Cardiac Enhancement Program
21 October 2005
North Sydney/Central Coast Area Health Service
This project was entered in the Baxter 2005 NSW Health Awards, Education and Training category.
Entries from the Baxter 2005 NSW Health Awards - full list
Author
Michele Corkhill, Wyong Hospital Central Coast Health Services, NSCCAHS
Abstract
As part of the planned redevelopment of Wyong Hospital, Medical 2 will change focus from an acute general medical ward to a combined Coronary Care Unit and Cardio-Respiratory Ward with telemetry capability. Staff were surveyed to identify interest in working in the Coronary Care Unit / Cardio-Respiratory Ward. Those who were interested in working in this area were then asked to self rate a number of statements in relation to their knowledge and ability to confidently care for the patient with a cardiac disorder. A program of theoretical and clinical education was designed to allow staff to enhance their knowledge and clinical expertise in preparation for the service change. A challenge paper was given at the commencement of the enhancement program. The paper was repeated at the completion of the education program. Results of the challenge papers demonstrate a significant increase in knowledge over the course of the program.
Aim
Facilitate safe nursing management of the acute cardiology patient by increasing knowledge base and clinical competence in cardiology nursing practice for staff interested in working in the CCU / Cardio-Respiratory environment.
Background
Medical 2 is a 30 bed acute general medical and palliative care unit. A 4 bed Acute Stroke Unit was opened in Medical 2 in July 2005. As part of the planned redevelopment of Wyong Hospital, Medical 2 will become a 28 bed Cardio-Respiratory Unit comprising a 6 bed Coronary Care Unit and 22 cardio-respiratory medical beds with 12 telemetry units. Some staff working in Medical 2 had previous experience working in Critical Care environments but the majority of staff have limited knowledge or experience in managing acute cardiology patients. In order to facilitate a smooth transition to the new work environment it was essential that a planned program of theoretical and clinical education be implemented. This would also ensure that acute cardiology patients, and those on telemetry, receive nursing management that was safe and appropriate for their care needs.
Methodology
As this was a planned service change staff were initially surveyed to determine their interest in working a Coronary Care Unit / Cardio-Respiratory Unit. The survey asked staff to identify if they were interested in working in Wyong CCU / Cardio-Respiratory Unit, the new Medical Ward which would include the Stroke Unit when it opened, or if they would like to work in other areas at Wyong or Gosford. 71% of the staff surveyed indicated they would be interested in working in the CCU/Cardio-Respiratory Unit. Discussions with staff identified their biggest anxiety in relation to working in the new environment was managing the acute cardiology patient. A further survey was undertaken of these to self assess their knowledge level. Both Registered Nurses and Enrolled Nurses were presented with a series of statements pertaining to cardiology nursing and asked to rate themselves using a 5 point Likert scale of highly disagree to highly agree. The Registered Nurses were presented with 14 statements while the Enrolled Nurses were presented with 8 statements concerning care of the cardiac patient. The results of the self rating were then used to identify knowledge deficits and plan for the education program.
Planning and Implementation
After collation of the ratings for the statements, discussion with stakeholders occurred to investigate options to meet the identified learning needs of the staff. A number of options were considered, and it was decided that best option would be day release to attend a program of theoretical education over a 6 week period, followed by a clinical rotation to the cardiac units at Gosford to consolidate the theoretical framework. There were 16 staff members who were identified to attend the enhancement program. The practical aspects of rostering to allow for the release of this number of staff, while at the same time continuing to provide a safe environment for the patients in the ward was challenging. A decision was made to run the enhancement program twice to reduce the number needed to be released at any one time. The theoretical program consisted of 6 days for Registered Nurses and 4 days for Enrolled Nurses. All participants were required to undertake prereading. A challenge paper was administered at the commencement of the theoretical program, and repeated on completion. At the completion of the first theoretical program staff would commence rotations to Gosford Cardiology to gain clinical experience in Cardiac nursing.
Outcomes and Evaluation
The challenge paper, when repeated on completion of enhancement program, showed significant increases in theoretical knowledge. Results of the pre-education and post-education challenge papers demonstrated an increase in knowledge from an average of 22% (range 7% to 48%) to an average of 48% (range 27% to 72%). The program evaluated well. All participants felt the majority of the sessions were relevant, informative and the right length. The exceptions were the rhythm interpretation workshop, ECG workshop, and cardiac drugs session. Sixty percent of participants felt the rhythm interpretation and ECG workshops were too short, while 100% of participants believe the cardiac drug session too short. One hundred percent of participants agreed or strongly agreed that the program met their individual learning needs. Clinical rotations to Gosford cardiology are still underway. The statements will be presented again following the completion of the clinical rotations to determine how staff rate their knowledge and ability acquisition after practical experience. During clinical rotations, staff from Gosford Cardiology have volunteered to work in Wyong M2, allowing an increased understanding of the work demands in both areas.
Future Scope
The enhancement program has helped to prepare staff for the commissioning of the Coronary Care Unit and Telemetry facilities in the near future. Whilst staff acknowledge that they are nor yet clinical experts in the field, undertaking the program has enhanced their confidence in their own knowledge and ability. Participation has also assisted with motivation to continue professional development, and accept new challenges. Continued rotations and knowledge sharing between both sites will enhance the professional networks, and ensure the cardiology patient is given the highest standard of care, whether admitted to Wyong or Gosford Hospital.
