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Hearts for Healing

Telemetry nurses working in cardiac rehabilitation must be good listeners and informed teachers.

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Cardiac rehabilitation, in my opinion, is one of the best kept secrets in cardiac health. Cardiac rehabilitation is so much more than just exercise. It's a life changer. It's a mind changer. It's a whole new outlook on life. And the people who work in cardiac rehab are a lifeline to those patients trying to get back to a normal life.

Cardiologists often prescribe cardiac rehab for patients who have been through a cardiac event. But unless they've been through it themselves, even the physicians don't realize the benefits it brings.

I have been a nurse for 32 years. So yes, I am one of the "old nurses" who has seen programs, techniques, ideas, and general rules of thumb change over and over again. No matter what developments revolutionize the industry, it always comes down to the same principle: what's best for the patient.

How can we best prepare a patient to take care of herself and help her live the rest of her life as heart healthy as possible? That is the mainstay of cardiac rehab. Patients must know we are their cheerleaders and will always be there for them. They must know they're not alone.

Telemetry nurses working in cardiac rehabilitation must be good listeners and informed teachers. We must, as a team, provide patients the tools they need to not be afraid every time they step out the door, or even when they lie down to go to sleep. We must provide education in stress management, dietary considerations and meal planning, medication usage - including learning about the medicines used to treat heart disease, as well as their side effects, how to take it and when to take it - and also smoking cessation for a thorough A-to-Z patient education.

Every patient must be treated as an individual with their own set of needs and abilities. Cardiac rehab at Rockcastle Regional Hospital is reaching the patient where they are and not putting them into a pre-fab program.

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Why Is Cardiac Rehab My Passion?

Being a nurse in the cardiac rehabilitation department of a hospital is the perfect specialty for me. I have always loved "hearts." I realize every day how fortunate I am to be a nurse in this discipline.

I began at Rockcastle Regional Hospital, Mt. Vernon, Ky., in 1980 straight out of nursing school. At that time, we had two cardiac monitors in a room close to the nurses' station. That was our version of "special care" for cardiac patients.

With the assistance of one of our new internal medicine doctors, we opened a special care unit in 1986. That was a thrill - being up close and personal with "hearts and lungs." I've managed that unit since it opened.

Continuing in the theme of serving this unique subset of patients, Rockcastle Hospital opened its "Breath of Fresh Air" cardiac rehabilitation program in 2004. Once again, I was thrilled to have the opportunity to manage the unique needs of patients in cardiac recovery, and excited to see patients get better and back to their lives.

If you're lucky enough to be a cardiac rehab nurse, you become the patient's family and friend for the rest of their life.

My Larger-Than-Life Event

My career as a telemetry nurse took on special meaning to me in the winter of 2006. I came as close to needing cardiac rehabilitation as I could have, without experiencing my own coronary event.

My father, Luther Eaton, underwent a 5-vessel bypass procedure, with the added complications of atrial fibrillation in the hospital, and a tension pneumothorax four weeks later at home.

I spent 45 days taking care of my dad - by his side in the hospital and at home. I was there when he was afraid to go to sleep because he was afraid he would die. I was there when depression overwhelmed him and he felt as if he'd never be able to do anything again. You see, this wasn't about me, but it was preparing me to understand more vividly what my patients are going through when I work with them every day.

Without cardiac rehab, my dad would have been a "cardiac cripple." My mom would bring him to rehab and he'd be exhausted just walking from the car to the rehab department. I watched in astonishment as rehab helped him understand he was not alone in this battle. He was with others who were going through the same ordeal.

We use a scale in cardiac rehabilitation to estimate how difficult a patient feels an exercise is to accomplish. The scale has a maximum of 20 on a scale of 5-20.

My dad would climb off the cross trainer and say, "that was a 50." But gradually, over his 12 weeks, I saw this once-strong man regain his confidence. He was able to go fishing again-something he never thought he'd be able to do.

A Typical Day in Telemetry

So what is a day in cardiac rehab typically like? Patients arrive in a timely basis, and we teach them how to place their monitors on. This gives them a sense of accomplishment.

After we check their monitor placement, we weigh them in and listen as they tease each other over a pound lost or gained. We ask questions about how they're feeling and listen to what they have to say. It's so important to give them your time - that is anyone's greatest gift.

We obtain their vital signs, ensuring the measurements are within that patient's normal range. I discuss with them how their heart medicines affect their heart rates and blood pressures.

Sometimes patients are asked to bring in their home blood pressure cuffs to rehab to compare their numbers to ours. This helps them feel safe when taking their blood pressure at home.

Above all, at this point, I make sure everything is going OK for them. If they've had any unusual pains, problems, concerns or dizziness, I give their cardiologist's office a call. We'll also call the cardiologist for any change in ECG patterns or general symptoms. And there are those, of course, who come in the door and get a free wheelchair ride to the emergency department for dysrhythmias or symptoms of chest pain and shortness of air.

The patients are asked to conduct their warm-up exercises and exercise ensues. Patients are hemodynamically and ECG-monitored. I keep a large set of pom-poms in the department, and when a goal is reached, such as 10 minutes on the cross trainer, I run, jump up and down, and cheer for that patient. Trust me - it's a workout for this old nurse by itself.

Our program can accommodate up to eight patients at a time. Classes are held three days per week, and patients work up to a goal of 50 minutes to an hour of cardiovascular exercise. Depending on a patient's particular case and insurance plan, they'll stay in the program an average of 12 weeks. About three-fourths of the patient load are postsurgical.

James Messer, MSPT, is the program director, and Morgan Kincer is our cardiac rehab technician. Both are supportive of the patients, encourage them to do their best and design a plan of care specific to their needs and abilities.

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A Setting Like No Other

In our cardiac rehab department, I see camaraderie as one of its greatest strengths. The socialization of these patients, who have something in common, becomes their greatest asset.

And time becomes their greatest gift. As I watch the patients come in to cardiac rehab on day one, using portable oxygen, using a cane or being pushed in a wheelchair, then watch them grow and become stronger physically and mentally, I am amazed.

Twelve weeks later, they no longer need that portable oxygen, cane or wheelchair, and leave strong under their own power. They're no longer afraid to go out their door for a good walk, or to go to sleep at night for fear of not waking up.

After 30 years, I'm still thrilled by hearts and thankful to offer such a valuable service.

So, yes, cardiac rehab is my passion and the favorite part of my working day. I am blessed to be a part of this team.

And yes, I will continue to pull out those pom-poms and cheer the accomplishments of my patients who thought they'd never be able to exercise like this again!

Patti Halcomb is emergency department coordinator, advanced cardiac life support instructor, nurse educator in ECG dysrhythmia training and coordinator of the cardiac rehabilitation program at Rockcastle Regional Hospital, Mt. Vernon, Ky.

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