Australia has a land mass similar to the United States of America, supporting

a population of just over 20 million, which is distributed predominantly

across the coastal perimeter. The Australian society is rich in cultural diversity fostered by decades of migration. Both these factors present challenges for health care. First, because resources are scare in rural and remote regions, health outcomes are poorer in these regions, especially among indigenous populations. Second, the cultural diversity of Australians is a challenge to providing evidence-based treatment recommendations. In Australia, in parallel with international trends, there is a strong association between

socioeconomic status, chronic conditions, and health outcomes

Clark, Robyn

Davidson, Patricia

Driscoll, Andrea

Newton, Phillip

Stewart, Simon

English

Davidson, Patricia M.

Deakin Research Online

Heart failure nursing in Australia : challenges, strengths, and opportunities

Driscoll, A.

Clark, R.

Stewart, S.

espace@Curtin

Heart Failure Nursing in Australia: Challenges, Strengths, and Opportunities

Davidson, PM

Driscoll, A

Clark, R

Newton, PJ

Stewart, S

OPUS - University of Technology Sydney

Progress in Cardiovascular Nursing

Heart failure nursing in Australia: Challenges, strengths, and opportunities

Davidson, Patricia M. (R9465)

Newton, Phillip J. (R11465)

Western Sydney ResearchDirect

Davidson, Patricia.

Driscoll, Andrea.

Clark, Robyn.

Newton, Phillip.

Stewart, Simon.

Name not available

Newton, Phillip J.

ACU Research Bank

Queensland University of Technology ePrints Archive

This is the author’s version of a work that was submitted/accepted for pub-lication in the following source:Davidson, Patricia., Driscoll, Andrea., Clark, Robyn., Newton, Phillip., &Stewart, Simon. (2008) Heart Failure Nursing in Australia: Challenges,Strengths, and Opportunities. Progress in Cardiovascular Nursing, 23(4),pp. 195-197.This file was downloaded from: http://eprints.qut.edu.au/43028/c© Copyright 2008 Le Jacq CommunicationsNotice: Changes introduced as a result of publishing processes such ascopy-editing and formatting may not be reflected in this document. For adefinitive version of this work, please refer to the published source:http://dx.doi.org/10.1111/j.1751-7117.2008.00017.xUpdate on Heart Fai lure ManagementLt Col Marla De Jong, USAF, NC; Lynn Doering, RN, DNSC, Sect ion EditorsHeart Failure Nursing in Australia: Challenges,Strengths, and OpportunitiesPatricia M. Davidson, RN, BA, Med, PhD;1 Andrea Driscoll, RN, Crit Care Cert, BN, MN, MEd, PhD;2Robyn Clark, RN, RM, ICU Cert, BN, Med, PhD, FRCNA;3 Phillip J Newton, BN (Hons) PhD;1Simon Stewart, PhD, FCSANZ, NFESC, FAHA4AUSTRALIAAustralia has a land mass similar to theUnited States of America, supportinga population of just over 20 million,which is distributed predominantlyacross the coastal perimeter. The Aus-tralian society is rich in cultural diver-sity fostered by decades of migration.Both these factors present challengesfor health care. First, because resourcesare scare in rural and remote regions,health outcomes are poorer in theseregions, especially among indigenouspopulations. Second, the culturaldiversity of Australians is a challengeto providing evidence-based treatmentrecommendations.1 In Australia, inparallel with international trends,there is a strong association betweensocioeconomic status, chronic condi-tions, and health outcomes.2THE AUSTRALIAN HEALTHCARE SYSTEMAustralia supports a system of universalhealth care coverage. The Australianhealth care system has 3 levels of gov-ernment—Federal, State, and Local.Australian nursing has an exclusivebaccalaureate entry level, althoughrecent workforce shortages andbudgetary concerns have threatened thisstatus.3,4 Overall, acute hospital servicesand outreach community-based services,such as HF programs, are predomi-nantly administered by the Stategovernment system. Community-basedservices, such as general practice (GP),are funded by the Federal government.Nurses are predominantly funded bygovernment systems, except in privatepractice settings. However, nurses work-ing in private, specialist cardiologypractices are in a minority.MODELS OF HEART FAILURE(HF) CARE IN AUSTRALIAImplementation of nurse-directed inter-vention HF models is variable and thereis significant heterogeneity in HFmanagement programs across Australia.5Often HF care models are determinedby available resources and stakeholderissues or preferences rather than avail-able evidence. The nurse practitioner(NP) role is still in its infancy inAustralia, compared with other devel-oped countries.6 Development of theNP role has been impeded by objectionsfrom medical colleagues and regulatoryissues.7 Driscoll et al.8 undertook a na-tional survey of 56 programs managingHF patients after hospital discharge.Only 22% of potentially eligible pa-tients were represented in these pro-grams and only 8% of these programswere located within rural regions. Hy-brid programs were common, with 75%of the programs providing HF outpa-tient clinics and 77% conducting homevisits. States with an enablingpolicy context for nurse-coordinatedmodels of HF management demon-strated an increased access to services.9Home-Based HF ProgramsSome of the seminal work in HFmanagement internationally has beenundertaken by Stewart et al.10,11 Ahome-based, nurse-led model developedin Australia has shown favorable short-term and long-term outcomes.12,13These programs incorporate self-man-agement principles and a treatment plannegotiated with patients, caregivers, andfamily members. Home-based programsfacilitate integrating evidence-basedpractice principles in the hospital andcommunity and encourage coordinationand communication with specialtycardiology providers.From the Centre for Cardiovascular and Chronic Care, School of Nursing andMidwifery, Curtin University of Technology, Sydney, NSW, Australia;1 Departmentof Epidemiology and Preventive Medicine, Monash University, Melbourne, Vic.,Australia;2 School of Health Sciences Centre for Research into Sustainable HealthCare City East Campus, University of South Australia, Adelaide, SA;3 andPreventive Cardiology, Baker Heart Research Institute, Melbourne, Vic., Australia4Address for correspondence:Patricia M. Davidson, RN, BA, Med, PhD, Centre for Cardiovascular and ChronicCare, School of Nursing and Midwifery, Curtin University of Technology, CurtinHouse 39 Regent St Chippendale 2008, New South Wales, Australia.E-mail: p.davidson@curtin.edu.auFall 2008 Progress in Cardiovascular Nursing 195GP ModelsWithin the Australian health caresystems, the general practitioner isthe gatekeeper to care. Over 90% ofAustralians visit a GP each year.14Despite the frequency of HF in GP,there is a well-documented treatmentgap attributable to lack of: resources,particularly access to echocardiogra-phy; knowledge of pharmacologicalHF management; and communicationbetween the tertiary and primary sec-tors.15,16 The role of the Australianpractice nurse in HF care is gaining in-creased attention from new workforceincentives and from the need for nursesto provide chronic disease manage-ment.17 Recently, the numbers of GPsemploying a nurse has increased from40% to 60%.18 The role of the practicenurse in providing integrated HF man-agement should be an important focusfor future development and evaluationof liaison and consultancy models.19Cardiac Rehabilitation (CR)In Australia, multidisciplinary CRprograms are predominantly coordi-nated by nurses and provided free ofcharge.20 These programs provide in-hospital education sessions, supervisedambulatory, and maintenance phases,consisting of group education as wellas individualized exercise prescription.In many centers, the CR model hasbeen tailored for individuals with HF.Often programs are increased to 12weeks, involve systematic disease man-agement, and include exercise pro-grams, known to be safe in stable HFpatients.21 Low participation rates inCR are potentially exaggerated amongHF patients, who are more likely to beolder and to have comorbidities.22In nonmetropolitan regions, genericchronic disease programs (ie, forchronic obstructive pulmonary dis-ease, diabetes, and other chronicconditions) are often in place andaccessed by individuals with HF.23Although this is not ideal, augmentingthese programs with expert consult-ancy and outreach services is consid-ered potentially cost-effective.Telephone MonitoringTelephone monitoring is an importantaspect of Australian HF management.Models vary from use of a centralizednumber for patient use to planned rou-tine calls from a health care worker.24Clarke et al.25 have shown that elderlyHF patients can adapt quickly and findtelephone monitoring an acceptable partof their health care regimen. Currently,more complex technologically basedmonitoring programs remain confinedto the research setting in Australia.Integrated Palliative Care ModelsA key advantage of the Australian healthcare system is that HF patients can becomanaged by both cardiology and pal-liative care teams.26 As a consequence,patients do not have to choose betweenhospice and cardiology care. As the im-portance of palliative and supportive carein HF management increases, manyprograms have developed collaborativerelationships.27Residential Aged CareMany HF nurses provide outreach andconsultancy to residential aged care fa-cilities. Often individuals with HF areadmitted to the hospital because the res-idential facility is no longer able to meettheir care needs or because there has notbeen effective advance care planning. InAustralia, a palliative approach withinresidential aged care facilities is requiredto care for residents whose condition isnot amenable to cure.28RECOMMENDATIONS FORFOSTERING HF NURSING INAUSTRALIADeveloping strategies for HF nursingin Australia requires systematic plan-ning in undergraduate and postgradu-ate education and in professionaldevelopment. Currently, there is nomethod of certification or credentialingof nurses working in HF. There is aneed to formalize roles and competen-cies for HF management. Clarificationof the unique contribution of the HFnurse, and of potentially shared roleswithin the multidisciplinary team, isneeded to ensure that nurses are ade-quately prepared and equipped to per-form these roles. The valuablecontribution of nursing skills to HFmanagement needs to be validated andacknowledged within policy recom-mendations and funding strategies.CONCLUSIONSRefining and scoping the specializa-tion of HF nursing is crucial inpreparing a workforce that is able tobe responsive of the future needs ofpeople with HF. Achieving consensusof outcome measures, credentialing ofHF specialist nurses, promoting inde-pendent nursing practice, and devel-oping consultancy models in aged careand GP are important issues for thefuture.29 Variability of specialist HFservice availability and accessibility—particularly in rural and remote re-gions—is of concern, particularlywithin the context of universal cover-age. Integrating outreach programsand the use of information technol-ogy, supported by the assessment,diagnostic, and therapeutic strategiesof the HF nurse, are likely to be thekey to ensuring the delivery ofoptimal evidence-based HF care toall Australians.REFERENCES1 Davidson P, McDonald P, Moser D, et al. Culturaldiversity in heart failure management: findingsfrom the DISCOVER Study (Part 2). ContemNurse. 2007;25(1):50–61.2 Australian Institute of Health and Welfare. Indicatorsfor chronic diseases and their determinants, Canberra,2008. Report No.: AIHW Cat. No. PHE 75.3 Jackson D, Daly J. Nursing and pre-registrationnursing education under the spotlight again. Col-legian. 2008;15(1):1–3.4 Gardner G, Carryer J, Gardner A, et al. Nursepractitioner competency standards: findings fromcollaborative Australian and New Zealand research.Int J Nurs Stud. 2006;43(5):601–610.5 Driscoll A, Worrall-Carter L, McLennan S, et al.Heterogeneity of heart failure management programsin Australia. Eur J Cardiovasc Nurs. 2006;5:75–82.6 Driscoll A, Worrall-Carter L, O’Reilly J, et al. Ahistorical review of the nurse practitioner role inAustralia. Clin Excellence Nurse Pract.2005;9(3):141–152.Progress in Cardiovascular Nursing Fall 20081967 Appel LG, Malcolm P. The triumph and continu-ing struggle of nurse practitioners in New SouthWales, Australia. Clin Nurse Spec. 2002;16(4):203–210.8 Driscoll A, Worrall-Carter L, Hare D, et al. Areheart failure programs targeting appropriatepatients? Heart Lung Circ. 2006;15(suppl 1):S300.9 NSW Health. NSW Chronic Care Program 2000–2003: Strengthening capacity for chronic care inthe NSW health system. Report on Phase one,NSW Health, Sydney, 2004.10 Stewart S, Murphy NF, McMurray JJ, et al. Effectof socioeconomic deprivation on the populationrisk of incident heart failure hospitalisation: ananalysis of the Renfrew/Paisley Study. Eur J HeartFail. 2006;8(8):856–863.11 Stewart S, MacIntyre K, Capewell S, et al. Heartfailure and the aging population: an increasingburden in the 21st century? Heart. 2003;89(1):49–53.12 Stewart S, Marley JE, Horowitz JD. Effects of amultidisciplinary, home-based intervention onplanned readmissions and survival among patientswith chronic congestive heart failure: a randomisedcontrolled study. Lancet. 1999;354(9184):1077–1083.13 Inglis SC, Pearson S, Treen S, et al. Extendingthe horizon in chronic heart failure: effects ofmultidisciplinary, home-based intervention relativeto usual care. Circulation. 2006;114(23):2466–2473.14 Commonwealth Department of Health and FamilyServices. General Practice in Australia: 2000. Canb-erra: Australian Government Printing Service; 2000.15 Krum H, Tonkin AM, Currie R, et al. Frequency,awareness and pharmacological management ofchronic heart failure in Australian general practice.The cardiac awareness survey and evaluation(CASE) Study. Med J Aust. 2001;174(9):439–444.16 Phillips SM, Marton RL, Tofler G. Barriers to di-agnosing and managing heart failure in primarycare. Med J Aust. 2004;181(2):78–81.17 Jolly R.Practice Nursing in Australia. Research Pa-per No. 10, 2007–08, Social policy section, Par-liamentary Library, Parliament of Australia,Canberra, Australia 2007.18 Australian Practice Nurses Association, Melbourne,Victoria. Available from http://www.apna.asn.au/displaycommon.cfm?an=2. Accessed March 14,2008.19 Halcomb E, Davidson P, Daly J, et al. The role ofpractice nurses in chronic heart failure: a review of theliterature. Eur J Cardiovasc Nurs. 2004;3:135–147.20 Recommended framework for cardiac rehabilita-tion 2004. 2006. Available from: http://www.heartfoundation.com.au/downloads/CR_04_Rec_Final.pdf. Accessed March 17, 2006.21 Smart N, Marwick TH. Exercise training for pa-tients with heart failure: a systematic review offactors that improve mortality and morbidity. Am JMed. 2004;116:693–706.22 Daly J, Sindone A, Thompson D, et al. Barriers inparticipation and adherence to cardiac rehabilita-tion programs: a critical literature review. ProgCardiovasc Nurs. 2001;17(4):8–17.23 NSW Department of Health. NSW Chronic CareProgram: Rehabilitation for Chronic Disease, Vol. 1.Sydney: NSW Department of Health; 2006.24 Clark RA, Inglis SC, McAlister FA, et al. Tele-monitoring or structured telephone support pro-grammes for patients with chronic heart failure:systematic review and meta-analysis. BMJ.2007;334(7600):942–950.25 Clark RA, Yallop JJ, Piterman L, et al. Adherence,adaptation and acceptance of elderly chronic heartfailure patients to receiving healthcare via telephone-monitoring. Eur J Heart Fail. 2007;9(11):1104–1111.26 Davidson P, Paull G, Cockburn J, et al. Integrated,collaborative palliative care in heart failure: the StGeorge heart failure service experience 1999–2002.J Cardiovasc Nurs. 2004;19(1):68–75.27 Krum H, Jelinek M, Stewart S, et al. CHF guide-lines core writers. Guidelines for the prevention,detection and management of people with chronicheart failure in Australia. Med J Aust. 2006;185(10):549–557.28 Australian Government Department of Health andAgeing. Guidelines for a Palliative Approach in Res-idential Aged Care. Report No.: 3467. Canberra:Australian Government Department of Health andAgeing; 2004.29 Halcomb E, Davidson P, Yallop J, et al. Strategicdirections for developing the Australian generalpractice nurse role in cardiovascular disease man-agement. Contemp Nurse. 2007;26(1):125–136.Fall 2008 Progress in Cardiovascular Nursing 197

Heart failure nursing in Australia: Challenges, strengths, and opportunities

Abstract

Similar works

Full text

Available Versions