Healing Hearts: The Nurse’s Role

Caring for patients with cardiovascular disease

February is American Heart Month, which brings attention to the world’s leading cause of death – cardiovascular disease. According to the American Heart Association, more than 17.9 million people die from cardiovascular diseases every year.

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What exactly is the nurse’s role in helping patients with cardiovascular disease? Consult QD talked with Shannon L. Pengel, MSN, RN, NE-BC to find out. In this Q&A, the Associate Chief Nursing Officer for Cleveland Clinic’s main campus shares her thoughts on advances in this ever-evolving role.

Pengel also serves as Clinical Nursing Director for the Sydell and Arnold Miller Family Heart & Vascular Institute and the Anesthesiology Institute.

Q: How has the nurse’s role in caring for cardiovascular patients evolved?

A: Cardiovascular medicine is continuously evolving to include new treatments and preventive measures. As a result, patients are living longer and many have complex problems that require a more advanced understanding of their disease and treatment needs. Nurses in this field must be acutely aware of patient needs and be able to respond to them in ways that may not have been possible until very recently. This includes new medications, procedures and preventive strategies to ensure the best possible quality of life.

Q: What types of healthcare advances have had the greatest impact on nursing care?

A: Cleveland Clinic is a leader in innovation and our nurses are among the first in the field to coordinate patient care after new and complex procedures. One example of this is transcatheter approaches to valve replacement. Cleveland Clinic was one of the first U.S. hospitals to perform transcatheter aortic valve replacement (TAVR). This is a treatment option for some patients who need aortic valve replacement, but are too sick to have a traditional surgery. Many of these patients are elderly with numerous health issues. In the past, they had no treatment options, but TAVR has helped improve the length and quality of life for them.

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Our program began in 2006, and we have treated more than 1,200 patients with highly successful outcomes. Recently, this technology has been applied to mitral valve replacement. These types of treatments require nurses to work with the patient’s healthcare team to develop new protocols to meet the needs of each patient. It is an amazing opportunity to be at the forefront of nursing care as new treatments and patient care opportunities emerge and develop.

Q: How have these innovations changed the scope of nursing?

A: Advances in cardiovascular care have expanded the scope of care our nurses provide to the highest level. For example, Cleveland Clinic is a world leader in endovascular and robotic surgery. These treatment options allow patients who need surgery to have smaller incisions and faster recovery times compared with traditional surgery approaches. These procedures have given our nurses the opportunity to become experts in this type of care, while still being extremely skilled in caring for patients who require intensive care for long periods of time, many of whom come to Cleveland Clinic after being told by other hospitals that they are out of treatment options.

Q: How do you manage the needs of patients who require complex care outside of the hospital?

A: The key to managing these patient populations is care across the continuum, which requires complex care coordination. Care coordinators help high-risk patients manage their health and navigate the healthcare system. These nurses are skilled at identifying at-risk patients and their needs, and they use evidence-based guidelines to close gaps in care and improve patient outcomes. Many times, the gaps are found in the care of patients with chronic diseases. To address this, Cleveland Clinic developed seven chronic care clinics to help patients manage ongoing and recurring diseases. Nurse practitioners run the clinics and help coordinate patient care, including same-day appointments.

Cleveland Clinic also offers alternatives to traditional care, such as walk-in clinics, in-home care, and virtual visits. Nurse On Call is a triage program that gives patients access to a registered nurse 24/7 who can address their problems or questions and make any necessary arrangements for care.

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Q: You mentioned advances in prevention of cardiovascular disease. What impact have these changes had on nursing?

A: Nursing has always been involved in helping patients understand their risk of heart disease and ways to prevent problems. This includes educating them on their ideal blood pressure, glucose level, cholesterol level, weight, and other health indicators, as well as making sure they know what they need to do to control them. However, patients get a lot of information outside of the healthcare setting, which may be inaccurate.

Nursing and patient education has evolved to encompass not only evidence-based guidelines, but also understanding the vast amount of information – proven and unfounded – that patients look to when making decisions about their care. Nurses and other members of a patient’s healthcare team are now tasked with helping patients sort through health information to understand what is helpful and what may be a passing and unproductive trend.

Q: What are some of the other crucial roles cardiovascular nurses play today?

A: A large part of nursing today involves understanding the needs of patients beyond inpatient care and outpatient appointments. Listening and individualized education is a crucial piece of the care we provide every patient. Whether it is a patient who has concerns about being able to get around the house when they get home or someone who is confused about their medications or which foods are best for them, nurses play an integral role in making sure their needs are met. Cleveland Clinic’s Heart & Vascular Institute is committed to every patient’s experience in and out of the hospital. We provide a dedicated toll-free number to every patient we see so they can call a registered nurse 24/7. We have seen great improvements in patient outcomes and satisfaction since this program started.