Patient Education Patient Education

Objectives

At the end of the session, the participant will have an increased understanding of the:

  • Heart and its function
  • Development of heart disease
  • Management of coronary artery disease

Facilitator

  • This session may be facilitated by a nurse or doctor.

Course content

To include the following information:

Topic Content Resources
Introduction

The anatomy of the heart

Discuss normal heart function
Heart model
Heart disease

The disease process

How atheroma develops and the progression of coronary artery disease
 
Angina

What is angina?

Angina as a warning symptom for coronary artery disease
 
STEMI/NSTEMI

What is STEMI/NSTEMI?

Healing process

Patient recovery
 
Investigations

Blood test – troponin

Angiogram

Echocardiogram

Nuclear tests

Scans

Risk factor modification

Medication

Angioplasty/stent

Bypass surgery

Examples of tests

Diagrams

Videos of treatments

Stent model

NSTEMI = non-ST elevation myocardial infarction; STEMI = ST elevation myocardial infarction

Objectives

  • At the end of the session, the participant will be able to:
  • Understand the difference between a heart attack and angina
  • Recognise warning signs of a heart attack
  • Understand that symptoms may vary from person to person
  • Treat and manage chest pain
  • Understand an individual chest pain management plan
  • Be aware of changes in cardiac health status
  • Understand CPR
  • Understand the safety aspects of CPR

Facilitator

This session may be facilitated by a doctor or cardiac nurse.

Course content

To include the following information:

Topic Content Resources
Myocardial infarction (MI) symptoms 

Recognising the symptoms associated with an MI

Symptoms may vary from person to person

Differences between an MI and angina

Stable vs unstable angina

How angina is managed

MI is a blockage of blood flow

Recognising the warning signs of MI

Silent MIs in diabetics
Heart Attack Facts
Chest pain management action plan

How to manage chest pain

Awareness of change in health status (re-presentation of symptoms; frequency, intensity and duration of symptoms)

Stable and unstable patterns of pain

Action Plans – individualise; cover how to get help; managing with a disability

How to use GTN safely

Difference between spray and tablet forms

Getting GTN with and without a prescription

Who to contact in an emergency:

  • If calling Triple Zero (000) does not work on a mobile phone, try 112
  • If hearing or speech impaired, can contact ambulance on 106 directly through a TTY (also known as a teletypewriter or textphone)

Chest pain action plan

Who to call in an emergency

Information for deaf and speech impairments, available at National Relay Service (NRS)

 

CPR

Watch the Australian resuscitation video

Understand the importance of learning CPR

Learn the safety aspects associated with CPR

Encourage individuals to do a CPR course

Australian Resuscitation Council CPR video

Objectives

At the end of the session, the participant will understand the:

  • Reasons for medication in heart disease
  • Actions and use of angina medications (e.g., Anginine® tablets, Nitrolingual® spray), and precautions
  • Use, actions and common side effects of commonly used medications
  • Optimal management of medications and how to access further information
  • Importance of keeping an accurate, up-to-date record of medication use

 Facilitator

This session may be facilitated by a pharmacist or cardiac nurse.

Course content

To include the following information:

Topic Content Resources
Introduction Reasons for medications in heart disease  
Nitrates for angina

Difference between long-term regular and acute for chest pain

Cost/use/handling issues

  • Anginine® tablets
  • Nitrolingual® spray 

Samples of medications

Consumer medication information (CMI)
Medication overview: actions, side effects, precautions

Beta blockers

ACE inhibitors

Angiotensin receptor antagonists (sartans)

Calcium antagonists

Antiplatelet medications

Warfarin

Lipid-lowering medications

Diuretics

Antiarrhythmic medications

Medicines (Australia)

National Prescribing Service (Australia)
Tel 1300 633 424

Consumer medicine information

How to be medicinewise

Managing your medicines

Medicines List

Medimate

NPS Medicinewise

Safe and effective use of medicines

Need to know:

  • Generic vs brand names
  • Actions, side effects
  • Dosage, missed doses
  • Storage
  • Stopping treatment 
 
Useful tips and summary

Pharmacist as source of advice/information

Travelling with medications

Safe disposal of medications

Dose administration aids

Medication list/chart/card

Examples of dose administration aids 

Example of a medicines list

Objectives

At the end of the session, participants should be able to:

  • Define a healthy and balanced diet
  • Identify the types of fats for a healthy heart
  • Identify foods with a lower salt content
  • Understand a food label
  • Identify the importance of remaining within the healthy weight range

Facilitator

This session may be facilitated by a dietitian or a cardiac rehabilitation nurse.

Course content

To include the following information:

Topic Content Resource
Introduction

Risk factors for heart disease

Heart healthy diet

How to change eating habits

BMI and waist circumference 
My heart, my life (National Heart Foundation of Australia manual for patients with coronary heart disease)
Healthy diet

Core food groups and the importance of variety across and within food groups

Serve sizes

Types of fats

Omega 3 fats

The Australian Guide to Healthy Eating

Healthy Eating (National Heart Foundation of Australia)
Lifestyle and dietary modifications

Sodium intake

Alcohol guidelines

Food label reading

Ways to include heart healthy fats

Healthy cooking methods

Nutrition Education Materials Online (NEMO): Weight control resources

Australian Alcohol Guidelines

Summary and discussion

Discuss individualisation of dietary management strategies depending on weight status

Consider further dietitian intervention if any other co-morbidities

Nutrition Education Materials Online (NEMO): Weight control resources

Objectives

At the end of the session, the participant will be able to:

  • Identify precautions relevant to the particular procedure they have undergone
  • Understand why these precautions are necessary and the nature of risk
  • Be aware of how long these precautions must be followed
  • Appreciate the implications these precautions have on activities of daily living (ADL)
  • Develop problem-solving skills to modify the way they perform activity in order to comply with the precautions

 Facilitator

This session may be facilitated by an occupational therapist.

Course content

To include the following information:

Topic Content Resources
Return to normal activity following cardiothoracic surgery through sternotomy

Interactive session encouraging patient questions and discussion to cover:

  • Details of the procedure and factors that increase the risk of sternal instability
  • Lifting limits and ways to avoid lifting
  • Strain during shoulder movement and how to avoid strain when pushing and pulling
  • Single-arm raising, implications for daily activity and how to modify the task to avoid strain
  • Reasons for fatigue and breathlessness during recovery
  • Managing expectations in relation to energy levels returning
  • Pacing and managing energy levels during recovery
  • Driving restrictions
  • Specific activities, including sexual activity

Ausroads. Assessing fitness to drive

Return to normal activity following a myocardial infarction (MI)

Interactive session encouraging patient questions and discussion to cover:

  • Reasons for classifying heart attacks/MIs as complicated or uncomplicated
  • Post-MI risks
  • Initial period of sedentary activity
  • Returning to normal activity, including work and leisure time
  • Defining vigorous activity, and associated issues before resuming high level of activity
  • Specific activities, including driving, air travel and sexual activity
 

Objectives

At the end of the session, the participant will understand:

  • The psychological aspects of cardiac illness
  • How to identify stress, anxiety and depression
  • A range of coping skills to assist with living with cardiac illness and engaging in cardiac rehabilitation
  • A range of coping skills to manage stress and emotional distress, including anxiety, anger and depression

Facilitator

This session may be facilitated by a psychologist, social worker or mental health worker.

Course content

To include the following information:

Topic Content Resources
The experience of living with a heart condition and its impact on the patient and family

New roles and responsibilities

Requires patient and family to adapt to change:

  • Changes in what the patient can do, patient independence and autonomy within the family
  • Changed life circumstances (e.g., employment, financial circumstances, attending medical appointments)

Coping with physical and emotional ups and downs

Lifestyle changes (e.g., smoking cessation, diet, exercise)

Family relationship issues

Group discussion:

For example, use the following to introduce the discussion:

“Name one thing that has changed for you and your family since you experienced a heart problem and how have you reacted to this change?”

Adjustment, grief and coping with change

Describe and normalise the experience of adjustment and grief

Strategies to deal with change and adjustment

Group discussion
Depression, stress, anger and anxiety, as they relate to a cardiac condition

Describe symptoms of depression and anxiety

Describe the stress response

Explain relationships between these and this new cardiac condition

Importance of managing these problems – including improving heart health, self-management of illness, involvement in activities and relationships, quality of life

See book on Taking care of yourself and your family

Coronary heart disease, anxiety and depression

Coping with stress. How to manage stress and help your heart

Beating the Cardiac Blues Project (Resources for patients and clinicians)
Importance of support, reducing social isolation

Identify social isolation as a risk factor for heart disease

Describe the benefits of support

Identify sources of support – family, friends, health professionals, cardiac rehabilitation, support groups, interests/hobby groups
 

Building a strong support system – identify supports, how they can help, planning support

Communicating with health professionals 
Group discussion 
Managing stress, anxiety, anger and depression

Maintaining healthy lifestyle – good diet, exercise, sleep pattern

Relaxation

Support

Problem solving

Engaging in helpful, constructive thinking

Cultivating a positive approach to life

Engaging in enjoyable and meaningful activities

Helping others

Medication

See book on Taking care of yourself and your family

See section on ‘Dealing with stress, worry, and anxiety’ in An everyday guide to living with heart failure

NB: The advice applies not only to  HF, but to heart disease in general

See sections on depression, social isolation and lack of social support in My heart, my life (National Heart Foundation of Australia manual for patients with coronary heart disease)
Managing relationships

Roles and relationships can change following onset of cardiac condition

The impact of anxiety on the patient and family

Managing anxiety – allowing the patient to get on with life

Assessing needs and expectations

The importance of good communication, mutual support, problem-solving approach to deal with current circumstances

Group discussion

See section on ‘Managing the changing relationships’ in An everyday guide to living with heart failure

NB: The advice applies not only to HF, but to heart disease in general

See www.heartfailurematters.org section on ‘Talking to your family about heart failure

NB: Although this information primarily focuses on HF, it is , however, relevant to all cardiac patients and their families
Working towards recovery

The health condition and what to do about it

Taking personal responsibility and working with your health care team

Attending cardiac rehabilitation

Making lifestyle changes

Addressing barriers to self-care (accepting what has happened, motivation, depression)

Strategies to maintain good self-care (motivation and cycle of change)

Setting goals

Getting support

Problem solving

Prioritise health 
Group discussion
Accessing help for psychological difficulties

Discuss with GP, rehab team or other medical team

Professional websites
 

Objectives

At the end of the session, the participant will understand the:

  • Difference between physical activity and exercise
  • Benefits of keeping active
  • General principles of exercise
  • Benefits of both aerobic and resistance training
  • Factors that impact upon exercise adherence and the strategies to enhance these
  • Exercise limitations imposed by co-morbid medical conditions

 Facilitator

This session may be facilitated by a physiotherapist or clinical exercise physiologist.

Course content

To include the following information:

Topic Content Resources
Physical activity and exercise Definition of physical activity versus exercise  
Benefits of keeping active

Deconditioning cycle

General benefits of exercise

WHO 2010: Global Recommendations on Physical Activity and Health

Physical activity guidelines

Warm up and cool down

FITT principle

Recommended exercise intensity (RPE – Borg scale)Types of exercise – aerobic and resistance training

Rating of Perceived Exertion (Borg scales)

See Exercise training
Safety issues

Self-monitoring

Management of symptoms

Precautions and when to cease exercise

Effect of medications on exercise
Examples of scenarios (e.g., chest pain, unreasonable shortness of breath, dizziness)
Exercise adherence

Home exercise

Identifying barriers and facilitators to exercise

Tools to enhance adherence

Alternative exercise options (e.g., Heartmoves, walking programs, other community programs)

Home exercise diary

Pedometer

Heartmoves

Local councils

Council on The Ageing (COTA): Living Longer Living Stronger

Specific conditions

Exercise and diabetes

Other relevant conditions (respiratory, peripheral vascular disease)
 
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  • Boyde M, Tuckett A, Peters R, et al. Learning style and learning needs of heart failure patients (The Need2Know-HF patient study). Eur J of Cardiovasc Nurs 2009;8:316-322.

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  • Beattie J, Goodlin S (Eds.). Supportive Care in Heart Failure. Oxford ; New York: Oxford University Press, 2008

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