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European Journal of Cardiovascular Nursinghttp://cnu.sagepub.com/
Education for nurses working in cardiovascular care: A European survey
e Working Group of the Education Committee of the ESC Council on Cardiovascular Nursing and Allied ProfessionEur J Cardiovasc Nurs2014 13: 532 originally published online 19 December 2013
DOI: 10.1177/1474515113514864
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http://cnu.sagepub.com/content/13/6/532
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European Society of Cardiology
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23, 20 14
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536 European Journal of Cardiovascular Nursing 13!"
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Astin et al. 53
Co&&unication ith patient% an! a&i"ie%
atient a!.ocacy an! patient centere! care
/einin# the ro"e o the &e&er% o the tea&
$ea! an! criti?ue re%earch or e.i!ence-a%e! care
U%e co!e o ethic% or nur%in#
&p"e&ent e.i!ence-a%e! c"inica" practice chan#e
ua"ity i&pro.e&ent inititia.e%
None
0 10 20 30 40 50 60 0 0 A0 100
Figure 3. E!ucationa" acti.itie% aout &u"ti!i%cip"inary tea& ui"!in# tau#ht in po%t-re#i%tration nur%in# pro#ra&&e% (nB41)
$o learn& -arriers $o learning& and 'o $o define and evalu,a$e
learning ou$co(es. l(os$ one,fif$' of $'e progra((es
repor$ed $'a$ $'e did no$ $eac' an educa$ional $'eor.
O'(ective 0) &s$c%osocial assessment and support.
os$ progra((es $aug'$ pa$ien$,cen$red care& psc'osocial
assess(en$ and $'e principle of involve(en$ of pa$ien$s and
fa(il. Jus$ over 'alf of $'e surveed progra((es included
con$en$ a-ou$ screening for nega$ive (ood s$a$es anie$ and
depression#.& 'erapeu$ic counselling $ec'niues& co(,(uni$&
lifespan and cul$ural co(pe$ences ere availa-le in less $'an 50
of progra((es. ee +igure 2.
O'(ective ) &romoting multidisciplinar$ team
/or2. Con,$en$ rela$ed $o (ul$idisciplinar $ea( or%
ere included in $'e (aori$ of $'e progra((es +igure 3#.
'e (os$ freuen$l repor$ed ac$ivi$ies cen$red on effec$ive
co((u,nica$ion s%ills& pa$ien$ advocac and $'e defini$ionof $'e roles of (ul$idisciplinar $ea( (e(-ers.
*eac%ing and learning met%ods. 'e (os$ idel used
$eac'ing and learning s$ra$egies in surveed progra((es ere
face,$o,face lec$ures and se(inars. +ace,$o,face lec,$ures and
se(inars 'en s$uden$s presen$ $opics $o o$'er s$uden$s
folloed - a discussion# ere ran%ed as $'e (os$ co((onl
repor$ed educa$ional deliver (e$'ods used in =7& and 85&
of progra((es respec$ivel.
'e predo(inan$ fra(eor% used $o assess $'e co(pe,
$enc levels for $'e educa$ion progra((es as (os$ of$en
-ased on a coun$r,defined assess(en$ 48#& or a s%ill
c'ec%lis$ 35#. +if$een
37# progra((es ere
lin%ed $o EC i$'
alloca$ed poin$s varing
fro( 7.5F180. :$'er
progra((es 'adi(ple(en$ed al$erna$ive
credi$ ss$e(s 'ils$ o$'ers
ere unsure of 'a$ as
offered for credi$
Assessmentapproac%es. varie$ of(e$'ods ere used $o
assess %noledge and s%ill
co(pe$enc -u$
ea(ina$ions/ %noledge
$es$s ere $'e (os$
freuen$l used $ec'niues
folloed - essas and
case s$udies. :$'er less
co((onl used assess(en$
approac'es ere o-served
s$ruc$ured clinical
assess(en$& por$folio& self
assess(en$ or peer revie.
o progra((es did no$
repor$ an assess(en$
approac' for s$uden$s.
Course evaluation.
>rogra((e evalua$ion as
(os$ fre,uen$l conduc$ed
- s$uden$s n3=& =5#&
educa$ors n24& 58#&
'ospi$als/universi$ies 16&
3=#& and e$er,nal
revieers n18& 44#. llresponden$s repor$ed an
in$eres$ in $'e develop(en$
of a pos$,regis$ra$ion pro,
gra((e in C! nursing
s'ould i$ -e availa-le.
4iscussion
Nurses are recognised as a
significan$ or%force and
'ave $'e po$en$ial $o
con$ri-u$e $o $'e vision of
$'e EC 'ic' is $o reduce$'e -urden of C!".
snaps'o$ of curren$ educa,
$ional provision gives a
useful insig'$ in$o $'e
capa-ili$ of $'e European
nursing or%force. )n 200=
less $'an 'alf of $'e ini$ial
nurse educa$ion as
provided - 'ig'er educa$ion
ins$i$u$ions.5 'is sugges$s
$'a$ organisa$ions providing
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7/24/2019 Eur J Cardiovasc Nurs 2014 532 40
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53 European Journal of Cardiovascular Nursing 13!"
voca$ional educa$ion ere so(e'a$ underrepresen$ed in our
sa(ple as over 70 of par$icipan$s ere e(ploed - a
universi$. *oever& despi$e $'is 'ig'er $'an average repre,
sen$a$ion fro( 'ig'er educa$ion ins$i$u$ions& onl 'alf of $'e
progra((es iden$ified offered gradua$e or pos$gradua$e level
educa$ion. 'is finding 'ig'lig'$s $'a$ a large propor,$ion of
nurse educa$ion con$inues $o -e delivered a$ a rela,$ivel loacade(ic level 'en co(pared $o o$'er 'eal$'care disciplines.
9'en eploring $'e con$en$ of $'e curricula i$ as evi,den$
$'a$ $'e educa$ional focus as -ased predo(inan$l upon $'e
(anage(en$ of pa$ien$s i$' coronar 'ear$ dis,ease C*"#
i$' less focus on $'e needs of pa$ien$s i$' o$'er for(s of C!
disease. 'e focus on C*" see(s logi,cal as i$ re(ains $'e
leading cause of dea$' across Europe& ecep$ in Hreece& $'e
for(er Kugoslav ;epu-lic of acedonia& and >or$ugal 'ere
s$ro%e $a%es $'e lead&1-u$ i$ ould -e advisa-le $o $a%e a ider
vie of $'e i(pac$ of C!" on 'eal$'. No$ all of $'e diagnos$ic
procedures received $'e sa(e a$$en$ion in C! educa$ional pro,
gra((es. ECH in$erpre$a$ion as included - al(os$ $'ree,uar$ers of par$icipa$ing organisa$ions 'ereas o$'er aspec$s of
p'sical assess(en$ suc' as cardiac and respira,$or
auscul$a$ion and c'es$ I,ra in$erpre$a$ion received less focus.
'is (a reflec$ $'e e$ended scope of nursing prac$ice
eviden$ in so(e coun$ries co(pared $o o$'ers.
'e assessed curricula included general infor(a$ion on
p'ar(acological (anage(en$ of C! pa$ien$s& e$ onl 'alf of
all progra((es 'ave in$egra$ed con$en$ of (edica,$ion
ad'erence 'ic' is a li(i$a$ion given $'a$ nurses are in an
ecellen$ posi$ion $o suppor$ pa$ien$s i$' $'e (an,age(en$
and ad'erence of prescri-ed (edicines. 'is is par$icularl
i(por$an$ given $'a$ (edica$ion ad'erence is a significan$
pro-le(. edicines ill onl or% if $'e are $a%en and less
$'an 'alf of pa$ien$s ad'ere $o $'eir reco(,(ended regi(e.14
:$'er aspec$s of self,(anage(en$ sup,por$ and lifes$le
c'ange ere -e$$er represen$ed -u$ $'e $'eories and
in$erven$ions lin%ed $o pa$ien$ educa$ion and -e'avioural
c'ange s$ra$egies ere less ell covered $'an $'e specific
'eal$' -e'aviours. 'is sugges$s $'a$ $'ere is a focus upon
'a$ lifes$le -e'aviours s'ould -e c'anged ra$'er $'an an
e(p'asis on 'o in$erven$ions can -e used $o facili$a$e
c'ange. Nurses can (a%e a significan$ con$ri,-u$ion $oards
reducing $'e -urden of C*" $'roug' $'eir con$ri-u$ion& as a
(e(-er of $'e (ul$idisciplinar $ea(& in $'e i(ple(en$a$ion
of secondar preven$ion guidelines in clinical prac$ice.15o do$'is $'e need $o -e euipped i$' a -asic unders$anding of
educa$ional and -e'avioural $'e,or. 'e lac% of e(p'asis on
$'is con$en$ i$'in $'e cur,riculu( as surprising as
co(pe$encies around effec$ive co((unica$ion& infor(a$ion
provision and educa$ion of pa$ien$s and fa(ilies for( $'e
corners$one of preven$ive cardiolog in prac$ice. 'ese aspec$s
of nursing curricula arran$ a$$en$ion. elf,(anage(en$
suppor$ $o fos$er a 'eal$' lifes$le for people diagnosed i$'
C!" is an
essen$ial co(pe$enc for'eal$' care or%ers in $'e21
s$cen$ur.
10
'e i(por$ance of
pa$ien$,cen$red care as
reflec$ed in curricula& as
as $'e assess(en$ of
psc'osocial needs and
fa(il involve(en$. :$'erareas suc' as screening for
neg,a$ive (ood s$a$es&
cul$urall co(pe$en$ care&
counselling s%ills and
(a$erial descri-ing nor(al
and a-nor(al coping
responses ere less
eviden$. Educa$ion a-ou$
uali$ i(prove(en$
ini$ia$ives as also fairl
li(i$ed& (eaning $'a$ an
a-ili$ $o de(ons$ra$e $'e
provision of 'ig' uali$care (ig'$ -e lac%ing.
'e a in 'ic' $'e
con$en$ is delivered as
$picall $'roug' face,$o,
face lec$ures. 'e gro$' of
educa$ional $ec'nolog ill
(ean $'a$ (ore crea$ive
learning and $eac'ing
approac'es ill evolve and&
'ere possi-le& (e$'ods $'a$
encourage nurses $o engage
i$' $'eir learn,ing and
consider cri$ical aspec$s of
care s'ould -e consid,ered.
Gi%eise& (os$ progra((es
used %noledge $es$s and
ea(ina$ions i$' o$'er
assess(en$ (e$'ods& 'ic'
are po$en$iall (ore li%el $o
assess unders$anding& so(e,
'a$ underrepresen$ed& e.g.
supervisors repor$ of clinical
s%ill& por$folio and self,
assess(en$. 'e 9*: repor$
argues $'a$ 'ig'l educa$ednurses are a-le $o provide
'ig' uali$ care and
ul$i(a$el reduce (or$ali$
200=#.3C'an 2013# argues
fur$'er $'a$ i$ is vi$al $'a$ e
crea$e and sus,$ain a -e$$er,
educa$ed nursing or%force
$o (ee$ $'e co(,ple service
needs of $'e fu$ure.16
)f e
are $o ac'ieve $'is ai( i$ is
necessar $o increase $'e
level of educa$ion of $'e
nursing or%force 'ils$
ensuring $'a$ learning and
$eac',ing (e$'ods produce
co(pe$en$& co(passiona$e&
%nol,edgea-le& cri$ical and
reflec$ive prac$i$ioners. )n
order $o adop$ a pan,
European approac' $o $'e
develop(en$ of nurse
educa$ion i$ (a -e
necessar $o e$end $'e use
of $'e EC poin$s 'ic' is
no$ e$ co((on. (ore
ide,spread adop$ion of $'is
ini$ia$ive ould suppor$
euiva,lence of aards
across differen$ ins$i$u$ions
'ic' ould confer a range
of -enefi$s suc' as en'ancing
s$uden$ (o-ili$& aiding
curriculu( design and
flei-le rou$es $o 'ig'er
aards as ell as suppor$ing
uali$ assurance
processes.7&8
)n su((ar& findings
sugges$ $'a$ curricula for
pos$,regis$ra$ion C!
educa$ion are s$ill largel
driven - a (ed,ical (odel
and c'arac$erised -
$radi$ional curricular
s$ruc$ures and (e$'ods.
oreover& $'e e(p'asis on'ospi,$al care is s$ronger
$'an on pri(ar and
co((uni$ 'eal$' care and
co(pe$encies $'a$ ould
prepare nurses $o care for
$'e eponen$iall,groing
group of pa$ien$s $'a$ live
i$' one or (ore c'ronic
illnesses including C!"
disease are given li(i$ed
a$$en$ion.
European corecurriculu( for pos$,
regis$ra$ion C! educa$ion
(a -e one approac'
$oards 'ar(onisa$ion of
nurse educa$ion across
Europe -u$ consensus (us$
-e reac'ed a-ou$ $'e
c'arac$eris$ics of $'e core
co(pe$encies and $'e
feasi-ili$ of $'is approac'
across coun$ries i$' diverse
regula$or& educa$ional and
legisla$ive fra(eor%s.
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Astin et al. 53A
9'ils$ $'is s$ud is one of $'e firs$ pu-lis'ed s$udies $o assess
C! nurse educa$ion in Europe i$ 'as several li(i$a,$ions 'ic'
(us$ -e considered. 'ere ere considera-le c'allenges lin%ed
$o $'e sa(pling approac' adop$ed. Hiven $'a$ no lis$ of
European pos$gradua$e progra((es eis$s& a s$aged sa(ple
approac' as needed. concer$ed effor$ as (ade $o securerepresen$a$ion across all coun$ries $o (ini(ise selec$ion -ias.
9e used %e infor(an$s in $'e various European coun$ries
'o su-seuen$l iden$ified and direc$ed us $o con$ac$s 'o
ere %noledgea-le a-ou$ pos$,regis$ra$ion C! nurse
educa$ion progra((es in $'eir respec$ive coun$ries. 'e
failure $o iden$if %e infor(an$s in all European coun$ries
and/or $'e su-seuen$ unsuccess,ful dis$ri-u$ion of surves
i$'in coun$ries& par$l -ecause of language -arriers as $'e
surve as in Englis'& resul$ed in a nu(-er of European
coun$ries no$ -eing included in $'e surve suc' as +rance&
)$al& pain& Nora& ;o(ania& for(er Kugoslavia& ur%e and
*ungar. 'e process as also $i(e consu(ing 'ic' resul$ed
in a dela -e$een so(e da$a -eing collec$ed and pu-lis'ed.
9e ac%noledge $'ese li(i$a$ions -u$& given $'e scarci$ of
infor(a$ion on $'is $opic& e -elieve $'a$ our findings s$ill
arran$ a$$en,$ion. 9e soug'$ advice regarding co((on
educa$ional $er(s $o suppor$ euivalence across differen$
coun$ries/lan,guages -u$& despi$e $'is& so(e $er(s (a no$ -e
accura$el $ransla$ed across educa$ional se$$ings.
Conclusion
)n conclusion& $'ere is varia-ili$ in $'e con$en$& $eac'ing&
learning& assess(en$ and evalua$ion (e$'ods in pos$,regis,
$ra$ion C! nurse educa$ion progra((es in Europe. 'isreflec$s $'e varia$ions in scope of nurse prac$ice across dif,
feren$ coun$ries. C! nurse educa$ion ould -e s$reng$',ened
i$' a s$ronger focus upon con$en$ $'a$ aligns (ore closel
i$' curren$ 'eal$' c'allenges faced in Europe. -roader vie
of C!" $o include s$ro%e and >!" ould -e advan$ageous
i$' an e(p'asis on preven$ion& re'a-ili$a,$ion and a grea$er
aareness of $'e i(pac$ of 'eal$' ine,uali$ies. s $'e
popula$ion ages& $ea(or%ing across professions and
special$ies ill -e %e as pa$ien$s ill -e older and presen$
i$' (ul$iple co,(or-idi$ies reuiring co(ple care and long,
$er( suppor$. n e(p'asis on in$erdisciplinar educa$ion ill
fos$er (ore effec$ive $ea(,or% across (ul$idisciplinar $ea(sand $'e use of advanced educa$ional $ec'nolog $o deliver
-lended learn,ing in a flei-le a can afford (an po$en$ial
-enefi$s.
"plications for practice
1 Educa$ional provision for cardiovascular
nurses varies considera-l across Europe.
2 ccess $o gradua$e level educa$ion for nurses&
$'e larges$ or%force in Europe& re(ains
inconsis$en$.
1 odernisa$io
n of nursing
curricula
s'ould
include
addi$ionaleduca$ion on
'per$en,sion&
s$ro%e and
perip'eral
vascular
disease
2 ddi$ional
educa$ion
lin%ed $o
lifes$le
-e'aviour
c'ange isreuired i$'
e(p'asis on
preven$ion&
re'a-ili$a$ion
and 'eal$'
ineuali$ies.
3 'e use of
educa$ional$ec'nolog(a idenaccess $oeduca$ion for
nurses.
Acknowledgeents
'e au$'ors ould li%e $o
ac%noledge $'e suppor$ of
$'e EC and na$ional socie$ies
in suppor$ing $'is s$ud.
Conflicts of interest
'e au$'ors declare $'a$ $'ereare no conflic$s of in$eres$.
Funding
'is researc' as suppor$ed
- funds fro( $'e European
ocie$ of Cardiolog.
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