Development of a postgraduate interventional cardiac nursing curriculum

doi:10.1016/j.aucc.2015.01.003

Australian Critical Care

Volume 28, Issue 4, November 2015, Pages 184-188

https://doi.org/10.1016/j.aucc.2015.01.003 Get rights and content

Abstract

Interventional cardiology practices have advanced immensely in the last two decades, but the educational preparation of the workforce in cardiac catheter laboratories has not seen commensurate changes. Although on-the-job training has sufficed in the past, recognition of this workforce as a specialty practice domain now demands specialist educational preparation. The aim of this paper is to present the development of an interventional cardiac nursing curriculum nested within a Master of Nursing Practice in Australia. International and national health educational principles, teaching and learning theories and professional frameworks and philosophies are foundational to the program designed for interventional cardiac specialist nurses. These broader health, educational and professional underpinnings will be described to illustrate their application to the program's theoretical and clinical components. Situating interventional cardiac nursing within a Master's degree program at University provides nurses with the opportunities to develop high level critical thinking and problem solving knowledge and skills.

Section snippets

Background

In Australia, there has been a 40% increase in coronary angiography procedures from 78,981 in 2000–01 to 110,614 in 2007.¹ Over this same time period, percutaneous coronary interventions have also risen to 34,972 per annum, an increase of 57%, with a corresponding decrease of 19% in coronary bypass grafting procedures from 16,696 to 13,612.¹ These data demonstrate the paradigm shift towards minimally invasive interventions as the preferred strategy for the treatment of acute coronary syndromes.

Development process of the interventional cardiac nursing (ICN) stream

The aim of the university degree program described in this paper is to improve patient outcomes by educationally preparing nurses to provide evidence-based nursing practice and clinical leadership in CCLs. This high level preparation will advance the discipline of nursing, the specialisation of interventional cardiac nursing and nurses’ own careers. The interventional cardiac nursing (ICN) program at Deakin University was created in 2013 within the existing Master of Nursing Practice (Cardiac

Governance of postgraduate programs

As the interventional cardiac nursing program was designed within the existing suite of critical care programs (Intensive Care, Cardiac Care, Emergency Care, Critical Care, Perioperative), it had to meet requirements of the Australian Qualifications Framework (AQF) that governs postgraduate programs in Australia.¹⁴ A postgraduate program in interventional cardiac nursing must meet AQF level 8 criteria whereby graduates will have advanced knowledge (theoretical and technical) and skills

Health educational frameworks

Consistent with the critical care suite of postgraduate programs, the interventional cardiac curricula was underpinned by health education frameworks of the World Health Organisation (WHO) Patient Safety Curriculum,¹⁶ the World Federation of Critical Care Nurses (WFCCN) Education Position Statement¹⁷ and the Australian College of Critical Care Nurses (ACCCN) Position Statement (2006) on the Provision of Critical Care Nursing Education.¹⁸ All aspects of the WHO Patient Safety Curriculum¹⁶ were

Teaching and learning frameworks

Teaching and learning in the program are guided by philosophies that encourage learner accountability and student engagement. The principles of adult learning²⁰ and the social construction of learning²¹ are the key learning philosophies of the course. In addition constructive alignment with clearly articulated intended learning outcomes,22, 23 backwards design,²⁴ Team-Based Learning25, 26 and the Epistemology of Testimony²⁷ underpin curricula of the interventional cardiac program. This

Professional frameworks – theoretical and clinical content

Theoretically and clinically, the curriculum is informed by clinical research, national and state health policies and standards28, 29 and professional competencies.³⁰ Consistent with University level study, the evidence base for nursing and collaborative care is taught and assessed. Students are expected to possess skills in sourcing, appraising and implementing research relevant to their practice domain. For health aspects of the program, the Australian Commission on Safety and Quality in

Collaborative program delivery with partner hospitals

Consistent with all postgraduate critical care programs at Deakin University, interventional cardiac students were concurrently employed a minimum of 24 h per week in their specialty area. This collaborative model whereby students have University and partner hospital educators delivering and assessing theoretical and clinical content respectively ensures high educational and clinical standards are met. The first cohort of students completed the program in 2013. The involvement of key

Conclusions

Interventional cardiology is the dominant therapeutic approach for managing acute coronary syndrome backed by overwhelming evidence of its effectiveness on patient outcomes. Nursing plays a key role in the care of patients undergoing interventional cardiac procedures; yet, to date, little has existed in the way of postgraduate educational opportunities. The postgraduate program described in this paper was designed and delivered to meet that need and is based on educational, professional,

Authors’ contributions

All authors contributed to the conceptualisation of the course described in this paper and writing of the paper.

Conflicts of interest

None.

Funding

None.

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What nurses involved in a Medical Emergency Teams consider the most vital areas of knowledge and skill when delivering care to the deteriorating ward patient. A nurse-oriented curriculum development project
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Capacity planning for future MET nurses is problematic without such information, and consequently deteriorating patients may have unmet needs, negatively impacting on patient safety and quality care. Given the unique nature of the MET or RRT, a lack of structured, formal education and training may leave nurses without a formal means of obtaining advanced knowledge and skills needed to care for this increasingly complex patient group (Currey et al., 2015; Jones, 2014; Jones et al., 2015c). Historically, specialist areas of clinical nursing practice have developed their own educational curricula, practice standards and clinical competencies (Gill et al., 2015; Jones et al., 2015b).
Critical care nurses have been involved in Rapid Response Teams since their inception, particularly in medically led RRTs, known as Medical Emergency Teams. It is assumed that critical care skills are required to escalate care for the deteriorating ward patient. However, evidence to support critical care nurses' involvement in METs is anecdotal. Currently, little is known about the educational requirements for nurses involved in RRT or METs.
We aimed to identify and describe what nurses involved in a MET consider the most vital areas of knowledge and skill when delivering care to the deteriorating ward patient.
An exploratory descriptive design was used and data was collected at a session of the Australian and New Zealand Intensive Care Society Rapid Response Team (ANZICS-RRT) Conference held at The Gold Coast, Australia in July 2015. All conference delegates were eligible to take part. Conference delegates totalled 293; 194 nurses, 89 doctors and 10 allied health professionals.
Data collection took place in three phases, over a 90-minute period. First, demographic data were collected from all participants at the start of data collection. These data were collected using paper-based surveys. Second, extended response surveys; that is, paper-based surveys that asked open-ended questions to elicit free text responses, were used to collect participants' individual responses to the question: “What are the specific theoretical knowledge, skills and behavioural attributes required in a curricula to prepare nurses to be high functioning members of a MET?”
Demographic, educational and work characteristics were descriptively analysed using SPSS (version 22). Participants perceptions of what knowledge, skills and attributes are required for nurses to recognise and respond to clinical deterioration were thematically analysed.
Participants were predominantly female (88.3%, n = 91) with 54.4% (n = 56) holding a Bachelor of Nursing. Participants had a median of 20 years (IQR 16) experience as RNs, and a median of 14 years (IQR 13) experience in critical care. Participants formed part of METs frequently, with nearly half the cohort seeing clinically deteriorating patients more than once per day (37.9%, n = 33) or daily (10%, n = 9). Thematic analysis of survey responses revealed four main themes desired in Rapid Response Team Curricula: Clinical Deterioration Theory, Clinical Deterioration Skills, Rapid Response System Governance, and Professionalism and Teamwork.
We suggest that a curriculum that educates nurses on the specific requirements of assessing, managing and evaluating all aspects of clinical deterioration is now required.
Nurses’ perceptions of the impact of Team-Based Learning participation on learning style, team behaviours and clinical performance: An exploration of written reflections
2017, Nurse Education in Practice
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Over the last two decades, a core set of health professional competencies designed to encapsulate knowledge skill and behaviours in a safety and quality framework has emerged (Australian Council for Safety and Quality in Health Care, 2005; Frank et al., 2008; Institute for Healthcare Improvement, 1998; Institute of Medicine, 2003; World Health Organization (WHO) Core Team, 2011). These competencies are considered as important to curricula as they are to clinical practice (Currey et al., 2015c). In tertiary education institutions across Australia, Europe and the US, incorporating teaching and assessment practices that develop and assess generic attributes are considered essential (Barrie et al., 2012; Collins and Hewer, 2014; National Institute for Learning Outcomes Assessment, 2012).
Team-Based Learning (TBL) is a teaching strategy designed to promote problem solving, critical thinking and effective teamwork and communication skills; attributes essential for safe healthcare. The aim was to explore postgraduate student perceptions of the role of TBL in shaping learning style, team skills, and professional and clinical behaviours.
An exploratory descriptive approach was selected. Critical care students were invited to provide consent for the use for research purposes of written reflections submitted for course work requirements. Reflections of whether and how TBL influenced their learning style, teamwork skills and professional behaviours during classroom learning and clinical practice were analysed for content and themes.
Of 174 students, 159 participated. Analysis revealed three themes: Deep Learning, the adaptations students made to their learning that resulted in mastery of specialist knowledge; Confidence, in knowledge, problem solving and rationales for practice decisions; and Professional and Clinical Behaviours, including positive changes in their interactions with colleagues and patients described as patient advocacy, multidisciplinary communication skills and peer mentorship.
TBL facilitated a virtuous cycle of feedback encouraging deep learning that increased confidence. Increased confidence improved deep learning that, in turn, led to the development of professional and clinical behaviours characteristic of high quality practice.
Regarding “Development of a postgraduate interventional cardiac nursing curriculum” by Currey et al.
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Family presence during management of acute deterioration: Clinician attitudes, beliefs and perceptions of current practices
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Further, previous research findings have identified that completing postgraduate nursing education increases nurses’ self esteem [51], ability to undertake their role [52], confidence to include evidence-based-care into their practice [53], problem solving skills [54] and analytical decision making [55]. It may be hypothesised that these characteristics are enhanced during postgraduate education programs [56] thereby contributing to our finding that postgraduate prepared nurses had more positive attitudes towards family presence during management of the deteriorating patient. Clinicians with more years of experience (in either healthcare or emergency care) had more positive attitudes towards including family during episodes of patient deterioration.
The nature of acute clinical deterioration has changed over the last three decades with a decrease in in-hospital cardiac arrests and an increase in acute clinical deterioration. Despite this change, research related to family presence continues to focus on care during resuscitation rather than during acute deterioration.
To explore healthcare clinician attitudes, beliefs and perceptions of current practices surrounding family presence during episodes of acute deterioration in adult Emergency Department patients.
Clinicians (n = 156) from a single study site in Melbourne, Australia completed a 17-item survey.
Participants disagreed that family members would interrupt (59.0%) or interfere (61.5%) with patient care if present during episodes of patient deterioration. Most (77.6%) participants stated that they included family during episodes of patient deterioration. Females, nurses and Australians/New Zealanders had a more positive attitude towards including family during episodes of patient deterioration when compared to males, doctors and clinicians of other ethnicities. Nurses with post-graduate qualifications and those with more years of experience had a more positive attitude towards including family during episodes of patient deterioration than nurses without post-graduation qualification and with less years of experience.
Clinicians had predominantly positive attitudes towards including family during episodes of patient deterioration and perceived it to be a common day-to-day practice. Gender, profession, country of birth, education level and years of experience all impacted on clinician attitudes, beliefs and perceptions of family presence during acute deterioration.

¹: Tel.: +61 3 9594 2177; fax: +61 3 9594 6007.

²: Tel.: +61 3 5227 8432; fax: +61 3 5227 8432.

³: Tel.: +61 3 9244 6608; fax: +61 3 9244 6159.

⁴: Tel.: +61 3 9251 7212; fax: +61 3 9244 6159.

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DiscussionDevelopment of a postgraduate interventional cardiac nursing curriculum

Abstract

Section snippets

Background

Development process of the interventional cardiac nursing (ICN) stream

Governance of postgraduate programs

Health educational frameworks

Teaching and learning frameworks

Professional frameworks – theoretical and clinical content

Collaborative program delivery with partner hospitals

Conclusions

Authors’ contributions

Conflicts of interest

Funding

J Am Coll Cardiol

J Am Coll Cardiol

Aust Crit Care

Clin Radiol

Cardiovascular disease: Australian facts

Guideline 14.3. Acute coronary syndromes: reperfusion strategy

2011 Addendum to the National Heart Foundation of Australia/Cardiac Society of Australia and New Zealand Guidelines for the management of acute coronary syndromes (ACS) 2006

Heart Lung Circ

ESC guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation

Eur Heart J

A system of care for STEMI reducing time to reperfusion for patients with ST-segment elevation myocardial infarction

Prehospital 12-lead ECG to triage ST-elevation myocardial infarction and emergency department activation of the infarct team significantly improves door-to-balloon times: ambulance Victoria and MonashHEART Acute Myocardial Infarction (MonAMI) 12-lead ECG project

Circ Cardiovasc Interv