Specialist heart failure nurse proves success of integrated approach

Categories: Care.

Find out how St Christopher’s pioneering approach to palliative care for heart failure patients is improving their quality of life and reducing hospital admissions.

Witnessing the sudden death of a close friend leaves a mark on everyone. When, as in Isobel Jackson’s case that friend is only 34 and they’d been offered no opportunity to discuss their wishes or preferences for care, it makes a really serious impression – especially given that Isobel is a nurse.

To that point, most of Isobel’s career had been in emergency and acute care. But she decided to write her dissertation on heart failure following the loss of her friend.

Isobel explains: “She was my best friend of 22 years. We knew she had heart failure, but no one even told us there was a possibility she might die so soon or that she had any palliative needs. It really made me think about all the other people that must be in a similar situation, their needs, why they’re not being met and what could happen to them.”

The research for the dissertation opened Isobel’s eyes even wider to the barriers preventing heart failure patients from accessing palliative care. One of the key stumbling blocks she discovered was a failure for healthcare professionals to engage this patient group in open dialogue about their prognosis and the type of care they would like as the disease progresses.

Having completed her studies, Isobel took on the role of Heart Failure Nurse for St Christopher’s in Bromley in a project that’s seen the successful integration of palliative care and mainstream heart failure nurses and doctors.

What does that success look like? Isobel’s proud to relate that the success is threefold. A huge drop in hospital bed days, substantial cost savings and improved quality of life.

“By treating the psychological impact of a life-limiting condition and adopting a rehabilitative approach we’ve been able to add life to years and not just years to life.”

Building on that success in Bromley means Isobel and her colleagues are now engaged in extending their reach in that borough and are taking the model to Croydon and it’s certainly going to plan so far. The aim was to reach 150 new patients across Bromley and Croydon within 12 months. They’ve exceeded that target after just nine months.

Long term, she says, the hope is to roll it out across all the boroughs St Christopher’s covers. And, perhaps even more ambitiously, Isobel wonders if this integrated approach could be applied to other conditions, like say neurological.

“The benefit of having someone with experience of palliative care and heart failure means we can understand the journey of those people and work with colleagues to build a bridge between the different disciplines,” she adds.

Isobel’s keen to share real-life examples of the difference this integrated service is making to the lives of south London people living with heart failure.

She shares the experience of a woman in her late 80s who has dementia as well as heart failure. It came as a shock to her and her husband when the hospital referred her to St Christopher’s, and they didn’t understand that the condition was life-limiting nor see the need for palliative care.

“I went to see them with a colleague and the referral really hadn’t gone down well,” Isobel recalls.

“But we were able to win them over quite quickly because we were able to administer some treatment there and then that wouldn’t normally be done outside hospital.

“She went back to living a pretty good life, she received some rehabilitative care to build up her mobility and we supported them to get the benefits she was entitled to. We also spent time with them talking about end of life care, what mattered to her and her wishes.

“Her husband was particularly full of praise because he could see how the focus had shifted from treatment that wasn’t really working, to an emphasis on quality of life for them to spend together.”

It’s not just the patients and their carers who are feeling the benefit, Isobel says.

“The reception from our health colleagues across the borough has been so positive. Being a point of contact and another source of support has made a real difference. Doctors are saying thank goodness they’ve got somewhere they can go that gives them and their patients hope. And the engagement with and support from consultant cardiologists has been excellent. We’re both happy to ask each other for advice.”

In advance of our conference, Improving Palliative Care for People with Advancing Heart Failure, on 19 June, Isobel has a message for her colleagues across the sector.

“More and more hospices are starting to support people with heart failure, but we really need to progress this movement towards integrating the specialist support of the services and look at how we can support the specific demography of an area.”

“I would love to see heart failure nurses, specialist palliative care nurses, commissioners, consultant cardiologists and anyone who can help shape services for this large patient group come to the conference. We need to identify the role nurses can play and empower them to be at the heart of this change.”

Isobel will be speaking at the conference, and you can find out more about the programme and full programme of speakers as well as secure your place for the early bird price of just £99 if book by 31 March. Simply click here.

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This article was first published on the St Christopher’s website and is reprinted here with permission.

 

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