Cara Murphy is a Clinical Nurse Specialist in heart failure in Wexford General Hospital. As well as working with heart failure patients for the past 12 years, Cara has worked in a range of other cardiac specialities, including cardiac rehabilitation and CCU so cardiac care has always been of importance to her.
‘I met patients during cardiac rehabilitation, that now 20 years later, I am seeing presenting to my heart failure clinic.
“The type of patients I see include those who have had an acute MI (heart attack) and immediately develop heart failure, those with an impaired ejection fraction (the amount of blood pumped out by the heart) post-acute event, people with atrial tachycardia / an arrythmia (irregular heartbeat) or the multimorbid patients who are also managing hypertension, diabetes, chronic renal failure, etc and go on to develop heart failure. The spectrum of patients is broad.”
In addition to the multiple conditions, age is also a varying factor, and Cara explained that while although many of her patients can be over age 70, some are in their 40s and 50s, with her youngest patient being 18, and the eldest being 104.
Cara’s role while difficult, is very rewarding. “Patients are so grateful for the support. They have a direct phone number they can call for advice, or if they would like to run something past us, it could be a simple query on ‘is it ok to take paracetamol with my current tablets?’, otherwise they would need to make an appointment with their GP which could take some time, and these queries can build on a person’s mind.
"“The very term ‘heart failure’ can be extremely frightening. During my clinic, I help people manage the diagnosis and condition."
Some people are horrified by the diagnosis, they think of dying or a reduced life-expectancy so my work includes teasing these worries out, and explaining that it is a chronic illness that can be managed by lifestyle changes. I dispel the myths and try to restore their confidence.”
The Irish Heart Foundation’s Heart Connect Service then compliments the heart failure clinic. “In recent years, I’ve realised that the Irish Heart Foundation offers so much and certainly the spectrum of services to the heart failure patient has grown significantly and is wonderful for the patient. The fact that it offers the psychological support, peer support, and even when a patient is finished with me, they still have that support of being able to pick up the phone, contact the Irish Heart Foundation, if they have another query or are afraid to bother someone in the hospital.
“These are the main things I signpost patients to, but I’m aware of additional services the Irish Heart Foundation can signpost patients to, like the gaining knowledge on disability benefit, financial support or formalising additional time off work to manage their condition.
“The psychological support and counselling, either online, by phone or in person has been the main resource I have used the Heart Connect Service for. It’s great to have those options. Sometimes I give out the leaflet directly to my patient but information on the IHF services are also available in our waiting area, should a person want more info to take home.”
The Irish Heart Foundation encourages both medical professionals and patients themselves to refer into the Heart Connect Service. “The referrals process is easy – I use the link. Sometimes it can take patients time to admit they need more support. They initially might think, ‘I’m coping fine, I’m doing perfectly. The fact that the patient can refer themselves for the Heart Connect Service is great, they can do so when they feel they need it.”
Psychological support is a key part of the Irish Heart Foundation’s Heart Connect Service, and it addresses the unmet psycho-social needs of individuals living with heart failure. It aims to improve the quality of life, reduce feelings of isolation, provide timely and accurate information, and raise awareness about effective symptom management.
“Some of my patients who have used the counselling service have said they found it very useful, it’s all about coping strategies and sometimes they need that one on one, to be heard, to have their opinion validated and it can be easier to talk to a stranger, especially on the phone if they’re not looking at you.
“I know that the patients that have availed of the psychological support and manage to relax enough to be able to cope with their symptoms are doing well, or are being looked after by the Irish Heart Foundation which means they don’t need that additional support from me.”
Cara and her patients have also used or recommended other Irish Heart Foundation services, including the Nurse Support Line, private Facebook group ‘Heart Support Network’ and information leaflets: “All the patient information leaflets are wonderful, we would be lost without them.”
Cara recommends the service, and said: “I would absolutely recommend the Heart Connect Service to other nurses, there are three of us in my clinic, and we are all very familiar with it and would use it and refer regularly. We have nowhere else to refer patients to when it’s individual psychological supports that the person requires, so it’s a very important service.”
