Heart disease has increased around the globe, but with this increase have come new diagnostic tools, treatment options and medications.

Transcription

1 Cardiovascular nursing has become a specialty in the past 50 years as a result of a focus on treating heart attack and other heart disorders rather than assuming heart attacks are usually fatal. Medical studies in the 1940s and 1950s of people being brought back from heart attack led to new initiatives in the study and treatment of cardiovascular disease. 1

2 Heart disease has increased around the globe, but with this increase have come new diagnostic tools, treatment options and medications. Cardiovascular nursing continues to grow as more understanding is gained of heart disease and how to prolong life. The first coronary care unit was founded at the Royal Infirmary in Edinburgh, Scotland, by Dr. Desmond G. Julian to attempt to deal with heart attack, sudden cardiac arrest and heart arrhythmias. He recommended all staff, including nurses, be trained in cardiopulmonary resuscitation (CPR) in order to treat patients with suspected heart attack as rapidly as possible. 2

3 He later emigrated to Australia, founded a similar unit in Sydney and began a similar training regimen for staff. HISTORY OF CARDIAC MONITORING (1962) All wards admitting patients with AMI should have a system capable of sounding an alarm at the onset of an important rhythm change and recording the rhythm automatically on an ECG the provision of the appropriate apparatus would not be prohibitively expensive if these patients were admitted to special intensive care units. Such units should be staffed by suitably experience people throughout the 24 hours. 3

4 Later that year the 1 st CCU in the US opened in Kansas City by Dr. Hugh Day. Early monitoring focused on observing heart rates and monitoring for life threatening arrhythmias. Monitoring equipment has changed greatly over the past 40 years. Other cardiac care units were founded shortly thereafter, in Philadelphia, New York and Miami, driving the need for skilled cardiac nurses interested in the treatment and also, increasingly, the prevention of cardiovascular disease : Birth of the coronary care unit, and active rather than passive treatment of acute myocardial infarction (heart attack) Cornell s Coronary Care Unit circa 1965, with Dr. Thomas Killip right, and nurse at left The first coronary care unit ("CCU") was described in the medical literature in the early 1960s, but this simple innovation concentrating patients with acute myocardial infarction, a potentially lethal disease, in one location with specially trained personnel and instant availability of emergency equipment for defibrillation was spread throughout the United States and the world as much by work done here at New York- Presbyterian Hospital/Weill Cornell Medical Center as anywhere else. Drs. John Kimball, first director of the CCU and Thomas Killip, then Chief of Cardiology, opened one of the earliest units in the US, initially 4 beds with monitors and defibrillators at every bedside. 4

5 The Medical Board was persuaded to allow nurses to read ECGs, diagnose life-threatening arrhythmias, and administer emergency medications as well as defibrillation a revolutionary step at the time. Kimball and Killip published in 1967 what was probably the single most influential journal article describing a major improvement in survival in CCUs, and within a few years every hospital in the country had such a unit. Cornell cardiologists trained CCU nurses all over the country in those early years. A description of how sick the patient was, and the likely mortality rate, has survived to this day as the "Killip classification", and Cornell was one of several centers around the country, the "Myocardial Infarction Research Units" ("MIRU") who collectively and competitively pioneered aggressive treatment of acute MI. Before the MIRUs, patients with acute MI were put to bed for 3 weeks or more, were sedated, not allowed to move (to the point where nurses would feed and wash patients), and certainly were never subjected to invasive procedures, nothing beyond a simple Intravenous line. 5

6 Cornell was one of the first centers to put small catheters into the heart itself within 24 hours of an MI, and the MIRU experience led eventually to earlier ambulation, early cardiac catheterization and angioplasty, anti-thrombotic therapy, and a host of modern treatments for acute MI : Birth of the coronary care unit, and active rather than passive treatment of acute myocardial infarction (heart attack) Cornell s Coronary Care Unit circa 1965, with Dr. Thomas Killip right, and nurse at left The first coronary care unit ("CCU") was described in the medical literature in the early 1960s, but this simple innovation concentrating patients with acute myocardial infarction, a potentially lethal disease, in one location with specially trained personnel and instant availability of emergency equipment for defibrillation was spread throughout the United States and the world as much by work done here at NewYork- Presbyterian Hospital/Weill Cornell Medical Center as anywhere else. Drs. John Kimball, first director of the CCU and Thomas Killip, then Chief of Cardiology, opened one of the earliest units in the US, initially 4 beds with monitors and defibrillators at every bedside (Figure 3). The Medical Board was persuaded to allow nurses to read ECGs, diagnose lifethreatening arrhythmias, and administer emergency medications as well as defibrillation a revolutionary step at the time. Kimball and Killip published in 1967 what was probably the single most influential journal article describing a major improvement in survival in CCUs, and within a few years every hospital in the country had such a unit. Cornell cardiologists trained CCU nurses all over the country in those early years. A description of how sick the patient was, and the likely mortality rate, has survived to this day as the "Killip classification", and Cornell was one of several centers around the country, the "Myocardial Infarction Research Units" ("MIRU") who collectively and competitively pioneered aggressive treatment of acute MI. Before the MIRUs, patients with acute MI were put to bed for 3 weeks or more, were sedated, not allowed to move (to the point where nurses would feed and wash patients), and certainly were never subjected to invasive procedures, nothing beyond a simple Intravenous line. Cornell was one of the first centers to put small catheters into the heart itself within 24 hours of an MI, and the MIRU experience led eventually to earlier ambulation, early cardiac catheterization and angioplasty, anti-thrombotic therapy, and a host of modern treatments for acute MI. 6

7 A survey in the journal Circulation in 1978 indicated coronary care units had reduced mortality from heart attack and sudden cardiac arrest by up to 20 percent in the previous decade. As a result, cardiac care units and departments continued to be added to larger hospitals, driving the need for more trained cardiac nurses skilled in CPR, cardiac monitoring and the administration of cardiac medicines. The Society for Peripheral Vascular Nursing (SPVN), founded in Boston in 1982 and renamed the Society for Vascular Nursing (SVN) in 1990, helped highlight cardiovascular nursing as an established nursing specialty. 7

8 The Society for Vascular Nursing (SVN) is a professional organization for vascular nurses for excellence in clinical practice, education, research and professional networking. The SVN aim to offer its members with opportunities and learning to ensure they have the basis to provide optimal care for patients with vascular disease. The American Association of Cardiovascular and Pulmonary Rehabilitation was founded in 1985 with the specific mission of reducing death or disability from cardiovascular and pulmonary disease through education, prevention and treatment, with particular emphasis on rehabilitation and disease management. The association provides education and training for cardiac nurses and other heart care professionals, as well as certification for cardiac rehabilitation facilities. 8

9 The Preventive Cardiovascular Nurses Association (PCNA) was founded in the United States as the Lipid Nurse Task Force (LNTF) in 1992 by a small group of nurses in California who were concerned about the lack of educational opportunities for nursing professionals specializing in cholesterol monitoring and the study of other lipid disorders. As membership expanded, the organization began to encompass evidence-based study of a wider array of cardiovascular disorders and pass this information along to its members. The American Nurses Credentialing Center (ANCC) is the world's largest nurse credentialing organization, and a subsidiary of the American Nurses Association (ANA). 9

10 The first Cardiac and Vascular Nurse examinations were administered by the PCNA in May 2001 in conjunction with the ANCC. The PCNA continues to offer the certification exams as well as continuing education courses online and live seminars and training events. In addition to the ANCC Cardiac/Vascular Nurse Certification, the PCNA supports the Accreditation Council for Clinical Lipidology (ACCL) certification examination. 10

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