What is the service we provide?
We provide a UK-wide evidence-based cognitive behavioural management programme for patients who have had an MI or cardiac surgery which is facilitated by specially trained clinicians. Called the Heart Manual Programme, it is six weeks long and comes in the form of an educational workbook and relaxation CD (Copyright NHS Lothian).
Evaluations of the programme have repeatedly shown a reduction in unnecessary disability, improvement in patients’ quality of life and that it can dramatically improve psychological outcome, as well as reduce unplanned admissions to care, thus reducing NHS costs (Lewin et al The Lancet 1992). This is clearly great evidence to those involved with anticipatory care.
What role do I play in it?
My role as lead nurse in this multidisciplinary department has both a managerial and leadership remit, to ensure that the high quality service provided by our team is clinically current, patient-tailored and specifically related to the broader issues of cardiac rehabilitation and long-term conditions management. My role, in essence, is only one part of the bigger wheel – the team.
How does our programme stand out?
The Heart Manual (HM) stands out because it was ahead of its time in development and evaluation in the late1980s, and deals with both psychological and risk management issues facing CHD patients and their families.
Since 2000 the international markets of Canada, Italy and Holland have embraced it as a core component of their cardiac care, particularly in rural areas where patients cannot access a class or clinic easily. Australia, Iran and Egypt are also keen to use it too.
The programme is simple to negotiate, is supported by a facilitator and the patient gets to keep the manual for life so they can reflect back to it, for example during periods of anxiety or low mood.
When was the service changed or innovation introduced?
In 2007 the HM programme was awarded funding from the BHF to develop a single manual/programme for people with coronary disease.
This 4th edition of the Heart Manual will be launched in April 2008, which will have an increased focus on additional self-management techniques that have proved successful over the last 15 years, eg goal-setting, and will be geared towards the long-term management of CHD, thereby aligning it to current UK government agendas.
In this ‘one’ manual there will be more conditions, treatments and pictures plus fewer words, making it accessible to a wider patient audience. Conditions covered will include angina, MI, PCI, CABG, heart failure 1 & 2 and ICD, and diabetes.
What were the main reasons for this?
• a demand identified from a survey conducted by the Heart Manual in 2004
• changes in clinical practice UK-wide with a strong commitment to long-term condition management
• capacity and resource issues for managers in the NHS
What were the main problems we had to overcome?
• Editing several cardiac conditions into one manual/programme, giving ‘enough’ motivating information to the patient and their family to encourage them to want and find out more
• There is a wealth of material on specific CHD conditions and no two clinicians will ever totally agree what has the most priority to go in!
What have we learnt from our experience?
• As the new edition reaches its penultimate draft, we have learnt to utilise help from our colleagues in the UK who are experienced clinicians and trainers in the Heart Manual plus also patient feedback
• A structured proforma for them to complete will provide us with feedback that we can translate/use where possible into the new edition and training packs for clinicians.
• We are re always learning!
How many patients/staff benefited?
• Approximately 14,000 patients benefit from the programmes each year in the UK and abroad.
• Around 3,500 practising facilitators on our database
• We have 39 Heart Manual accredited trainers in the UK
• This modified programme will bring more choice to NHS managers, patients and facilitators in the treatment of CAD nationwide
What tips can you give to others?
• The HM programmes are evidence-based and flexible enough to accommodate most resources, skill mix and capacity. The programme can be introduced in the acute hospital and followed up via home visits or telephone calls at convenient times for clinician and patient
• Like everything else it takes time and practice to gain competence and as such we have included in the training pack a self-directed competence framework to enable such, which can also be used as part of an individual’s PDP
• We would suggest that after training as a facilitator you establish peer support to discuss issues that arise and learn from each other’s experiences, and the heart manual team are contactable should any immediate queries arise
• Another final tip we would suggest is that you audit your patient outcomes from using the programme; this will help identify its overall effectiveness and in turn the sustainability of the programme in your area.