Advanced Practice Nurse Specialization in Adult Congenital Heart Disease
Chaudry, Rosemary Valedez
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Publisher:The Ohio State University
Series/Report no.:The Ohio State University. College of Nursing Doctor of Nursing Practice Final Document Projects
Background: The population of adults with congenital heart disease (ACHD) is one of the fastest growing segments of patients in cardiology. Although the incidence of congenital heart defects remains stable, the probability of survival of these infants to adulthood is now at least 90%. In 2005 the estimated number of ACHD exceeded the number of children with congenital heart disease for the first time in history. Approximately 400, 000 ACHD have moderate or complex disease that requires lifelong care by providers specialized in ACHD. The number of ACHD-specialist providers is relatively small and until recently no formal training programs existed for physicians; none exist now for advanced practice nurses (APNs). Purpose: The purpose of this narrative study was to describe the knowledge and skills identified by current APNs in a pediatric hospital as requisite to caring for ACHD. The findings from this study contribute to a foundation from which to develop a specialty training program for APNs to develop competence in caring for ACHD. Methods: A qualitative design with a focus group interview was used with the population of APNs in The Heart Center at Nationwide Children's Hospital in Columbus, Ohio. These APNs practice in the inpatient, critical care, procedural, and outpatient areas. They all have had to learn to manage ACHD without benefit of formal training in ACHD. The interview guide derives from the question: “What do you now know that you wish you had known when you began to take care of adults with CHD?” Data were analyzed using content analysis techniques to identify themes and patterns. Results: Participants identified knowledge of comorbidities, medications, and institutional resources as essential. Essential skills included active listening and critical thinking. Analysis of the participants’ discussion of their experiences caring for ACHD in a children’s hospital revealed three themes: complexity, multidisciplinary team, and divergent needs. Conclusions: Findings from this project suggest that an educational program for APN specialization in ACHD should facilitate strong interpersonal skills and critical thinking. Knowledge should be broad-based to include both physical and psychosocial domains. The program should foster interdisciplinary collaboration.
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