a healthy person is 0 3 5 140 5 3 0

15. Nurses as professionals within the primary care team and secondary prevention programs can be champions for cardiovascular disease prevention Encourage patients to “Move a little more and eat a little less!”

16. “An ounce of prevention is worth a pound of cure” (Benjamin Franklin)