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Nurses' Roles in Person-centered End Stage of Cardiac Failure

Discuss about the Cardiac Nursing for Journal of Heart Failure.

This paper focuses on Cardiac Nursing which involves caring for patients who suffer from various problems of the cardiovascular system. Nurses participate in caring for patients especially to help them stabilize the issue of heart failure. The cardiac nurses exercise the postoperative care which involves the stress test examinations, the surgical unit, monitoring the cardiac issue, vascular control, and the health investigations (Haddad, Saleh & Eshah, 2017). The Nurses are expected to have the significant certification in the advanced cardiac life support and the basic. They are required to embrace various skills based on the cardiac stage of the patient. Cardiac Nurses operate in different surroundings such as the Intensive Care Units (ICU), Cardiac Catheterization, the coronary units of care, and the operation theatres. Also, the cardiac nurses also work in the rehabilitation centers such as the wards for surgery, the wards for cardiac medical and clinical research. For this paper, the role of a nurse in the person-centered management of the end stage cardiac failure has been critically analyzed.

Nurses have a key role in the management of cardiac failure patients. The nurses largely focus on monitoring and follow-up of patients who portray a high risk of clinic (re)admission. According to reports, and observations from the health care researchers, multidisciplinary care involving the nurses contribute largely to the improvement of patients (Johnson, 2007). The role of nurses in the end stage of cardiac failure is currently recognized in international guidelines. The increased emphasis on the control of acute heart failure has given the nurses a significant role in the cardiac failure journey, and their contributions have led to the delivery of quality care and improvement of patient outcome.

The Cardiac Nurses plays a great role in the person-centered management of the end stage of cardiac failure.  A patient who is at the end stage of cardiac failure is associated with various symptoms as discussed below. It is easy to confuse the end stage of cardiac failure with other illnesses or aging. The patient may experience a shortness of breath especially if they walk on the stairs. Sleep issues are common where a patient fails to breathe well (Chawla, Herzog, Costanzo, Tumlin, Kellum, McCullough & Workgroup, 2014). The end stage cardiac failure may cause a patient to cough during the night and daytime especially when an individual is resting. Fatigue is another symptom evident in the end stage of cardiac failure. Swelling in some parts of the body such as legs and ankles due to the failure of blood flow is evident.  The patients may lack appetite, and they may as well lose a lot of weight.


Therefore, the nurses have their roles to care for the end stage cardiac failure patients to at least help to prolong their life. Most of the patients in the end stage cardiac failure are set to undergo the medical therapies which some of them are viewed as burdensome. Others are set to undergo cardiac transplantations. Such interventions require the nurses involved in the end stage cardiac failure to have proper communication skills. They will need to communicate the progress of the patient to the family members and also may have the abilities to develop mutual goals with the family expectations regardless of the situation (Anker, 2014). Therefore, nurses are obliged to exercise effective communication to define the goals of care to the patients (Riley, 2015). The cardiac nurses at the end of care stage cardiac failure should have the abilities to conduct more research based on the end of life care. Cardiac Nurses at the end stage cardiac failure are obliged to take part in the advanced care planning where they determine the patients’ issues through diagnosis (Morton, Fontaine, Hudak & Gallo, 2017). The Cardiac Nurses at this stage monitor and investigate the patients to ensure that they are set to appropriate interventions and medications. They ensure that the patients are provided with the appropriate doses, and they should also monitor the optimization of medications especially when the patients require complex treatments.

The nurses are required to have the knowledge to improve the patient’s knowledge concerning the cardiac failure. They have a role to help the patients understand the condition and offer them advice concerning the interventions. The Cardiac Nurses at the end stage of cardiac failure works closely with other specialists and agencies to ensure the patients receive standard individualized care (Whellan, Goodlin, Dickinson, Heidenreich, Jaenicke, Stough & Heart Failure Society of America, 2014). They also work closely with the families of the patients and keep them updated on the patient’s condition. Nurses should collaborate with the agencies such as the cardiothoracic center and specialists such as the rehabilitation team, the psychological services, and the pharmacists. In simple words, the nurses need to liaise with other specialists dealing with the end stage cardiac failure to ensure the patients are well attended and informed regarding their conditions. The nurses at end-stage cardiac failure take audits to ensure the care provided to the patients is standard.


The period when the patients are in hospital serves as the perfect time to educate the patients about monitoring and management of heart failure. In some cases, the patients and family may wish to be incorporated in the self-care program carried out by the cardiac nurses. During the program, the nurses recognize significant changes in the patients, they monitor their conditions and take the appropriate action. The nurses introduce the patients to some of these concepts during the in-hospital period. Often, there is a mismatch between the information given by the health care professionals and a patient’s knowledge about the management of their cardiac failure. Taking the case of the Euroheart failure survey, for instance,

Cardiac nurses play the role of managing cardiopulmonary instability or acute breathlessness along with the diagnosis of end-stage cardiac failure patients. After the diagnosis of Euroheart, the results of a survey conducted indicated that the sick individuals remembered only forty-six percent of advice given concerning the self-care (Melnyk & Fineout-Overholt, 2011). The COMET study indicated that the patients’ beliefs concerning the medications determined their adherence. Therefore, Cardiac Nurses are obliged to provide advice to the patients concerning self-care. The education of patients concerning self-care are recognized in the modern individualism of the education for Cardiac patients. Nurses are obliged to help the patients retain and learn new information hence the patient anxiety levels decline (Perk, De Backer, Gohlke, Graham, Reiner, Verschuren & Deaton, 2012). Other nurses adopt the teach-back approach where the patients are required to repeat the information provided using their words. Through this technique, nurses ensure that the patients understand and they help in rephrasing the misunderstood information. At the same time, it increases the time of the nurse to interact with the patient to discuss the cardiac failure and its control. The technique is beneficial since it allows knowledge retention which is valuable to the patients based on the cardiac failure. The nurses ensure all patients especially those with low health literacy understand the basic knowledge concerning the cardiac failure (Magalhães, Ribeiro, Barreira, Fernandes, Torres, Gomes & Viamonte, 2013). Research shows that there is a high mortality rate for the patients who are discharged with the end of life stage of cardiac failure. Patients die despite the advances in technology which are adopted in health care to boost their lives. There, some of the nurses participating in the admission of the patients diagnosed with the cardiac failure at the end of life stage. These nurses have ample time to recognize the patients with worse symptoms hence they are set to supportive measures in health care. For instance, the measures include providing the discussions based on the planning of future care concerning pain relief (Fletcher, Ades, Kligfield, Arena, Balady, Bittner & Gulati, 2013). Through these services the symptoms are minimized, the depression issues decline, the quality of life improves hence increasing the life span of the patients suffering from cardiac failure. These nurse services reports the increase in the advances in the planning of cardiac failure interventions. The nurses in Advanced Practice of heart failure engage in the titration and prescription of the cardiac failure symptom control and treatment. Referring and screening for the cardiac failure for sleep studies is conducted by the nurses.


Several hospitals allow the implementation of the multidisciplinary plan which is nurse-directed to provide care for the cardiac patients at the end of life stage. This step is viewed as a significant strategy which some hospitals embrace to minimize the costs of care for the cardiac patients at the end of life stage (Amakali, 2015). Also, the strategy ensures that the inpatient admissions are reduce. The multidisciplinary plan is education inclusive, detailed with the drug examination, a follow–up of the patients to receive home care, and planning of early discharge. Nurses are ethically guided with ethical principles which are justice oriented towards fulfilling the needs of the cardiac patients. The sick individuals are human beings hence they need to be provided with the appropriate care which matches their needs. For that reason, the cardiac nurses exercise respect and autonomy to meet the demands of patients at the end of life stage (Glogowska, Simmonds, McLachlan, Cramer, Sanders, Johnson & Purdy, S. (2015). The heart is recognized as the only part which allows oxygen which is the basic need for an individual therefore nurses are trained to observe dignity when providing care to the cardiac patients (Browne, Macdonald, May, Macleod & Mair, 2014).  Nurses are obliged to ensure that the cardiac patients make informed decisions based on the interventions. The nurses also take roles to judge the level of truthiness applied by other physicians in regard to the cardiac interventions for the patients at the end of life stage. They make a follow-up to ensure the patients receive honest and appropriate information concerning the treatments. Additionally, nurses exercise goodness which focuses on the interventions regarding care for the cardiac patients at the end of life stage. It is evident that within health care there may be intentional harm or unintentional which can be more harmful to these patients. Cardiac nurses are obliged to protect the patients from any harm either intentional or unintentional. For the intentional, the nurses design the right interventions and they prioritize immediate implementation to avoid contaminations from people within the clinical setting (McDonagh, Gardner, Lainscak, Nielsen, Parissis, Filippatos & Anker, 2014). For the unintentional harm, nurses should be careful to ensure the potential errors are evaded throughout the process of administering the medications. This is because the cardiac patients are delicate especially at the end of life stage (Hjelmfors, Strömberg, Friedrichsen, Mårtensson & Jaarsma, 2014), hence they may experience deadly side effects if care is not observed through the process of administering medications. Once the interventions are issued, nurses take part in examining the impacts of the care provided to the cardiac patients. Finally, nurses ensure that the multi-disciplinary plan implemented for the patients at the end of life focus on the goals set to help the cardiac patients. The plan must be evaluated, and the nurses ensure that it meets the standard needs and wants for the cardiac patients.

Conclusion

In conclusion, this paper explores the discussion concerning the roles of nurses in a person-centered management of the end-stage cardiac failure. Johnson, 2007 argues that cardiac failure is a critical issue which needs standard care and interventions to help prolong the patient’s life. This paper outlines the roles of nurses in the person-centered management of the end-stage cardiac failure. Patients with the end stage cardiac failure experience various issues which can compromise the patient’s health hence they should be highly trained and certified. Various organizations such as the American Nurses Credentialing Center (ANCC) take part in certifying the Cardiac Nurses. Evidently, the cardiac nurses are obliged to use the technology remotely to monitor the status of patients having a cardiac failure at the end-stage. The admissions are unplanned hence the nurses are set and always ready to co-ordinate the management of the illness. For that reason, the management technique for cardiac failure is implemented which includes the early evaluation, detailed education, and the modification of behaviors to manage and improve the quality of life for the cardiac patients. Therefore, cardiac nurses educate, coach, support, monitor and provide care for the cardiac patients at the end-stage to achieve positive outcomes in the treatment.

References

Amakali, K. (2015). Clinical care for the patient with heart failure: a nursing care perspective. Cardiovascular Pharmacology: Open Access.

Anker, S. D. (2014). Heart failure association of the European Society of Cardiology specialist heart failure curriculum. European journal of heart failure, 16(2), 151-162.

Browne, S., Macdonald, S., May, C. R., Macleod, U., & Mair, F. S. (2014). Patient, carer and professional perspectives on barriers and facilitators to quality care in advanced heart failure. PLoS One, 9(3), e93288.

Chawla, L. S., Herzog, C. A., Costanzo, M. R., Tumlin, J., Kellum, J. A., McCullough, P. A., ... & Workgroup, A. X. (2014). Proposal for a Functional Classification System of Heart Failure in Patients With End-Stage Renal Disease. Journal of the American College of Cardiology, 63(13), 1246-1252.

Chen-Scarabelli, C., Saravolatz, L., Hirsh, B., Agrawal, P., & Scarabelli, T. M. (2015). Dilemmas in end-stage heart failure. Journal of geriatric cardiology: JGC, 12(1), 57.

Fletcher, G. F., Ades, P. A., Kligfield, P., Arena, R., Balady, G. J., Bittner, V. A., ... & Gulati, M. (2013). on behalf of the American Heart Association Exercise, Cardiac Rehabilitation, and Prevention Committee of the Council on Clinical Cardiology, Council on Nutrition, Physical Activity and Metabolism, Council on Cardiovascular and Stroke Nursing, and Council on Epidemiology and Prevention. Exercise standards for testing and training: a scientific statement from the American Heart Association. Circulation, 128(8), 873-934

Glogowska, M., Simmonds, R., McLachlan, S., Cramer, H., Sanders, T., Johnson, R., ... & Purdy, S. (2015). Managing patients with heart failure: a qualitative study of multidisciplinary teams with specialist heart failure nurses. The Annals of Family Medicine, 13(5), 466-471.

Haddad, N. E., Saleh, M. N., & Eshah, N. F. (2017). Cardiac catheterisation and patients' anxiety levels. British Journal of Cardiac Nursing, 12(7), 353-358.

Hjelmfors, L., Strömberg, A., Friedrichsen, M., Mårtensson, J., & Jaarsma, T. (2014). Communicating prognosis and end-of-life care to heart failure patients: A survey of heart failure nurses’ perspectives. European journal of cardiovascular nursing, 13(2), 152-161.

Johnson, M. J. (2007). Management of end stage cardiac failure. Postgraduate medical journal, 83(980), 395-401.

Magalhães, S., Ribeiro, M. M., Barreira, A., Fernandes, P., Torres, S., Gomes, J. L., & Viamonte, S. (2013). Long-term effects of a cardiac rehabilitation program in the control of cardiovascular risk factors. Revista Portuguesa de Cardiologia (English Edition), 32(3), 191-199

McDonagh, T. A., Gardner, R. S., Lainscak, M., Nielsen, O. W., Parissis, J., Filippatos, G., &

Melnyk, B. M., & Fineout-Overholt, E. (Eds.). (2011). Evidence-based practice in nursing & healthcare: A guide to best practice. Lippincott Williams & Wilkins

Morton, P. G., Fontaine, D., Hudak, C. M., & Gallo, B. M. (2017). Critical care nursing: a holistic approach. Lippincott Williams & Wilkins.

Perk, J., De Backer, G., Gohlke, H., Graham, I., Reiner, Ž., Verschuren, W. M., ... & Deaton, C. (2012). European Guidelines on cardiovascular disease prevention in clinical practice (version 2012). International journal of behavioral medicine, 19(4), 403-488

Riley, J. (2015). The Key Roles for the Nurse in Acute Heart Failure Management. Cardiac Failure Review, 1(2), 123.

Whellan, D. J., Goodlin, S. J., Dickinson, M. G., Heidenreich, P. A., Jaenicke, C., Stough, W. G., ... & Heart Failure Society of America. (2014). End-of-life care in patients with heart failure. Journal of cardiac failure, 20(2), 121-134.

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