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Who makes a Cardiovascular Nurse?
Dr B Soma Raju
“No greater opportunity or obligation can fall to the lot of a human
being than to become a physician or nurse. In the care of the suffering
they need
• technical skill,
• scientific knowledge, and
• human understanding.
Those of them who use these with
• courage, with
• humility, and with
• wisdom
will provide a unique service to their fellow humans, and build an
enduring edifice of character within themselves. The physician or nurse
should ask of their destiny no more than this; they should be content
with no less.”
- Tinsely R.Harrison
These words are written by Dr Tinsley R. Harrison (1900 - 1978). He was
an American physician and the editor-in-chief of the first five editions
of Harrison's Principles of Internal Medicine, a textbook well-known to
medical students and junior doctors. These words inspired thousands to
excel in their careers. I am very happy to see a new course of
Cardiovascular Nursing taking off.
Cardiovascular disease (CVD) is the leading cause of death in the India,
taking a life every 30 seconds. In light of the staggering health and
economic costs of this disease--as well as stunning advances in
prevention, diagnosis, and treatment--the health care industry acutely
needs cardiovascular advanced practice nurses to be among those taking
the lead in prevention and treatment.
For past few years Healthcare industry is being categories as a service
industry. While outwardly it appear true that healthcare delivery is a
set of specialized services rendered by medical and nursing
professionals and assisted by paramedics and aides, inside healthcare is
uniquely different than any other profession. The demands that a career
in healthcare industry puts on an individual are indeed enormous and
profound. It is important that anyone working in the healthcare industry
to understands the core values in medicine.
Core Values in Medicine
James Spence wrote that "the essential unit of medical practice is the
occasion when in the intimacy of the consulting room or the sick room, a
person who is ill, or believes himself to be ill, seeks the advice of a
doctor whom he trusts. This is a consultation and all else in medicine
derives from it."
The history of medicine and science is replete with calls for
professional conduct. Increasing attention is being focused on
professionalism as the health care system adapts to a number of
societal, scientific and financial stresses.
Cardiovascular nurses must ground their careers in the core values of
medicine and make them the cornerstone of their career paths. The core
values are enumerated here:
- Commitment
- Caring
- Competence
- Integrity
- Confidentiality
- Ability to work in a team
- Concern for the individual and community
- Education and training
- Contributing to the knowledge base of the discipline
These personal qualities are indeed interrelated. These are believed
important and to be cultivated by physicians and nurses for sensitive
patient care and optimal individual adjustment to the stresses of
medical practice.
Qualities of a Physician or a Nurse or Health Care Professional
A Mayo Clinic study conducted telephone interviews with patients in 14
medical specialties of the Mayo Clinic to identify behaviors that define
their idea of the “ideal” physician. The study team found that seven
ideal physician behavioral themes became evident through the interview
transcripts:
1. Confident
2. Empathetic
3. Humane
4. Personal
5. Forthright
6. Respectful
7. Thorough
The authors concluded that training physicians about these interpersonal
skills could eventually benefit behavioral and medical outcomes,
including compliance and patient recovery.
I would like to enumerate an extended set of quality to be cultivated by
a cardiovascular nurse.
- Empathy.
- Passion and Enthusiasm.
- A full personal knowledge of the branch practiced/taught.
- A sense of obligation to teach and be taught.
- The art of detachment.
- A systematic method.
- The quality of thoroughness.
- Self Reliance and Non-Conformity
- Honesty and Integrity
- Attitude.
- Physical stamina & Appearance.
- Humility.
- Unreserved respect for excellence.
- The conviction that right things are possible.
Let us elaborate on each:
1. Empathy: It is feeling of concern and understanding for another's
situation or feelings. Empathy is to be distinguished from sympathy,
which is usually nonobjective and non-critical.
2. Passion and Enthusiasm: The deep love of the subject and people. The
desire to teach and care for people without which, all medical knowledge
becomes cold and lifeless. Do not take up a subject that doesn't
interest you for any length of time. By doing this, you are not only
harming yourself but also the patients under your care.
3. A full personal knowledge of the branch taught: Not second hand
information derived from books, but the living experience derived from
practical, well tested experience of a life time.
4. A sense of obligation: The feeling which impels a teacher to be also
a contributor, and to add to the stores of medical knowledge from which
we so freely draw to teach and practice medicine.
5. Art of detachment:
The faculty of isolating ourselves from the
pursuits and pleasures incident to routine life and an emotional
detachment to the diagnoses we make. In all matters medical, what is
right is more important than who is right.
6. System or the virtue of the method: Unless one is a genius, a
systematic method is essential to learn medicine. We must plan each day
of ours in such a way that minimal amount time is wasted in unnecessary
things. What we do daily is going to decide what we are going to be at
the end of a year or two. These few years as student are going to make
or break career.
7. The quality of thoroughness: Is essential in matters medical be it a
preparation for a talk, examination, or patient evaluation and
management.
8. Honesty and Integrity: In dealing with the lives of people who come
trusting us requires honesty. The ability to admit a mistake, take
another opinion or help when we are not sure requires courage and
conviction on our part. We must conduct ourselves in an irreproachable
manner so that not even the slightest doubt would be raised about our
integrity.
9. Attitude: A doctor should be tolerant and patient. We should avoid
judging people and take on sides because we undertake to take care of
every body irrespective of their origin or status.
10. Physical Stamina and Appearance: We must pay attention to the
appearance and behavior as society often tends to judge us on this
basis. A dignified and cheerful manner is particularly important in
dealing with the sick people.
11. The grace of humility: Whatever excellence one achieves in medicine,
there can never be perfection in it. There are always places to go and
people to meet from whom we can learn to do better things. This
realization makes us humble and without this quality, one stands out as
an intolerable character.
12. Unreserved respect for excellence: Excellence in any branch of
science or medicine, from whatever person, institution or country it
emanates should be respected and duly acknowledged. It is true that a
healthy competition or rivalry helps in achieving the higher objectives
in medicine, but when carried too far it becomes counter-productive.
13. Unswerving conviction that right things are possible: In the present
vitiated atmosphere of medical practice and medical education,
contributed by the profession, the politician, and the bureaucrat, it
easy to give up all hope of doing anything extraordinary and become part
of the corrupt system. Only the strong conviction that right things are
still possible and the courage to withstand the pressures and put up
with criticism help to achieve the desired goals.
This conviction should be maintained in spite of heavy odds in day to
day work. The best time to start learning these attitudes is now when
one is a student but it is never too late even for an older doctor. The
attitudes towards friends, classmates, seniors, juniors, patients and
their families is an indicator of what one is going to be when becoming
a doctor. This is the time one must learn to interact with people and
patients. It is not enough to be a good student. One must strive to be a
likable person in the college, hospital, and home. Once cultivated,
these habits like bad habits are also contagious. The best target is the
students at various levels who are yet to be spoiled by exposure to the
“tricks of the trade” of medicine today.
Emotional Intelligence
Nurses spend maximum time with the patients. It is very important that
they learn to cope with their emotions, mostly laden with fear,
insecurity and pain.
Emotional Intelligence is described an ability, capacity, or skill to
perceive, assess, and manage the emotions of one's self, of others, and
of groups. I enumerate here 13 attitudes I found important for a nurse
to develop:
- Ability to give and receive unconditional love
- Certain degree of insensitivity or obtuseness to criticism.
- Willingness to take another opinion in the best interest of the
patient.
- Lack of bitterness and ability to forget and forgive people.
- Ability to lead people and be willing to be lead. (‘We” vs. “I”)
- Ability to stay unprovoked even in the face of extreme provocation.
- Ability to say: “I was Wrong”
- No Blame Method of Handling other’s mistakes
- Ability to handle failure
- The Recognition of Uncertainties of Medicine
- Acceptance of The Imperfections of the World
- Extreme Emotional Intelligence
- Be willing to ask “What Do I Want to Be Remembered for?”
The figure below gives a comprehensive picture of the skill mix required
to be a good cardiovascular nurse.
What this course will do to you?
Advanced practice cardiovascular nurses assume a variety of positions.
Clinical Nurse Specialists work in hospitals and medical centers, often
combining expert clinical practice with education, research,
consultation and clinical leadership. In addition, cardiovascular
advanced practice nurses find work as case managers, educators in
hospitals or colleges, and middle managers or administrators in clinical
or health plan settings.
This 1 year PG course is designed to supplement the basic nursing
training with a focus on cardiovascular nursing. The goal is to add to
the knowledge that you already use when caring for cardiac patients and
go more in-depth into the most important topics related to providing
excellent cardiac care to patients.
This course is designed to meet the needs of intensive coronary care
nurses, and nurses working in a variety of clinical settings where
critical and progressive care nursing is delivered.
What does this course contain?
The course would involve teaching by practicing Cardiologists on
miscellaneous Cardiac Topics such as cardiovascular A&P, physical
assessment, valve disease, hypertension, dyslipidemias, cardio-myopathies,
infectious diseases.
Experts will tell you about Cardiac Arrhythmias imparting arrhythmia
interpretation skills, bradycardias and their treatment, tachycardias
and their treatment, pacemakers, ablation, ICDs. You will learn
differentiating wide QRS rhythms: aberration or ventricular ectopy,
Narrow QRS tachycardias, Wide QRS tachycardias, Preexcitation syndromes,
AV blocks and AV dissociation.
You will be taught 12 Lead ECG Fundamentals covering basic 12 lead ECG,
leads, axis, bundle branch block, bedside monitoring principles, and
wide QRS patterns. You will learn about 12 leads Axis determination,
Bundle branch block, Fascicular blocks, myocardial ischemia, injury, and
infarction.
Practitioners will provide you Cardiovascular Drug overview. You will
learn about Physiological basis for drug therapy, Antiarrhythmic drugs,
Beta blockers, Ca channel blockers, ACE inhibitors, Vasoactive drugs.
You will be introduced to Case study approach to Advanced Cardiac Life
Support (ACLS) drugs.
You will be provided understanding of Heart Failure and Acute Coronary
Syndrome by discussing types of Heart Failure, Pathophysiology of Heart
Failure, Treatment of Heart Failure, Definition of ACS: Unstable Angina,
Elevation Myocardial Infarction (STEMI), Non ST-Elevation Myocardial
Infarction (NSTEMI), Pathophysiology of ACS, Diagnosis of Coronary
Artery Disease and ACS (including ECG changes, biomarkers) Treatment of
STEMI and NSTEMI Case Studies.
During the course doctors will also talk to you about Revascularization,
Hemodynamic Monitoring, IABP, Oxygenation & Ventilation, Pulmonary
Pathology, Endocrine Disorders in Critical Care, Neurological Disorders
of the Brain, Electrolytes and Renal Issues, Shock States, Systemic
Inflammatory Response Syndrome (SIRS), Sepsis, Septic Shock, and
multiple organ dysfunction (MOD).
Conclusion
Nursing continues to develop a wide body of knowledge and associated
skills. There are a number of educational paths to becoming a
professional nurse but all involve extensive study of nursing theory and
practice and training in clinical skills. I hope this PG level
Cardiovascular Nursing course will pave way to develop newer human
competencies and overall strengthen the practice of Cardiology.
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