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Improving knowledge of CHD

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Kathryn King, BSc (Hons), MSc, RN, NT.

Senior Lecturer and Doctoral Student, University of Sunderland


The National Service Framework (NSF) for Coronary Heart Disease (CHD) (DoH, 2000) reinforced the message, once again, that CHD is one of the most significant causes of morbidity and mortality in the UK.

The framework endorses the Government's commitment to tackle the disease. It states that adequate provision of health care will be available to meet the needs of local populations and that the concept of the 'postcode lottery' of care will become a thing of the past.

CHD in Sunderland
CHD is a major concern in Sunderland, in the north-east of England, where 865 deaths occur from the disease per 100 000 population in those aged 65-74 years, compared to 661 nationally. Between 1995 and 1997, 210 more people died as a result of CHD in Sunderland than if the death rate had been line with the national level (Sunderland Health Authority, 2000).

Consequently, Sunderland's Health Improvement Programme (HImP) has identified CHD as a priority area. In 1999 a multi-agency group was established, which is responsible for planning and monitoring all CHD services in accordance with national guidance.

The NSF cites that primary care teams, health authorities, primary care groups/trusts and hospital trusts will all contribute to the delivery of the framework. Primary care is the gateway for the provision of quality health care, with practice nurses and community nurses considered suitable and well placed to deliver health promotion activities.

Training needs analysis
A training officer was commissioned to support the local HImP and conduct a training needs analysis in Sunderland. The aim was to find out the educational status of nurses in primary and secondary care in terms of the management of CHD. The analysis revealed a general lack of knowledge and academic attainment and the Sunderland HImP group identified an urgent need for an educational programme.

Also at this time partnerships were being developed between primary and secondary care and the University of Sunderland. A tripartite relationship developed and soon plans were underway to develop an appropriate educational programme to not only ensure the recommendations in the document Fitness for Practice and Purpose (UKCC, 1998) were met, but also to realise the needs of the national health-care agenda and support the local agenda in Sunderland.

Expert advice was sought from a prominent cardiologist, a clinical lead nurse specialist for CHD and her team of specialist nurses. Key stakeholders from across Sunderland were consulted to ensure a co-ordinated and collaborative approach.

Educational initiative
After discussions with all interested parties, a CHD module was designed and validated by both the University of Sunderland and the English National Board.

The 15-week module was initially validated with 20 credits at level 2, and has recently been validated with 20 credits at level 3. The module has been designed, developed and is taught by local specialists. It addresses local priorities and endorses the concepts of 'knowledgeable doers' (DoH, 1999) and 'fit for purpose practitioners' (UKCC, 1998).

The module content synopsis includes exploring developments in the management of CHD, the analysis of physiological, psychological and sociological principles of the patient with CHD, as well as practical workshops relating to diagnostic testing, for example ECGs. The module, which encourages the student to become a reflective practitioner and a change agent, is offered to all nurses involved in addressing the Sunderland agenda for CHD.

The first CHD module has been evaluated successfully. The course participants said that they found it 'very enabling and informative,' and 'very relevant to clinical practice'. As a result of attending the module, all participants felt competent and confident to enhance patient care and the patient experience.

In keeping with the concept of lifelong learning, the CHD module is an example of best practice in the delivery of health-care provision. It is available as a standalone short course or as part of a programme of study, such as the Diploma in Higher Education (HE) or the BSc (Hons) Nursing degree.

This exciting educational initiative has been funded by the Sunderland HImP, and involves all local NHS organisations, including the health authority, two local hospital trusts, the primary care groups, primary care trust, social services, the community health council and the University of Sunderland.

The success of the programme is the result of working in partnership, having a co-ordinated approach across primary and secondary care, and having a common goal to improve health-care provision for the people of Sunderland.

Such a cohesive, co-ordinated strategy will ensure high standards of health-care in the area and demonstrates the concept of true collaboration and best practice. Together we will 'make a difference' and tackle coronary heart disease.

- The authors would like to thank Dr Martyn Farrer, Cardiologist,City Hospitals Sunderland; Sandra Ansah, CHD Specialist Nurse, Sunderland, Carol Donkin, CHD Specialist Nurse, Sunderland, and Paula Sinclair CHD Specialist Nurse, Sunderland.

The CHD module is available to health-care professionals at a nominal charge and franchise arrangements are possible. For further information please contact Kathryn King at University of Sunderland, Fleming Building, Wharncliffe Street, Sunderland SR1 3SD. Email kathryn.king@

Department of Health. (1999) Making a Difference. London: The Stationery Office.

Department of Health. (2000)The National Service Framework: CHD. London: The Stationery Office.

Sunderland Health Authority. (2000)Annual Report. Sunderland: Sunderland HA.

UKCC. (1998)Fitness for Practice and Purpose. London: UKCC (now NMC).

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