University of East London: Role of Nurse in Chronic Heart Disease

This report delves into the crucial role of nurses in managing patients with chronic heart disease. It begins by highlighting the increasing prevalence of cardiovascular diseases and the significance of nursing interventions in mitigating related risks. The literature review covers acute heart failure, pharmacological treatments, and essential patient education topics. The report emphasizes the importance of nursing assessments, interventions, and patient education in managing the condition, including promoting patient comfort, reducing fluid overload, and increasing patient awareness about their health condition. It also provides insights into pharmacological management and the importance of a multidisciplinary approach involving cardiologists, heart failure specialist nurses, and other healthcare providers. The report also explores the importance of psychosocial assessments and provides an overview of essential patient education topics, including understanding the causes and symptoms of heart failure, risk factor modification, and dietary and exercise recommendations. Overall, the report underscores the proactive role nurses play in improving patient outcomes and reducing readmissions in chronic heart disease care.

Running head: ROLE OF THE NURSE IN CARING FOR PATIENTS WITH CHRONIC
HEART DISEASE
Role of the nurse in caring for patients with chronic heart disease
Student Name
Student ID:
Author’s note:

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Table of Contents
INTRODUCTION...........................................................................................................................1
Introduction..................................................................................................................................1
Background..................................................................................................................................1
Rationale......................................................................................................................................2
LITERATURE REVIEW................................................................................................................3
Nursing intervention in Acute heart failure.................................................................................3
Pharmacological management.....................................................................................................4
Essential topics in patient education............................................................................................6
Role of the nurses in reducing repeated incidents of CHF..........................................................8
Gap in literature.........................................................................................................................10
Summary........................................................................................................................................10
Reference list.................................................................................................................................11

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INTRODUCTION
Introduction
Cardiovascular health is gaining immense prominence in the recent times. Aligning the
current health statistics and health condition of the people, it can be stated cardiovascular
condition, is a major cause of comorbidity (Kutzleb et al. 2015). The current assignment thus
works on understanding the role of nurses and the required nursing intervention for providing
care to the patients suffering from chronic heart conditions. The research literature therefore aims
to understand the importance of educating the patients and the role of the nurses in the mentioned
stage. The literature additionally provides a brief overview about the possible pharmacological
intervention that can be undertaken to improve the chronic conditions such as chronic heart
disease
Cardiovascular disease (CVD) is termed as one of the leading causes of premature death
among individuals, irrespective of gender. In the last twenty years; prevalence of stroke and
CVD increased among the developing countries with low to middle range of income. Schulman‐
Green et al. (2016), stated the fact, series of immutable and modifiable factors are seen to
contribute towards the increasing rates of stroke related incidents. In regards to the mentioned
incident, American Heart Association recognized role of nurses in reducing disability and even
death. Recent statistics show, nearly 25% of death by 2025 (Dharmarajan et al., 2016). For more
than 40 years, registered nurses have taken up the prime role in managing multiple and even
single risks associated with cardiovascular problems such as smoking, hypertension, diabetes and
even cardiac rehabilitation. By embracing primary roles as team leaders in providing case
management as per the patient requirements, nurses are seen to issue rehabilitation centres and

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stick to the health guidelines. Such disease programs were seen to exhibit improved outcomes;
coupled with cost effectiveness, in developed and developing countries.
Evidence based data is seen to support role of nurses in playing a proactive role in
regards to stroke prevention. Research based study conducted by Heery et al. (2015), stated the
fact that intervention laid by the nurses to reduce the risks related to CVD documents cause
regression of disease; coupled with reduction related to clinical events. Study conducted in
hospitals found the fact, admitted patients suffering from CAD, were shown to exhibit significant
reduction in rates of mortality and morbidity after a year followed by care from the nurses. It
would be fair enough to state that CVD adherence to guideline recommendations for secondary
and even primary prevention can be substantially improved by the teams directed by the nurses.

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LITERATURE REVIEW
An overview of acute heart failure (AHF), impact on patient and nursing strategies
Acute heart failure is not a single disease, rather a combination of multiple worsening
signs that reflects inability of heart to pump blood. The cause of AHF can be termed as build-up
of fatty deposits leading to poor blood supply to the heart. Understanding the collective and even
the individual contribution of the nurses in preventing CVD is a proactive step in transforming
the nurses into leaders. The Global Cardiovascular Nursing Leadership Forum (GCNLF), is such
an intervention, designed to champion the existing nursing intervention across the lifespan of an
individual in both developed and developing countries. Fergenbaum et al. (2015), reaffirmed the
comment restating the global burden of CVD on the provided specifics of both middle income
and low income countries. The challenges can be highlighted on global healthcare platform;
including, cultural, economic and even environmental; widening the gap between the rich and
the poor. The shortage of nurses has been defined as one of the prime deterrents in CVD. While
addressing optimal role of the nurses Ulin et al. (2016), underlined the importance of patient
centred care, quality improvement initiatives and even evidence-based practice. The research
rationale as obtained through previous study leads to the following finding:

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Nursing intervention Significant Outcomes
Optimizing the management of dyslipidemia Improved measures in dyslipidemia
Reducing the risk associated with
cardiovascular disease; through the use of diet
and lifestyle changes
10 year cardiovascular disease risk reduction
Hypertension Weight reduction, BMI and blood pressure
Hypertension and diabetes Diabetes and blood pressure improved leading
to limited vascular complications and better
cardiac health (Kutzleb et al. 2015)
Stop the habit of smoking by educating the
patient about potential side effects
Important “quit” rate
CVD risk with medication management and
counselling
Less CAD progression
CVD risk management and evaluation of the
cost
Cost effective
Table 1: Nurse Case Management Trials—Summary of Findings
(Source: Ulin et al., 2016)
Nursing intervention in Acute heart failure
The keynote provided above addresses the information and the burden associated with
CVD, in respective countries and regions; coupled with involvement of the nurses. A progressive
approach can be termed as one of the most important interventions in answering the healthcare

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needs of chronic heart condition. The goal within nursing management is established through the
implementation of nursing assessment of patient’s functional capacity and even haemodynamic
status. The importance of nursing intervention was further stated by Qureshi et al. (2016),
providing an idea that nursing assessment can reveal the underlying condition that leads to heart
failure. The nursing goals in regards to care for patient with constant cardiac problems should be
as follows:
 Promoting comfort of patient while reducing the events of breathlessness.
 Reducing the signs related to fluid overload.
 Maintaining the peripheral perfusion.
 Increasing the awareness of the patient in educating them in current health condition.
 Attending to self-care deficits often arising due to hypoxia and overload of fluid.
Monitoring the patient should be done immediately upon admission and focus should be
made on identifying the response to treatment. As stated by Clark et al. (2015), monitoring a
cardiac patient includes basic observations such as serial ECGs, oxygenation, heart rate,
respiratory rate and even blood pressure. Care of invasive monitoring system are as per local
nursing guidelines with prime intervention to prevent infection. As observed by Friesen-Storms
et al. (2015), nursing implication in regards to cardiac conditions is often seen to monitor the
fluid restrictions.
Advanced monitoring system is inclusive of invasive monitoring system as central
venous pressure monitoring and even arterial line. Hourly nursing assessment is dependent on
the clinical status of the patient. Identification of degrading conditions such as increase in blood

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pressure, rates of respiration and so on is the primary role of the nurse. If the patient is seen to
respond positively to the implemented nursing intervention, it becomes important to continue the
same (Albert, 2016). The patient may lack the basic ability to execute events in daily life. The
nursing care thus supports the patient in daily activities. Nurses are often held responsible for
identifying the deficits; specially paying special attention towards the skin and associated
pressure areas. Additionally, the patients with pre-existing cardiac problems are often subjected
to peripheral oedema in the limbs leading to breakdown of the skin. Based on the nutritional
perspective, patient may be subjected to nausea and even anorexia; as a result of poor perfusion
to the digestive system. A dietary consultation is of prime importance in the mentioned scenario.
As stated by Reeder et al. (2015), generally the patient would be on low salt diet and advised to
eat in limited amounts to prevent nausea and feeling of fullness. Use of anti-emetic is made 30
minutes before meal for prevent the feeling of nausea. The lack of strong perfusion within the
digestive system risks altering the bowel movement and thus laxatives are often prescribed.
Pharmacological management
Treatment Adverse effects or nursing implication
Morphine  Depression in respiratory rate
 Vasodilatory effects causing hypotension
Diuretics  Imbalance of the electrolytes
 Hypotension
 Dehydration
 Resistance to diuretics if already on oral
diuretics
Vasodilators  Headache

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 Hypotension
 Tolerance towards nitrate
Inotropes  Increased incidence of atrial and ventricular
arrhythmias
Type III phosphodiesterase inhibitors  Monitor the blood pressure
 Dobutamine and milrinone may be
administered peripherally
Vasopressors  Administer via the use of central line
 Observing special incident of vasoconstriction
Table 2 a: Nursing intervention in case of heart problem- a pharmacological intervention
(Source: Reeder et al., 2015)
The table presented above is seen to describe the specific nursing intervention on
pharmacological level. Once the patient gain a good hold on stability; patients subjected to
mobility programs. Ownership in domains of self-care is important and promoted initially with
assistance and then independently. Maintaining and measuring the body weight on daily basis is
an important intervention. Educating the patient thus gains prime importance in mentioned
condition. As stated by Kogan, Wilber and Mosqueda (2016), patient education is often termed
as a mode of self-care in regards to heart failure and prevention of other exacerbations. Thus, it
can be stated; self-care is set of actions that aims at maintaining high levels of physical activity
that may worsen the health condition. Following the condition of the patient, multidisciplinary
approach is undertaken by the nurses in collaboration with physicians and other service

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providers. Following are the nursing interventions undertaken in case of treating patients with
chronic heart conditions
 Contact during the course of hospitalisation, coupled with early follow up after discharge
 Targeting high risk symptomatic patients
 Facilitating access during the course of decompensation
 Optimised medical management
 Access to advanced option for treatments
 Psychosocial support for the patients and family members
Collaborative role
However, it becomes important to note the fact that nurses alone do not play a proactive role in
reducing risks associated with heart failure. A collaborative effort is in demand for ensuring
better health outcomes among the patients
Roles of cardiologist in heart failure unit
Investigating the cause of heart failure
Functional and Prognostic stratification
Using neuro-hormonal treatment
Evaluating the advanced therapeutic practises
Roles of the Heart Failure specialist nurse
Holistic assessment of the patient Functional, social and cognitive dependency is
tested
Multidisciplinary approach; engaging with
different types of services
Education of the patient during the course of Teaching the patient about the events of self-

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stay care
Planning the discharge and providing the
primary care to the patients
Follow-up with the patients and ensuring
continuous care
Table 2b: Nursing intervention during the course of in-patient care
(Source: Kogan, Wilber and Mosqueda, 2016)
Psychosocial assessment
A complete psychosocial assessment of the patient by a registered nurse is termed as one
of the key strategies in heart failure programs. The mentioned intervention starts 24 hours upon
patient admission. The nurses are often seen to implement different services that constitutes of
the components in internal medicine and even cardiology (Moore et al. 2015). It becomes duty of
the nurses to ensure proper care to the patient even during the time of admission and after the
course of discharge.
Essential topics in patient education
Educational Topics Skills and self-care Behaviour
Cause and definition of heart failure Understanding the exact reason for heart failure and the
possible symptoms.
Signs and symptoms Understanding the signs and symptoms
Recording the daily weight and monitoring the rapid
weight gain
Reporting unexpected weight gain
Using appropriate diuretic medication
Pharmacological treatment Recognising the potential side effects of each of the

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drugs prescribed
Understanding the indication of dosage and effects of
the drugs
Risk factor modification Understanding the importance of calling quits to habit
of smoking
Monitoring blood pressure if suffering from events of
hypertension
Avoid obesity
Monitoring the level of blood glucose
Diet recommendations Limiting the level of sodium intake
Avoiding alcohol
Preventing excessive fluid intake
Exercise recommendations Avoid heavy exercises
Use of light weight exercise is recommended on
regular basis
Immunisation Receiving important immunisation on pneumococcal
disease and even influenza
Sleep and breathing disorders Work on recognizing the behaviour or events that gives
rise to such issues and sleeping problems; such as
increase in body weight.
Abstinence from alcohol and cigarettes
Avail the possible treatment options if available
Adherence Understanding the importance of follow-up treatment

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and maintaining a constant motivation to adhere to the
same mode of treatment
Psychosocial approach Learning the possible modes of treatment available
Understanding the possible causes of depression
Prognosis Seeking psychosocial support
Understanding the efficacy of prognostic factors for
undertaking realistic decisions
Pregnancy and contraception Pregnancy can degrade the heart condition
The benefit and risk measured to mother and baby
Travelling Places at high altitudes and even areas with high rates
of humidity must be avoided
Table 3: Important topics in patient education
(Source: Kogan, Wilber and Mosqueda, 2016)
The provision for care management is highly focussed on the patients with chronic heart
conditions are subjected to high rates of risk. The increasing pressure from the hospitals demands
extra care for the patient (Bhatt et al., 2017). Readmission is a common occurrence after
cardiovascular event as the patient is neither aware of the disease nor aware about the ways to
manage it. Nurses implementing health related educational program can work on improving the
knowledge of the patient and prevent further chances of readmission to hospital. Even though the
role of health education is important in providing care to the patient, yet limited value is given to
the same in regards to daily clinical practise. Among the several reasons, limited number of time

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and even shortage of nurses’ act as a hindrance in patient education. Benetos et al. (2015),
argued the fact that nurses do not view patient education as part of their profession.
Role of the nurses in reducing repeated incidents of CHF
Leininger has been termed as one of the significant nursing influential and it she who
identified the importance of social mandate in providing care to the community (Victor, Sommer
& Khan, 2019). In similar regards, nurses as member of society can play important role in
decreasing the burden related to cardiovascular diseases. A study conducted by Salmond and
Echevarria (2017) reported nurses are often seen to view public service a part of their
professional responsibility. Social responsibility coupled with civic sense help the nurses to
participate in welfare. The concept of public nursing is not new and is deeply rooted in the past
incidents of nursing profession. Taslakian, Sebaaly and Al-Kutoubi (2016), pointed out the fact
that nurses can effectively work on participating in CVD deterrence policies by introducing and
even implementing suitable public health interventions. Epidemiological studies confirm, change
in lifestyle plays a critical role in managing CVD related burden. Healthy diet and monitoring the
disease on time can help in addressing further health issues. Reducing the risk factors would
ultimately lead to the reduction in rates of mortality and morbidity associated with CVD. The
role of nurses can be highlighted in reducing the risk factors by affecting the people around
themselves; through suitable application of strategies for preventing and managing
cardiovascular disease (Ross et al., 2017).
Research is seen to support the fact; nurses are seen to spend more time with patients as
compared to other healthcare providers. Fong (2016), pointed out the fact health outcome of a
patient is highly affected by quality of nursing care. having adequate knowledge to initiate the
process of resuscitation is important for saving the lives of patients. Nurses equipped with life

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support skills and knowledge is important for everyone. As identified by Yu et al. (2016),
following are the roles of nurses termed to be useful in case of resuscitation:
 Initial CPR
 Provision of airway and ventilation, defibrillation drugs, invasive lines and even tubes
 Prompting documentation and team members to initiate critical actions
 Ensuring follow-up
The mentioned roles can work on reducing the rates of mortality and morbidity among the
patients. The role of nurses in emergency care is different and needs attention. Atleast 10 people
die every one hour in Canada and approximately 34% of the total deaths are caused due to
cardiac problems (Harjola et al., 2019). The statistics continue to be same in case of other
countries such as the UK; where one out of three people is seen to die due to cardiac issues;
irrespective of gender (Victor, Sommer and Khan, 2019). An observational study provides a
clear understanding in case of ST elevated myocardial infarction (MI). Even the slightest time
frame is important; as the proven benefits of thrombosis is time bounded. The timeframe for
thrombosis is within an hour of the onset of heart-attack is termed as “golden hour” (Murtaugh et
al., 2017). Usually, nurses are responsible for preparing medication and administering the same.
Implementation of thrombolytic medications in case of critical care and can prevent further
deterioration in health condition of the patient.
Gap in literature
There remains no doubt that professional background of the nurses is often bounded by
professional limitations. However, previous research failed to understand the possible factors
that works on influencing the behaviour of the nurses in treating the patients with chronic heart
conditions. In addition to that, the previous research failed to provide the possible impact of

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nursing intervention on patient health in terms of percentages. The research understands the
prospects that nurses are important members in meeting complex care needs. Nurses are termed
as second to the doctor in terms of professional and social and professional view in developed
countries. It is fact that there exists huge difference between the mentioned professions. Both
nurses and doctors work towards the same goal of managing the patients; through high quality of
treatment. The essence related to professional obligation is different as nurses are to care and
doctors cure. Neither is mutually exclusive and cannot succeed without another. Patient
assessment is termed as a negotiated area of patient administration; leading to confusion. The
research in the current context, failed to address the issue stated above.
Summary
Nurses are seen to embrace primary roles as team leaders in providing suitable care as per
patient conditions. Thus it can be concluded CVD is a major concern causing high rates of death.
It is affecting the age of the adults and the patients are seen to emerge as a financial burden.
There has been limited exploration about the emerging roles of the nurses as leaders. Hence, it
can be easily believed that the best role of the nurses in addressing the coronary heart failure
(CHF) is yet to be addressed. Thus, it can be concluded, nurses need to have specialised
knowledge and most importantly skills to provide efficient care for the people suffering from
cardiac issues. Suitable strategies are needed for ensuring participation of the nurses in
decreasing the burden of cardiovascular diseases through the list of emerging roles. Hence, it can
be concluded further evaluation in role of nurses is needed for defining the competencies
required for dealing with CHF in the 21st century

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