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Reflecting on the Impact of Cardiovascular Nurses in Australia and New Zealand in the International Year of the Nurse and Midwife

Caleb ferguson.

a Western Sydney Nursing & Midwifery Research Centre, Western Sydney Local Health District & Western Sydney University, Blacktown Hospital, Sydney, NSW, Australia

Sally C. Inglis

b IMPACCT and School of Nursing & Midwifery, Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia

Robyn Gallagher

c Charles Perkins Centre & Sydney Nursing School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia

Patricia M. Davidson

d School of Nursing, Johns Hopkins University, Baltimore, MA, USA

“Nursing is the glue that holds everything together” Patricia M. Davidson [ 1 ]

To say 2020 has been difficult and challenging is an understatement. Signalled the International Year of the Nurse and Midwife, in the bicentenary of Florence Nightingale’s birth, we thought there would be celebrations, filled with joy and time for reflection. 2020 has diverged far from this plan. Across the world, individuals, families, and communities have been devastated. Moreover, it is evident that our work as nurses is becoming more challenging during these unprecedented and uncertain times. COVID-19 has not only created illness and suffering but propelled the world into a serious global economic recession and laid bare cracks in society with many traditionally underserved and vulnerable people suffering more.

During the COVID-19 pandemic, cardiovascular nurses have demonstrated strong, cohesive leadership through the writing of the Cardiac Society of Australia and New Zealand (CSANZ) COVID-19 Cardiovascular Nursing Care Consensus Statement (published in this journal), as well as working on the frontlines in our hospitals and communities [ 2 ]. The joint consensus statement was prepared by an expert writing group comprised of members of the CSANZ Cardiovascular Nursing Council and the CSANZ Interventional Nurses Council [ 3 ]. The statement is aimed to support cardiovascular nurses to reduce the risk of virus transmission whilst delivering care by adapting to novel models of care, and to educate and inform nurses of the cardiovascular implications of COVID-19. The rapid development of this Statement was impressive, and demonstrates the high levels of leadership, commitment, cohesion, collaboration, and engagement of these nurses. Expert cardiovascular nursing input was also sought for the CSANZ Statements on rural and remote cardiology [ 4 ], and the provision of secondary prevention and cardiovascular rehabilitation during the pandemic [ 5 ].

The Breadth of Cardiovascular Nursing

Nurses comprise the single largest discipline cohort of registered health care professionals, and we often stand at the forefront of health care delivery. We are a highly skilled and educated workforce who provide care across the lifespan, across diverse care settings—caring for newborns to supercentenarians. Perhaps never before in history has the role of nurses, nor the value or outstanding contributions of nurses in health care been so public and prominent across the globe. It is therefore timely that 2020 is recognised by the World Health Organization as the International Year of the Nurse and Midwife: the pandemic has not only demonstrated the value of nursing but the power of multidisciplinary teams that include nurses—health professionals working together to improve the lives of individuals, families and communities.

The Influence of Cardiovascular Nurses

Cardiovascular nurses have an outstanding record of accomplishment in leading and delivering world-class clinical, public health, and other health services as well as epidemiological research that is impactful. Nurse clinicians and scientists in the Australian and New Zealand region “punch above their weight” in science, innovation, and clinical care. Nursing is consistently ranked as ‘ well above world standard’ across several universities, and many Australian universities have featured near the top of global University rankings for the nursing discipline.

Cardiovascular nursing leadership is strikingly evident in CSANZ. At time of writing, there are 373 (234, Australia; 139, New Zealand) registered cardiovascular nurse members of CSANZ. Of these, professorial appointments across universities and research institutes in Australia and New Zealand are common with, 13 members holding professorial titles, and a further 21 having completed PhDs, including six elected fellows of the CSANZ. Several nurse members hold multiple fellowships including of the American Heart Association (FAHA) and the European Society of Cardiology (FESC), reinforcing their international reputation in cardiovascular care.

Amongst our current cardiovascular nursing research leaders are National Heart and Medical Research Council (NHMRC) Investigator Fellows, Heart Foundation Future Leader Fellows and alumni, and chief investigators on numerous NHMRC, Medical Research Future Fund (MRFF) and Heart Foundation grants, amongst many other national and international competitive funding sources, driving evidence-based health care policy, clinical care and implementation science. Strong records of accomplishment in competitive research funding attests to the impact and track records of cardiovascular nurse research leaders, especially against the highly and increasingly competitive research funding landscape [ 6 ].

Contributing to Cardiovascular Research

Our cardiovascular nurses have made plentiful and notable contributions to science and to model-of-care innovation, with worldwide research and impact. Research led by CSANZ cardiovascular nursing members has been published in prominent medical and cardiovascular journals internationally, including the New England Journal of Medicine, The Lancet, The British Medical Journal (The BMJ), Cochrane Database of Systematic Reviews, Circulation, Journal of the American College of Cardiology, and the European Journal of Heart Failure, and in leading nursing journals, such as the International Journal of Nursing Studies and the European Journal of Cardiovascular Nursing.

Internationally recognised research includes nurse-coordinated approaches to care delivery. This is exemplified by nurse-led interventions for weight loss in overweight and obese people with heart disease or nurse-delivered acute care interventions to reduce death and disability in stroke [ 7 , 8 ]. Further, nurses have helped answer questions on the most effective method to deliver care or the best strategy to educate our patients about their heart failure or atrial fibrillation [ [9] , [10] , [11] ]. Nurses have also pioneered important studies to characterise cardiovascular diseases and examine their treatment patterns, including research to understand hospitalisation trends [ 12 ], or benchmarking the quality of heart failure or atrial fibrillation management or cardiac rehabilitation [ [13] , [14] , [15] ].

Research that generates new robust, high-level evidence that informs guideline recommendations has also proven valuable. Important clinical questions have been answered through the development of pivotal Cochrane reviews to support the use of telehealth for heart failure or to evaluate new digital methods of heart failure education [ 16 , 17 ].

Nurse investigator-initiated research has been fundamental in: understanding issues of adherence; uptake of services, such as cardiac rehabilitation; translation of new evidence into practice; and, optimisation of therapies in practice. Examples include exploring barriers and enablers relating to the uptake of digital technologies or adherence and persistence to medications [ 18 , 19 ]. Advances have been made in the quest to understand and decrease inequity, especially in terms of access to evidence-based cardiovascular care [ 20 ]. Contributions include examining cardiovascular disease in women [ 21 , 22 ], in rural and remote populations [ 23 ], and in culturally and linguistically diverse populations [ 24 ].

A consistent thread throughout cardiovascular nursing research is the clear focus and ongoing commitment to patient-centred, family-focussed research and team science. Research spans across the continuum of care—from pre-hospital care, emergency cardiac care, nursing care provided in the cardiac catheter lab, and cardio-surgical care to post-hospital care, such as hospital-in-the-home or research that advances novel models of cardiac rehabilitation and follow-up care.

Leading Implementation Science

Nurses are most often the last stop in the journey medical science makes from the bench to the patient. Medication, treatment, exercise, and lifestyle change adherence is underpinned by tailored patient education and complex behavioural change strategies, most often provided, and reinforced, by nurses throughout the patients’ journeys in the health care system. The fundamental role of nurses in implementation science should not be overlooked. Nurses are the linchpin to changing practice, delivering care, and ensuring adherence and the sustainability of interventions in the long-term.

Engaging with nurses as partners and co-investigators throughout the research process will ensure successful implementation of new interventions and models of care. It is important that nurses are valued and active members of guideline and policy committees, and that they are provided with opportunities for leadership of these committees and their contribution recognised commensurate with their clinical and/or research leadership and expertise.

Our nurse practitioners, while fewer in number than our international colleagues, lead important patient care efficiency and effectiveness strategies. This is strongly evident in care of heart valve patients, provision of palliative care, or leading multidisciplinary heart failure services and in the development of chest pain clinics [ 25 , 26 ].

Leaders, Advocates, Innovators, Educators and More

Australian and New Zealand cardiovascular nurses are committed and strong contributors to national and international policy discussions and advocates for cardiac patient care. Nurses are present in the Cardiovascular Nursing, Interventional Nursing, Prevention, Heart Failure and Digital Health Councils of CSANZ and make substantial contributions to the Society overall, including the CSANZ Scientific Committee, Education Committee, Professional and Ethical Standards Committee, and the Annual Scientific Meeting Program Committee, as well as many different working groups.

We lead discussions on secondary prevention, acute cardiac patient care including catheter laboratories, and have been at the forefront of responsive changes in care delivery during the current pandemic [ 27 ]. Nurses show strong leadership in patient-centred research including patient reported outcomes. We often lead the way through collaborating with patients and their families in practice and research from co-design to implementation. Not surprisingly, nurses are at the forefront of very innovative models of delivery, for which they are recognised internationally [ 28 , 29 ] Nurses are experts in identifying barriers and challenges in self-management and self-care for patients and take action by being in the vanguard of patient support strategies. Nurses have developed patient-education avatars, gamified applications, and incorporated trackers and engaged in social media in advance of other health disciplines [ [30] , [31] , [32] ].

CSANZ nurse members have created a legacy to change practice in resuscitation. Studies into out-of-hospital cardiac arrest have demonstrated issues in access to defibrillators and issues with equity for older people, and influenced policy for ambulance transport to percutaneous coronary intervention (PCI)-capable facilities as well as specific pre-hospital treatments [ 33 ]. Work continues in assessing the availability and attitudes of bystanders [ 34 ]. Furthermore, nurse leaders contribute strongly to international guidelines for heart failure patient care and atrial fibrillation [ 35 ].

Cardiovascular nurses provide leadership across a range of settings and roles. Notable leadership roles held by nurses who began their careers caring for cardiovascular patients include the current CEO of the Heart Foundation, CEO of Her Heart, and executive leadership appointments at our higher education institutions along with numerous other nurses in executive roles throughout health care, university and research institutes and industry, not for profit and corporate organisations.

Resilient in the Face of Uncertainty and Adversity

The COVID-19 pandemic has been a call to action that has been answered by health care professionals around the world, and that response has impacted our own health. In Australia recently, we see daily increases in infections amongst health care workers, with nurses alone representing 42% of the current burden of active cases of COVID-19 among health professionals, and representing 13% of the overall total of active cases in Victoria as at 9 August 2020 [ 36 ].

Nurses, in particular, have been at the forefront of caring for patients across the world and sadly too many have lost their lives [ 37 ]. Facing uncertainty and unnecessary death and suffering has led many health professionals to experience moral distress, particularly because we are unable to meet the needs of patients and their colleagues [ 38 ]. This will be an important issue to face as we recover and build on our resilience during and following the pandemic. Rather than being overcome by the challenges that face us, we will need to respond to some critical learnings from this pandemic. We have learned that preparedness and leadership matters, and that we need a robust public health infrastructure that can interface with all facets of the health system locally and globally. Workforce planning, supply chain management and leadership are of the utmost importance.

This pandemic has shown us that the people who are most vulnerable to cardiovascular disease are susceptible to COVID-19; that those with cardiovascular disease are at significant risk of poor outcomes, and that a whole new population of patients requiring cardiovascular care may be generated by COVID-19. This vulnerability underscores the importance of addressing the social determinants of health, and nurses are uniquely placed to advocate for equity in healthcare.

Closing Calls

Australia and New Zealand have some of the most talented, brilliant, passionate, caring, and well-educated cardiovascular nurses in the world. Our nurses deliver high quality and evidence-based care, innovate practice, educate patients, develop, and implement policy, pioneer world-leading high impact research, and lead our organisations and health systems.

Considering the scope of nursing practice, high level of expertise and invaluable insights of nurses to the care team, in-depth understanding of psychosocial and physical wellbeing of people with cardiovascular disease, and the internationally recognised research track records of our cardiovascular nurse members, inclusiveness and partnering with expert cardiovascular nurses should be expected. Whether in committees, policymaking, publications or research funding applications, the absence of cardiovascular nursing input should be questioned and not excused. CSANZ can provide details of leading cardiovascular nursing experts across cardiovascular research, policy and clinical care to facilitate inclusiveness and partnership. As we work together during a once-in-a-century pandemic, take time to recognise the contributions in practice, health care delivery, research and policy of your nurse colleagues and actively facilitate opportunities to include nurses as partners in research, policy and healthcare delivery.

Lastly, a reminder that Heart, Lung and Circulation is committed to publishing articles across all aspects of cardiovascular care and welcomes submissions from cardiovascular nurses across the world.

Conflicts of Interest

No conflicts of interest to disclose.

Acknowledgements

Caleb Ferguson is supported by a Postdoctoral Research Fellowship (Ref: 102168) from the National Heart Foundation of Australia. Sally C. Inglis is supported by a Heart Foundation Future Leader Fellowship.

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Article Contents

Cardiovascular nursing research: challenges and opportunities.

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Chantal F Ski, David R Thompson, Cardiovascular Nursing Research: Challenges and Opportunities, European Journal of Cardiovascular Nursing , Volume 10, Issue 1, 1 March 2011, Pages 1–2, https://doi.org/10.1016/j.ejcnurse.2010.09.002

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Cardiovascular nursing has developed markedly in recent decades and research is now being seen as a legitimate activity. Cardiovascular nurses and nursing have made significant research contributions in key areas, notably in the design and evaluation of cardiac rehabilitation [ 1 , 2 ], secondary prevention [ 3 , 4 ] and heart failure disease management programmes [ 5 , 6 ]. This work has informed not only the evidence base for interventions and outcomes but also for guidelines and policies. However, there remain important and pressing research questions regarding why some of these programmes vary, for example in terms of design and outcomes [ 7 , 8 ], and these need to be acknowledged.

Many of these cardiovascular disease management programmes are multi-faceted and diverse in design with a multitude of contextual factors. They are essentially complex interventions and new approaches may be needed to seek explanations regarding their appropriateness, feasibility and effectiveness. Three major challenges appear to face nursing about such programmes: what is the strength of evidence; what works for who, when and why; and how best to evaluate complex interventions? [ 9 ]. It is therefore essential to establish reliable and robust evidence on prevention and management of cardiovascular disease. By doing so, this will provide a solid foundation on which to progress a systematic approach to nursing research into cardiovascular disease.

If nurses are to engage fully in this research enterprise they need to rapidly shift their focus and efforts. There remain significant challenges not only in terms of research capacity and capability but also sustainability. Nurses need to think bigger about research [ 10 ] with appropriate vision, strategy, focus, energy and confidence. What is needed is a ‘paradigm shift’ to harness the expertise and capacity that currently exists and apply these efforts to large-scale, multi-centre, team-led, thematic programmes of research [ 11 ]. This should not only apply to nursing but in collaboration with other disciplines to be truly inter-/multi/trans-disciplinary.

Local collaboration is all well and good but to have real significance and impact it needs to move to a national and international level to conceive, design, conduct and disseminate original research. There are some good examples of international networking and research collaboration in cardiovascular nursing, including the UNITE (Undertaking Nursing Interventions Throughout Europe) research group of the European Society of Cardiology Council on Cardiovascular Nursing and Allied Professions [ 12 , 13 ]. However, if it is to be truly collaborative and to have ‘reach’, nursing research should be strongly linked with medicine, the basic sciences and the social sciences.

Such an enterprise is likely to yield improved productivity in terms of generating and addressing key research questions that span bench to bedside (translational research), outputs (including publications, grants, and research training) and succession planning (training and development of the next generation of researchers).

Research is now indeed a global enterprise and international collaboration is not only desirable but necessary [ 14 ]. The advent of the World Wide Web and the Internet make this mission all the more attainable. Groups have greater stores of knowledge and research capacity than individuals. Nurses have an important role to play in the advancement of cardiovascular research. Nurses are appositely placed within cardiovascular health services to initiate, engage and lead collaborative research projects that will lead to rapid clinical changes and improved patient outcomes. If they truly wish to be seen as equal partners now is the time to seize the opportunity and rise to the occasion of the new generation of nursing scholars who are engaging in assiduous interdisciplinary cardiovascular health research.

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[Research priorities and research topics for cardiovascular nursing: the Swiss Research Agenda for Nursing]

Affiliation.

• 1 Abteilung Klinische Pflegewissenschaft, Universitätsspital Basel, Basel.
• PMID: 19048518
• DOI: 10.1024/1012-5302.21.6.404

Cardiovascular diseases are worldwide a major challenge for the health care system and the number one reason for premature mortality and lost life years. Many accomplishments to reduce risk factors and improve treatment in acute and chronic disease and rehabilitation have been initiated by medical research but were also embraced by nursing research, which provided valuable knowledge about supporting risk factor modification and patients' self-management. Nursing research in the cardiovascular field has a long tradition in the US. In Europe cardiovascular nursing research also developed over the past decade, with increasing participation of Swiss nurse researchers. Efforts in this field of cardiovascular nursing have been made to convey projects in nursing research that help to enhance the health of the population sustainably and improve well-being in patients with acute and chronic courses of cardiovascular disease. Scientific knowledge is pivotal in developing evidence-based nursing interventions. Since both the German and the French speaking part of Switzerland have been lacking a literature-based and expert-supported agenda for nursing research, the aim of the Swiss Research Agenda for Nursing (SRAN) project was to develop an agenda providing researchers, funding agencies, and politics with orientation. This article takes the seven priorities of the SRAN project and links them to the topics of risk factor modification, rehabilitation programs, self-care, and patient education. The article presents the first agenda for cardiovascular nursing for the years 2007 to 2017. The agenda will serve to develop an action plan and to promote nursing research projects in the field of cardiovascular nursing in Switzerland.

• Cardiac Rehabilitation
• Cardiovascular Diseases / nursing*
• Cardiovascular Diseases / prevention & control
• Clinical Nursing Research / standards*
• Clinical Nursing Research / trends
• Patient Education as Topic
• Primary Prevention
• Risk Factors
• Switzerland

Cardiac Nursing Research Paper Topics

Cardiac nursing research paper topics are crucial for the academic and professional development of nursing students. This area of study is incredibly vital, given the increasing prevalence of heart diseases worldwide. Engaging in research related to cardiac nursing not only helps students deepen their knowledge and skills but also contributes to advancements in patient care, treatment methodologies, and preventive strategies. This article provides a comprehensive list of research paper topics divided into relevant categories, a detailed discussion on the significance of cardiac nursing, and an overview of the services offered by iResearchNet to assist students in their academic pursuits.

100 Cardiac Nursing Research Paper Topics

The field of Cardiac nursing is a specialized area of nursing that deals with patients who have heart-related problems. It is an incredibly significant branch of healthcare, given the rising incidence of heart diseases worldwide. Cardiac nursing encompasses a wide range of research topics, from understanding different heart diseases to patient care, technological advancements, and preventive care. The study of Cardiac Nursing research paper topics is not only essential for the academic growth of nursing students but also crucial for the development of strategies that can help in the prevention, diagnosis, and management of heart-related ailments. The following is a list of 100 research paper topics in the field of Cardiac Nursing, divided into 10 categories, each containing 10 topics:

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• The role of genetics in heart diseases.
• The impact of diabetes on heart diseases.
• The relationship between obesity and heart diseases.
• The effect of smoking on heart diseases.
• The role of cholesterol in heart diseases.
• The impact of hypertension on heart diseases.
• The relationship between stress and heart diseases.
• The role of inflammation in heart diseases.
• The impact of a sedentary lifestyle on heart diseases.
• The relationship between diet and heart diseases.
• The role of a cardiac nurse in patient care.
• The importance of patient education in cardiac care.
• The impact of family support on cardiac patients.
• The role of a multidisciplinary team in cardiac care.
• The importance of communication in cardiac patient care.
• The impact of nursing interventions on patient outcomes.
• The role of self-care in cardiac patients.
• The importance of medication adherence in cardiac care.
• The impact of a supportive environment on cardiac patients.
• The role of telemedicine in cardiac patient care.
• The role of electronic health records in cardiac care.
• The impact of telemonitoring on cardiac patients.
• The role of mobile applications in cardiac care.
• The importance of wearable devices in cardiac care.
• The impact of artificial intelligence on cardiac care.
• The role of virtual reality in cardiac rehabilitation.
• The importance of remote monitoring in cardiac care.
• The impact of advanced imaging techniques on cardiac care.
• The role of robotic surgery in cardiac care.
• The importance of telemedicine in cardiac care.
• The role of lifestyle modification in preventing heart diseases.
• The importance of regular exercise in cardiac care.
• The impact of smoking cessation on cardiac health.
• The role of a healthy diet in preventing heart diseases.
• The importance of stress management in cardiac care.
• The impact of regular health screenings on cardiac health.
• The role of medication in preventing heart diseases.
• The importance of weight management in cardiac care.
• The impact of alcohol reduction on cardiac health.
• The role of blood pressure management in preventing heart diseases.
• The role of a pediatric cardiac nurse.
• The impact of congenital heart diseases on children.
• The role of family support in pediatric cardiac care.
• The importance of early diagnosis in pediatric heart diseases.
• The impact of surgical interventions in pediatric cardiac care.
• The role of rehabilitation in pediatric cardiac care.
• The importance of regular follow-up in pediatric cardiac care.
• The impact of lifestyle modification in pediatric cardiac care.
• The role of medication management in pediatric cardiac care.
• The importance of psychological support in pediatric cardiac care.
• The role of a geriatric cardiac nurse.
• The impact of aging on heart health.
• The role of medication management in geriatric cardiac care.
• The importance of regular health screenings in geriatric cardiac care.
• The impact of comorbidities on geriatric cardiac health.
• The role of family support in geriatric cardiac care.
• The importance of lifestyle modification in geriatric cardiac care.
• The impact of preventive care on geriatric cardiac health.
• The role of advanced care planning in geriatric cardiac care.
• The importance of palliative care in geriatric cardiac care.
• The role of a cardiac nurse in emergency care.
• The impact of timely intervention in cardiac emergencies.
• The role of advanced cardiac life support in emergency care.
• The importance of rapid diagnosis in cardiac emergencies.
• The impact of pre-hospital care on cardiac emergencies.
• The role of telemedicine in cardiac emergency care.
• The importance of teamwork in cardiac emergency care.
• The impact of public awareness on cardiac emergencies.
• The role of continuous education in cardiac emergency care.
• The importance of post-emergency follow-up in cardiac care.
• The role of a cardiac surgical nurse.
• The impact of preoperative care on surgical outcomes.
• The role of postoperative care in cardiac surgery.
• The importance of patient education in cardiac surgical care.
• The impact of family support on cardiac surgical patients.
• The role of pain management in cardiac surgical care.
• The importance of wound care in cardiac surgical patients.
• The impact of rehabilitation on cardiac surgical outcomes.
• The role of advanced surgical techniques in cardiac care.
• The importance of regular follow-up in cardiac surgical care.
• The role of a cardiac rehabilitation nurse.
• The impact of exercise on cardiac rehabilitation.
• The role of lifestyle modification in cardiac rehabilitation.
• The importance of psychological support in cardiac rehabilitation.
• The impact of family support on cardiac rehabilitation.
• The role of medication management in cardiac rehabilitation.
• The importance of regular monitoring in cardiac rehabilitation.
• The impact of a supportive environment on cardiac rehabilitation.
• The role of stress management in cardiac rehabilitation.
• The importance of patient education in cardiac rehabilitation.
• The role of psychological support in cardiac care.
• The impact of depression on cardiac health.
• The role of stress management in cardiac care.
• The importance of family support in managing cardiac-related stress.
• The impact of anxiety on cardiac health.
• The role of counseling in cardiac care.
• The importance of social support in cardiac care.
• The impact of positive thinking on cardiac health.
• The role of relaxation techniques in cardiac care.
• The importance of addressing grief and loss in cardiac care.

The significance of researching Cardiac Nursing research paper topics cannot be overstated. With the increasing prevalence of heart diseases globally, it is of utmost importance to continuously advance our knowledge and practices in this field. The above list of topics provides a comprehensive guide for students and researchers interested in cardiac nursing. By exploring these topics, one can contribute to the development of strategies and interventions that can improve the overall health and well-being of cardiac patients. iResearchNet is here to assist in your academic journey by providing customized solutions and services tailored to your needs.

Cardiac Nursing

And the range of research paper topics it offers.

Cardiac nursing is a specialized field of nursing that focuses on the care of patients with cardiovascular diseases. This area of nursing involves the assessment, planning, implementation, and evaluation of care for patients with acute or chronic cardiac conditions. With the increasing prevalence of heart diseases globally, the significance of cardiac nursing and the range of Cardiac Nursing research paper topics it offers is more critical than ever.

Cardiac nurses play a crucial role in the healthcare system as they provide specialized care to patients with various cardiac conditions, including heart failure, coronary artery disease, arrhythmias, and myocardial infarction. They work in a variety of settings, including hospitals, outpatient clinics, and home health care. Their responsibilities include monitoring vital signs, administering medications, providing emotional support, educating patients and their families about their condition, and developing care plans.

One of the most critical aspects of cardiac nursing is patient care. Providing comprehensive care to cardiac patients involves a holistic approach that encompasses not only the physical aspects of the disease but also the psychological and social aspects. Cardiac nurses need to have a thorough understanding of the pathophysiology of heart diseases, as well as the skills and knowledge required to manage the symptoms and complications associated with these conditions. Additionally, they need to be adept at providing emotional support to patients and their families, as dealing with heart diseases can be incredibly stressful and emotionally taxing.

Technological advancements have also played a significant role in shaping the field of cardiac nursing. The use of advanced diagnostic and monitoring equipment, as well as innovative treatment modalities, has improved the quality of care provided to cardiac patients. Telemedicine, electronic health records, remote monitoring, and mobile applications are some of the technological tools that have become indispensable in cardiac care. These tools not only facilitate the monitoring and management of patients but also improve communication between healthcare providers and patients. Cardiac nurses need to be proficient in using these technologies to provide optimal care to their patients.

Preventive measures are another essential aspect of cardiac nursing. With the increasing prevalence of risk factors such as hypertension, diabetes, obesity, and sedentary lifestyle, the importance of prevention cannot be overstated. Cardiac nurses play a vital role in educating patients about the importance of lifestyle modification, regular exercise, smoking cessation, and medication adherence. They also provide guidance on managing stress, maintaining a healthy diet, and monitoring blood pressure and cholesterol levels.

The field of cardiac nursing offers a diverse range of research paper topics. From understanding the pathophysiology of heart diseases, the role of genetics, the impact of comorbidities, and the effectiveness of various treatment modalities to exploring the psychological aspects of cardiac care, the role of technology, and the importance of preventive measures. Other potential topics could include the challenges faced by cardiac nurses, the effectiveness of various nursing interventions, and the role of cardiac rehabilitation in improving patient outcomes.

In conclusion, cardiac nursing is a crucial field in healthcare that plays a vital role in the management of patients with cardiovascular diseases. With the increasing prevalence of heart diseases and the associated risk factors, the significance of cardiac nursing and the range of Cardiac Nursing research paper topics it offers is more important than ever. By exploring these topics, researchers can contribute to the development of strategies and interventions that can improve the overall health and well-being of cardiac patients.

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Advancing cardiovascular care through nursing research, quality improvement, and evidence-based practice

Diana-Lyn Baptiste, Quanlei Li, Jennifer L. Milesky, Rebecca Wright

Johns Hopkins School of Nursing , Baltimore, MD , USA

Abstract: In the changing landscape of health care, it is imperative that health care providers remain abreast of current literature, research, and innovations that support positive health outcomes for patients, families, and communities. Over time, nurses have become more engaged in health care research. This research has been conducted through many methods, more recently, using rapid cycle methods such as evidence-based practice and quality improvement projects. Cardiovascular disease continues to be the number one cause of death in the United States, confounding the need for research to reduce poor health outcomes such as unplanned readmissions, morbidity, and mortality. In China, healthcare priorities are now shifting from infectious disease to cardiovascular disease. Nurses are uniquely qualified to engage and lead scientific inquiry targeted to improve outcomes among patients living with cardiovascular disease.

Keywords: Cardiovascular; evidence-based practice (EBP); nursing research; quality improvement

Received: 01 February 2019; Accepted: 13 February 2019; Published: 25 February 2019.

doi: 10.21037/shc.2019.02.01

Introduction/background

The global burden of cardiovascular disease is growing problem accounting for 17.3 million deaths in 2013 and projected to increase to 23.6 million by 2030 ( 1 ). Similar to other countries around the globe, in the United States, cardiovascular disease is endemic, remaining the greatest cause of hospitalization and mortality; attributing to more than 45% of deaths among American adults ( 1 , 2 ). The American Heart Association [2017] reports more than 92.1 million American adults living with some form of cardiovascular disease such as hypertension, peripheral vascular disease, or heart failure ( 1 , 2 ). These alarming statistics cannot not be ignored, confounding the need for research, implementation of practice guidelines and innovations that can improve health outcomes.

As the second largest economy in the world after the United States, China is the most populous nation and has the largest elderly population in the world ( 3 ). The healthcare priorities in China are now shifting from infectious diseases to non-communicable diseases ( 4 ) along with China’s tremendous economic development and people’s lifestyle change since the past four decades. Cardiovascular disease has been and will remain the leading cause of death for adults among both urban and rural Chinese population, accounting for approximately 43% and 45% of deaths in urban and rural areas ( 5 ), with hypertension as one of the most common risk factors ( 6 ).

Clinical practice guidelines

There are several approaches that can be used to target cardiovascular problems. The American Heart Association and American Colleges of Cardiology (AHA/ACC) promotes this through patient-centered research and the development of clinical practice guidelines for health care providers ( 7 ). Practice guidelines provide recommendations applicable to patients with, or at risk of developing cardiovascular disease. The focus of these guidelines is on medical practice in the United States, but guidelines developed in collaboration with other organizations can have a global impact. Although guidelines may be used to inform regulatory or payer decisions, they are intended to improve patients’ quality of care and align with patients’ interests. Guidelines are intended to define practices meeting the needs of patients in most, but not all, circumstances and should not replace clinical judgment ( 7 ).

In China, the first evidence-based clinical practice guidelines in the field of cardiovascular disease nursing was published in 2016 focusing on nursing care for acute heart failure adult patients ( 8 ). The guidelines together developed by National Center for Cardiovascular diseases, Committee of Heart Failure of Chinese Medical Doctor Association, and Beijing Nursing Association, systematically synthesized and clearly stated recommendations (including quality of evidence and strength of recommendations) with regard to factors including rapid assessment and triage, treatment, monitoring, follow-up ( 9 ).

Evidence-based practice (EBP)

The Johns Hopkins Hospital (JHH) is located in the east side of Baltimore city in Maryland, USA. A level-one urban academic medical center, the JHH receives more than 3 million patients and more than 360,000 emergency room visits per year. In the emergency department, more than 20% of patients seen for treatment are presenting with one or more cardiovascular related complaint. The JHH serves the east Baltimore community and beyond, providing treatment for a wide range of local, national and international patients. Health care teams at JHH work interdependently with the faculty of Johns Hopkins University, specifically with the schools of nursing, medicine, and public health, to support research development ( 10 ).

The Johns Hopkins Nursing Evidence-Based Practice (JHNEBP) model incorporates three critical components of professional nursing: practice, education and research ( 11 ). Since 2007, the JHNEBP model and tools have been guiding nursing professionals in their reporting of the scientific evidence ( Figure 1 ). This model has served as an essential foundation of professional standards to guide nurses’ integration of the best available evidence, including research findings, into guiding practice decisions ( 11 ).

Compared with the JHNEBP model, the Joanna Briggs Institute (JBI)’s approach to evidence-based healthcare, or the JBI model ( 12 , 13 ), is more often utilized in nursing practice in China ( Figure 2 ). Since the first center for evidence-based nursing was established at Fudan University School of Nursing in Shanghai in 2004, seven nursing schools and hospitals have established collaboration centers with the JBI to advance EBP in nursing and healthcare through evidence generation, evidence synthesis, evidence transfer, evidence implementation, and global health ( 15 ).

Quality improvement

Nurses and other health care professionals can lead quality improvement projects with a focus on improving processes, policies, and protocols on a unit or organizational level ( 11 ). Quality improvement teams work in tandem with leadership teams to develop a systematic approach in improving patient outcomes. Models such as the “Plan, Do, Study, Act” (PDSA) are often used to implement rapid cycle change in the hospital setting ( 11 ). The quality improvement process can also be guided by translational frameworks that guide the translation of research to clinical practice. At Johns Hopkins, nurse-led quality improvement projects are often targeted toward improving cardiovascular outcomes by reducing unplanned readmission, door-to-balloon times, and improving discharge patient education.

Chinese nurses have long been asked to enhance the nursing role to improve health outcomes of cardiovascular disease ( 16 ). However, great efforts are still needed to motivate nurses to play the critical role in educating patients and their lifestyle change, even though the majority of the nurses are considered to be knowledgeable about cardiovascular disease risk factors ( 17 ). At the same time, international successful experience as well as local unique factors should be taken into consideration to promote nurse-led multidisciplinary programs aiming at health improvement and quality improvement.

Nurses have the opportunity to identify gaps in healthcare, explore this unknown territory, and generate new knowledge. Examples of Johns Hopkins nurses working diligently to advance cardiovascular healthcare include studying the impact of technology on health promotion, studying the impact of self-care and depression on heart failure readmissions, and studying health literacy in heart transplantation.

Johns Hopkins Professor of Nursing, Jerilyn Allen, along with a colleague and BSN nursing student, studied the impact of smartphone technology on weight loss in young adults. In a randomized control trial, researchers implemented a smartphone application for weight loss with text messaging from a coach. The data were compared to a control. The results showed statistically significant weight loss, reduction in body mass index (BMI) and reduction in waist circumference compared to the control group ( 18 ). Nurses in this scenario recognized the cultural trend of use of cell phone application and text messaging and optimized this practice to promote health outcomes.

Heart failure readmission is an important issue in the United States, with heart failure admissions costing the American health care system $39 billion annually and heart failure being the highest frequency 30-day readmission ( 19 ). Identifying readmission causes and finding solutions is imperative to promoting the health of our population, as well as sustaining our healthcare financial infrastructure. Johns Hopkins research nurses explored the possible link between self-care and depression and heart failure readmission. They found that those with major depressive symptoms were five times more likely to delay hospitalization than those without. This stemmed from feelings of uncertainty or indecision about whether their symptoms were urgent. Those hospitalized were also found to be less likely to consult healthcare providers prior to hospitalization, thus possibly avoiding a hospitalization ( 20 ).

Johns Hopkins nursing professors, along with colleagues from the Institute of Nursing Science Switzerland, the Academic Center for Nursing and Midwifery in Belgium, and the University of Missouri, USA, collaborated to study the health literacy in heart transplantation. The understanding of health literacy is imperative in supporting transplant recipients during their journey, providing educational materials and programs, and maintaining treatment adherence and compliance. In an international multicenter, cross-sectional study which surveyed heart transplant recipients across 11 countries and 4 continents, the BRIGHT study determined that 33.1% of heart transplant recipients had inadequate health literacy. Adequate health literacy was associated with compliance with physical therapy, but not with other health behaviors ( 21 ). Understanding health literacy of heart transplant candidates is critical to ensure patient adherence to treatment and understanding of their disease process.

Like the United States, great attention has been paid to nursing research on cardiovascular disease in China. According to a hot spot analysis of 5 years [2012–2016] in China’s nursing research (both English and Chinese language articles), “nursing on cardiovascular diseases” was identified as the leading cluster among all nursing research hot spot topics ( 22 ). When combining evidence-based nursing and cardiovascular disease research, nurses can be equipped with most updated best nursing practice, and patients can be provided with best available nursing recommendations.

Multidisciplinary, interdisciplinary and transdisciplinary teams

Cross-discipline team-based care is the gold standard model that underpins each approach highlighted in this article ( 23 , 24 ). The complexity of patient conditions and evolving health care systems means that silo working is increasingly risky for patient safety ( 23 ). Conversely, different team-based models employed across the spectrum of management issues of cardiovascular disease have been found effective, leading to decreased hospitalizations and hospital mortality, and reduced length of stay ( 24 , 25 ). Broadly speaking, there are three main models for cross-discipline team-based care and research that can be employed: multidisciplinary teams, interdisciplinary teams, and transdisciplinary teams. These terms are sometimes used interchangeably but do have specific definitions. Multidisciplinary teams are comprised of mixed-discipline practitioners who share their expertise but may not interact regularly and may still work in isolation ( 26 ). Interdisciplinary teams are again, formed of mixed-discipline practitioners, but in this model, they work more collaboratively, drawing together their expertise to develop a cohesive plan of patient-centered care ( 26 ). Transdisciplinary teams go a step further, often drawing in non-healthcare partners and encouraging practitioners to move beyond the remit of their training and discipline with the purpose of integrating expertise to solve problems and generating new knowledge ( 27 ). The nurse’s role in these teams may vary depending on the scope of practice which can vary from country to country. However, in general as well as specific to cardiovascular care, nurses are increasingly encouraged to take leading roles in EBP, advocacy and collaboration between disciplines ( 26 ).

While all three models can support effective healthcare delivery as well as research, EBP and quality improvement efforts to improve cardiovascular care, it is the transdisciplinary approach that is of particular relevance to this article. As one transdisciplinary model demonstrates, such teams are well suited to serve as clinical research teams who can perform research, EBP and quality improvement from conception through to implementation and translation ( 27 ). An example of this approach that has focused on cardiovascular disease comes from a transdisciplinary team based at Johns Hopkins University ( 28 ). This group established a transdisciplinary research center with the aims of reducing cardiovascular morbidity and mortality, and improving quality of life and healthcare experiences for African Americans and others affected by disparities in the local area. The transdisciplinary team includes but is not limited to partners from medicine, public health and nursing, with additional collaborations with colleagues from a range of disciplines such as pharmacy, nutrition, economics and psychology, insurance and the community. Among its many efforts to achieve these aims, the center houses a shared resources core, provides training and career development, and supports both research and quality improvement projects ( 28 ). While this is a particularly large undertaking across multiple settings with significant resources and funding, smaller transdisciplinary teams can also operate successfully within a single setting, which may be particularly useful when integrating evidence-based quality improvement projects ( 29 ).

Conclusions

Cardiovascular disease continues to be the number one cause of death in the United States, confounding the need for research to improve health outcomes. In China, cardiovascular disease is also shifting as a health care priority. The alarming statistics on both sides of the globe underscore the need for transdisciplinary teams that engage in EBP, quality improvement and research. As this paper discusses, there are numerous models and frameworks that can used to support the health care practitioner in this endeavor. Further research is necessary to explore the effectiveness of these models, and how they impact cardiovascular outcomes cross-culturally.

Acknowledgments

The authors would like to thank Professor Changqing Pan, Chairman and Xiaoxin Liu, Director of Nursing Department at Shanghai Chest Hospital.

Funding: None.

Provenance and Peer Review: This article was commissioned by the editorial office, Shanghai Chest . The article did not undergo external peer review.

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/shc.2019.02.01 ). The authors have no conflicts of interest to declare.

Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/ .

• American Heart Association. Heart Disease and Stroke Statistics 2017: At-a-Glance. Available online: https://healthmetrics.heart.org/wp-content/uploads/2017/06/Heart-Disease-and-Stroke-Statistics-2017-ucm_491265.pdf
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Vaccines not blamed for new cardiovascular-kidney-metabolic syndrome | Fact check

The claim: American Heart Association announced 90% of vaccinated population now has ‘deadly heart defects’

A May 18 Instagram post ( direct link , archive link ) includes an image that ties vaccines to heart problems.

“American Heart Association: 90% of Vaxxed Population Now Have Deadly Heart Defects,” reads the text on the image, which is a screenshot of a May 17 article from The People’s Voice .

Another version of the claim spread widely on X, formerly Twitter . 

More from the Fact-Check Team: How we pick and research claims | Email newsletter | Facebook page

Our rating: False

This claim mischaracterizes a study published in May that found that almost 90% of American adults meet the criteria for cardiovascular-kidney-metabolic syndrome, a condition first defined by the American Heart Association in 2023. The organization did not make any announcement tying the findings to vaccines, and COVID-19 vaccines hadn't yet been released during the time period examined by the study. The claim stems from a website that routinely publishes misinformation .

Study is 'unrelated to vaccines of any kind'

The social media posts “make connections that cannot be attributed to the American Heart Association,” said spokesperson Suzanne Grant . 

Almost 90% of American adults met the criteria for a condition called cardiovascular-kidney-metabolic syndrome in a May study by Harvard Medical School researchers published in the Journal of the American Medical Association. 

The Harvard study uses the American Heart Association's definition of the condition that was announced in October 2023 . Cardiovascular-kidney-metabolic syndrome is the overlap of cardiovascular disease, kidney disease, Type 2 diabetes and obesity, according to the organization . The study noted people of older age, men and Black adults were at increased risk for advanced stages of the condition.

Fact check : No evidence COVID-19 vaccine 'shuts off' the heart, contrary to anti-Kelce post

The post connects the study to the COVID-19 vaccine with its reference to the "vaxxed population," but this is wrong on multiple fronts.

For one, the study predates the COVID-19 vaccines. The last survey cycle for this study ended in March 2020 – months before the vaccine became available .

And the study did not say vaccination status of any kind played a role, because vaccines weren't part of the research.

“Our research did not deal at all with vaccines and is unrelated to vaccines of any kind,” said Dr. Muthiah Vaduganathan , a Harvard Medical School cardiologist involved in the study.

Similarly, neither the American Heart Association's announcement nor other statements the organization published about the condition mention vaccines. Rather, it said the condition is a “consequence of the historically high prevalence of obesity and Type 2 diabetes in both adults and youth.” 

The association has said the COVID-19 vaccine could have rare side effects including heart inflammation and blood clots. It added, however, that the virus itself could also cause such health issues and that the benefits of the vaccine far outweigh the potential risks.

USA TODAY has debunked an array of false claims from The People’s Voice about vaccines, including that a billion people have died since the COVID-19 vaccine rollout, that the World Health Organization declared “mass vaccination” is required to combat climate change and that the WHO admitted fully vaccinated mothers are giving birth to babies with heart defects. 

USA TODAY reached out to the user who shared the post for comment but did not immediately receive a response.

Our fact-check sources:

• Suzanne Grant , May 21, Email exchange with USA TODAY
• Muthiah Vaduganathan , May 20, Email exchange with USA TODAY 
• JAMA, May 8, Prevalence of Cardiovascular-Kidney-Metabolic Syndrome Stages in US Adults, 2011-2020 
• American Heart Association, Nov. 14, 2023, A Synopsis of the Evidence for the Science and Clinical Management of Cardiovascular-Kidney-Metabolic Syndrome: A Scientific Statement From the American Heart Association 
• American Heart Association, Nov. 14, 2023, Cardiovascular-Kidney-Metabolic Health: A Presidential Advisory From the American Heart Association 
• American Heart Association, Oct. 9, 2023, Heart disease risk, prevention and management redefined 

Thank you for supporting our journalism. You can subscribe to our print edition, ad-free app or e-newspaper here .

USA TODAY is a verified signatory of the International Fact-Checking Network, which requires a demonstrated commitment to nonpartisanship, fairness and transparency. Our fact-check work is supported in part by a grant from Meta .