‘She’s an angel in disguise.’ The evolving role of the specialist community heart nurse

Abstract

The 4H Project is a two year study (February 2001 – January 2003) designed to evaluate the impact of a nurse-led community cardiac rehabilitation service in an inner city area. The population has a high prevalence of coronary heart disease and low uptake of existing services for secondary prevention. Based on initial research exploring the needs of potential service users, the community heart nurse (CHN) delivers a holistic service to postmyocardial infarction patients in their own homes. The CHN has also initiated community-based interventions such as the setting up of support groups and a ‘Walk your Way to Health’ group. The CHN offers specialist advice to primary health care teams and works in close liaison with general practitioners (GPs) and practice nurses. This paper reports on service users’ qualitative evaluation of the CHN role. Semi-structured interviews were carried out with 34 service users, from three weeks to 18 months postmyocardial infarction. The following aspects of the service were seen as important: the sharing of information and the accessible way it was presented; offering coping strategies; confidence building and reassurance; home-based care; easy access to CHN; regular checkups; and the opportunity to meet other patients. Additional services provided by the CHN such as advice on benefits or housing were not widely used, but were appreciated by those who did need this type of assistance. The emerging model of service delivery has both strengths and limitations but is entirely consistent with the increased emphasis on reducing health inequalities and promoting evidence-based care. However, with a relatively small caseload of patients, it is not surprising that a high level of patient satisfaction has been achieved. This paper will therefore include reflection on the difficulties besetting research attempting to evaluate complex, community-based interventions.