Almost two-and-a-half million Canadians live with heart disease, a statistic that should make people pay more attention to their health. February is Heart Month and nurse practitioner Nancy Clark, MN/NP’03, a registered nurse for 25 years and current clinical nurse practitioner (NP) lead for the coronary care unit (CCU) NPs at Calgary’s Rockyview General Hospital, has this piece of advice for everyone:
You know your body better than anyone, and for that reason do not hesitate to call 911 or present to your local emergency department to have your symptoms assessed. Please let us, the health-care team, determine if your symptoms are cardiac in nature, rather than waiting for time to pass in the hope that your (chest/back/arm/jaw) discomfort — which can feel like heaviness, pressure, squeezing, burning or pain, shortness of breath, sweating sensation or nausea/vomiting — will go away on its own. The delay of hospital presentation or activation of 911 can increase the risk of heart damage due to coronary artery disease.
Clark, now also a PhD student at UCalgary Nursing, knows what she is talking about when it comes to cardiovascular health. She moved into ER nursing after her immediate undergraduate degrees (a BA in psychology in 1993 and her BScN in 1997) at St. Francis Xavier University and began to develop her clinical expertise, as well as a deeper foundation, in emergency medicine. It was during these beginning years of clinical practice, she says, that her interest in medical cardiology and acute cardiac patients, especially the presentation of coronary syndrome, was sparked.
“I was encouraged to apply and relocate Calgary where I was recruited to work at the Foothills Medical Center in the Cardiac Intensive Care Unit,” she explains. “It was during this opportunity that I expanded my nursing career — grounded in advanced clinical practice, independent assessment and counsel to patients and their families — regarding modifiable risk factors related to heart disease. I also wanted to share and support other nurses and health-care team members in care and management of individuals living with heart disease.”
In 2001, Clark was one of the five students admitted to the new integrated Master of Nursing/NP program at UCalgary Nursing in the acute care stream of medical cardiology/neurosurgery subspecialties.
“My research interest was in the stories of patients who lived outside of the Calgary zone and were relocated to Calgary for the expert cardiology care and diagnostic/interventional management that higher acuity centers can provide,” she says now. She adds that since graduating as an acute care NP in 2003, she has been privileged to assess, diagnose, prescribe and treat hundreds of individuals living with heart disease.
Her advanced practice role at the Rockyview General Hospital within the Libin Cardiovascular Institute of Medical Cardiology involves both clinical and administrative responsibilities. This unique CCU is the first 24/7 NP-led collaborative practice with physician partners as well as an extended team of nurses, clinical pharmacists and allied health-care providers and has provided fertile ground for Clark’s curiosity.
“The clinical ‘rub’ that awoke in me the desire to pursue a PhD involved the wonder of what is it like to be diagnosed with a recurrent cardiac event as a younger individual,” says Clark. “I wanted to better understand, to learn from, the experiences of younger men (age less than 55 years) who are diagnosed with a second coronary syndrome, a medical diagnosis related to potential blood flow limiting coronary artery disease that can result in unstable angina or myocardial infarction.”
Her clinical experience as well as the current literature identifies a gap after discharge for younger men with this syndrome. She hopes her research outcomes will indicate the need for a discharge recognition different from what currently exists.
“It is in this recognition of difference that I hope to be able to suggest appropriate supports with appropriate health-care providers at local, provincial and national levels.”
Clark says Heart Month, in addition to bringing awareness to cardiac health for the public, can serve to encourage young nurses to enter the field. “As cardiovascular RNs and NPs, we have the privilege to be present for cardiac patients at one of the most vulnerable times in their lives,” she says.
“The reality of life and death exists in this population and whether our role is in resuscitation or supporting the palliative care related to death and dying, moments arise where you too may be awoken to the idea of are we doing enough? Is there a gap in our patients’ experience? Have we, as cardiovascular nurses and NPs, asked that question?
“Advancements in pharmacological, interventional, as well as lifestyle modification, have generated much research that is commonly implemented into our practice settings, but I know that there is more left for the inquiring mind to explore.”