"Expanding the role of advanced nurse practitioners—risks and rewards" Skills to manage appropriate pain and/or sedating agents and monitor therapeutic effects for patients receiving mechanical ventilatory support. Therefore, the left column reflects the competencies expected of most NPs and PAs practicing within adult cardiovascular medicine. Skill to facilitate timely referral to cardiac rehabilitation following acute coronary syndromes. Know the pathophysiology, differential diagnosis, and management of ventricular arrhythmias. Skills to clinically evaluate and manage patients with acute and relapsing pericarditis. Model cardiovascular teams are composed of members including but not limited to cardiologists, NPs, PAs, behavioral scientists, cardiovascular technologists, clinical nurse specialists, data/informatics professionals, exercise physiologists, genetic counselors, nurses, occupational therapists, pharmacists, physical therapists, registered dieticians, and social workers. Know basic and pathological cardiac embryology and epidemiological influences on the development of congenital heart disease. Skill to recommend lifestyle interventions for patients with stable coronary artery disease. Know the differential diagnosis of heart failure or shock following cardiac transplantation. Know the structure of normal arteries and basic vascular biology of atherosclerosis. Know the indications, contraindications, and monitoring implications of medications used in adults with complex congenital heart disease. Skills to develop, implement, manage, and evaluate an evidence-based, age-appropriate plan of care for patients with lipid disorders. The table does not necessarily reflect relationships with industry at the time of publication. Medical Knowledge about established and evolving biomedical, clinical, and cognate (e.g., epidemiological and social-behavioral) sciences and the application of this knowledge to patient care. Cardiovascular NP and PA Competencies 2487, Table 1. Competency Framework for Nurse Practitioners and Physician Assistants in Adult Cardiovascular Medicine 2487, Table 3. A person is deemed to have a significant interest in a business if the interest represents ownership of ≥5% of the voting stock or share of the business entity, or ownership of ≥$5,000 of the fair market value of the business entity; or if funds received by the person from the business entity exceed 5% of the person’s gross income for the previous year. Skills to recognize and document distinguishing characteristics of heart murmurs and sounds, vascular bruits, and peripheral pulses. Know normal and abnormal hemodynamic values and factors affecting cardiac output. Know the indications, contraindications, and adverse effects of anticoagulants in patients with atrial fibrillation and flutter. Know the indications, risks, and benefits for electrophysiology studies and catheter ablations. Eric S. Williams, MD, MACC‡Former Competency Management Committee member; member during this writing effort.Former Competency Management Committee co-chair, co-chair during this writing effort.Former Competency Management Committee chair, chair during this writing effort. Skills to develop, implement, and evaluate lifestyle interventions for prevention and treatment of patients with cardiovascular risk and/or comorbidities. Core Competencies and Scope of Practice in Nursing Informatics November 30, 2020 / in / by developer The continued integration of information technology within the nursing profession is resulting in the development of nursing informatics as a distinct specialty. Skill to initially evaluate patients with extracranial carotid and vertebral artery disease. According to the ACC, a person has a relevant relationship if: a) the relationship or interest relates to the same or similar subject matter, intellectual property or asset, topic, or issue addressed in the document; b) the company/entity (with whom the relationship exists) makes a drug, drug class, or device addressed in the document, or makes a competing drug or device addressed in the document; or c) the person or a member of the person’s household, has a reasonable potential for financial, professional or other personal gain or loss as a result of the issues/content addressed in the document. Skills to evaluate and manage patients with inherited and acquired forms of vasculitis. Know the methods to evaluate and manage hypertension, diabetes, and dyslipidemia in diverse patient populations. Nurse Practitioner Core Competencies Scientific Foundation Competencies 1. Know the methods to assess preoperative risk for patients with known or suspected cardiovascular disease undergoing noncardiac surgery. The American College of Cardiology requests that this document be cited as follows: Rodgers GP, Linderbaum JA, Pearson DD, Fernandes SM, Housholder-Hughes SD, Mendes LA, Berg NC, Day J, Drajpuch D, Erb B Jr, Farquhar-Snow M, Johnson H, Keegan P, Kindler C, Larsen R, Le VT, Nickolaus MJ, Phillips CM, Ross L, Webb SR, Zado ES. 6. J Am Coll Cardiol 2015; 65:1721-1723. Know the indications for insertion of implantable cardioverter-defibrillators. 2 0 obj Skill to counsel patients about levels of physical activity appropriate to their cardiovascular health status. 19/11/2020 Office hours this holiday season. ). Skill to participate in hemodynamic catheterizations in patients with heart failure. The American College of Cardiology Lifelong Learning Oversight Committee approved this document in January 2020. Skills to evaluate and manage patients with supraventricular tachyarrhythmias. For copies of this document, please contact Elsevier Inc. Contact Us. Know the indications for cardiac catheterization for adults with simple congenital heart disease. Know the common cardiovascular complications of noncardiac surgery. Skill to recognize cardiac devices that are designated magnetic resonance imaging conditional. Skill to manage patients with acute myocardial infarction and associated complications. Know the indications for hemodynamic catheterization in adults with complex congenital heart disease. This resulting document describes the key anticipated competencies for cardiovascular NPs and PAs, including those in general cardiovascular practices and those in focused areas of cardiovascular medicine. Know the pharmacological agents that may interfere with blood pressure control (e.g., nonsteroidal anti-inflammatory drugs). These relationships were reviewed and updated in conjunction with all meetings and/or conference calls of the writing committee during the document development process. Skill to participate in advanced cardiac life support, emergent defibrillation, transcutaneous pacing, and cardioversion. Available at: https://www.aanp.org/practice/practice-information-by-state. These competencies may be assessed by the review of one’s individual practice, by review of hospital data, or through performance assessments or practice improvement initiatives. Know the risks, preventive measures, and treatments for acquired heart disease in the congenital heart disease population. Acknowledgments The College of Nurses of Ontario (CNO) would like to thank CNO members who participated in the review and revision of this document. Skill to assess the cardiovascular risks associated with recreational and/or competitive sports, physically demanding occupations, and other vigorous physical activities. 33. Accessed November 14, 2019. Identify and address socioeconomic barriers impacting cardiovascular care and refer to other team members as needed. Know the risks, benefits, indications, and timing for diagnostic coronary angiography. Skills to initiate management of urgent or emergent cardiovascular conditions and prioritize management of patients with multicomponent illness. A Nurse Practitioner is an Advanced Practice Nurse who integrates clinical skills associated with nursing and medicine in order to assess, diagnose and man- age patients in primary healthcare (PHC) settings and acute care populations as well as ongoing care for populations with chronic illness. Know the indications for genetic screening of premature atherosclerotic disease. Know the anatomy and physiology of the cardiac conduction system. Skill to recognize patients with common inflammatory disorders or systemic diseases that may adversely impact cardiovascular disease risk. The ACC approved the document for publication with endorsement from the American Academy of Physician Assistants, American Association of Heart Failure Nurses, American Association of Nurse Practitioners, American Heart Association, American Nurses Credentialing Center, Association of Physician Assistants in Cardiology, Heart Rhythm Society, Physician Assistant Education Association, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and The National Organization of Nurse Practitioner Faculties. "Primary care workforce shortages: nurse practitioner scope-of-practice laws and payment policies" Cardiovascular Disease Prevention Competencies for Cardiovascular Nurse Practitioners and Physician Assistants 2498, Table 9. Nurse Practitioner Core Competencies with Suggested Curriculum Content 2017 In the development of the nurse practitioner (NP) population-focused competencies, a task force had extensive discussions of competencies vs. content. 4. Skills to utilize and titrate medical therapy for patients with heart failure in both the hospital and outpatient care settings. Skill to obtain a problem-focused history and physical examination in patients with coronary artery disease and variant angina. Skill to identify genetic syndromes in adults with congenital heart disease. They serve as guidelines for educators, Skill to participate in intubation and extubation of patients from mechanical ventilatory support. Skill to perform pre-pregnancy risk assessment and peripartum coordination with obstetric colleagues for women with congenital heart disease. The statement emphasized the important collaboration between cardiologists, nurse practitioners (NPs), physician assistants (PAs), and other cardiovascular team members in the care of patients. The American Academy of Physician Assistants, American Association of Nurse Practitioners, American Heart Association, Physician Assistant Education Association, and The National Organization of Nurse Practitioner Faculties endorsed the document in March 2020. Know the effect of arrhythmias on heart failure status, initial treatment of arrhythmias, and referral for patients with arrhythmias. Recommendations in these statements are based on available evidence and, where evidence is lacking, reflect the consensus of expert opinion. Identify one AACN BSN Essential that will be most important in improving quality in your future nursing practice. / Practice and CNS Role / CNS Competencies / Adult/Gero Competencies. Prerequisite education, training, experience, and demonstrated competency provide a foundation to function in a collaborative team environment with significant autonomy, extending the capabilities of the general or subspecialty cardiologist and the entire cardiovascular team. The writing committee convened by conference call and e-mail to finalize the document outline, develop the initial draft, revise the draft based on committee feedback, and ultimately approve the document for external peer review. Skill to identify physical findings of pericardial effusion, tamponade, and chronic constrictive pericarditis. Know the types of, indications for, and contraindications to mechanical circulatory support, including intra-aortic balloon counterpulsation, percutaneous and surgical ventricular assist devices, and extracorporeal membrane oxygenation. Know the indications for and contraindications to pharmacological agents for treatment of acute and relapsing pericarditis. Know basic lipoprotein biochemistry and metabolism. Competencies for Registered Nurses will take effect September 2020. Collaborate in screening patients for investigational therapies and clinical trials, as applicable. Former Competency Management Committee member; member during this writing effort. Know the transitional and outpatient strategies to avoid preventable hospitalizations in patients recently discharged with heart failure. Skill to triage patients by phone or in person according to their presenting symptoms and medical urgency. This competency framework addresses the common core competencies and the wider range of skills, knowledge and behaviours a nurse needs, to be a fully proficient General Practice Nurse (GPN). Skills to evaluate and manage patients with ventricular arrhythmias. "A comparison of conventional and expanded physician assistant hospitalist staffing models at a community hospital" Know the indications for selection of pacemaker systems and cardiac resynchronization therapy. It is important to recognise that these competencies may take time to fully develop and consolidate, progress will vary according to working context and the individual. Know the indications for genetic testing and counseling in patients with known or suspected inherited thoracic aortic syndromes. Assess for and manage human responses exhibited by individuals with cardiovascular disease (e.g., depression, spiritual distress, nonadherence, decisional conflict). The ACC Competency Management Committee oversees development of competency statements for cardiovascular specialists covering the entire career spectrum. Know the principles of adult learning theories to plan and deliver education for atherosclerotic cardiovascular disease risk reduction. Know the interventions and surgeries performed for complex congenital heart disease. Know the genetic implications of family history and environmental and lifestyle factors in the development and clinical course of cardiovascular disease. . Know interventions to reduce risk of deterioration of physical and mental functioning in patients with acute heart failure. Skills to recognize and manage musculoskeletal limitations during cardiac rehabilitation sessions. Know the pathophysiology and clinical findings of pulmonary arterial hypertension. Know the pathophysiology, differential diagnosis, and management of cardiac conduction disturbances. "2015 ACC health policy statement on cardiovascular team-based care and the role of advanced practice providers" Skill to identify genetic syndromes associated with inherited thoracic aortic syndromes, including Marfan Syndrome and Loeys-Dietz. Skill to obtain a history and physical examination as clinically indicated in patients with suspected acute coronary syndromes. Know the appropriate timing to refer patients with heart failure for cardiac resynchronization therapy, invasive monitoring, invasive support, and/or transplant. Know the noninvasive diagnostic studies and indications for vascular screening for carotid artery disease, abdominal aortic aneurysm, and peripheral artery disease. Scholarly activity and clinical research are also important in lifelong learning and professional competency. Know the pathophysiology, differential diagnosis, and management of atrioventricular nodal re-entrant tachycardias and accessory pathways. Know the complications of vascular access. Know the differential diagnosis and clinical features of patients with typical angina, variant angina, and noncardiac chest discomfort. Know the pathophysiology and management of bicuspid aortic valve and associated aortopathy. Know the postoperative complications of patients admitted to the critical care unit following cardiac surgery or catheter-based interventions. Know the pathophysiology, differential diagnosis, clinical signs, and symptoms in patients with shock, systemic inflammatory response syndrome, and acute respiratory distress syndrome. View all . Skill to counsel adults with congenital heart disease on exercise modalities. Attend to one’s own health, well-being, and abilities in order to maximize personal and professional performance. (2020). Know the pharmacological effects, risks, and benefits of vasoactive and inotropic agents. Writing committee members volunteered their time to this effort. Know pharmacotherapy for the management of patients with acute coronary syndromes. A member of the ACC Competency Management Committee served as lead reviewer to ensure a fair and balanced peer review resolution process. 7. Participate in practice-based continuous quality improvement and safety initiatives. Skill to participate in the insertion of permanent pacemakers, internal cardiac defibrillators, or cardiac resynchronization devices. Know the indications and contraindications for advanced cardiac imaging in patients with heart failure. Skills to perform and evaluate a cardiac risk assessment in patients undergoing vascular procedures. Skill to integrate clinical information and test results to assess risk, establish diagnosis, formulate treatment, and manage follow-up for patients with cardiovascular disease. Skills to evaluate and manage patients with bradyarrhythmias and heart block. Skill to manage patients with chronic ischemic heart disease and associated risk factors. Skills to perform and interpret findings of physical examination for detection of acute and chronic arterial compression syndromes. All cardiovascular NPs and PAs should have the skills to assess new research findings and appropriately incorporate new diagnostic and treatment modalities in patient care. Know the indications for duplex ultrasonography of the aortic, carotid, renal, mesenteric, and extremity arteries; arterial bypass grafts and stents; aortic endografts; and intracranial vessels. Know the indications, risks, and complications of device extraction. Know the epidemiology of cardiovascular conditions, including incidence, prevalence, age, gender, and ethnicity, and the implications for diagnostics, management, and surveillance recommendations.
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