Cardiac Nursing Can Be a

Cardiac nursing can be a frenzied experience with doctors sometimes losing their cool and harried nurses overreacting, under reacting, or, due to the stress and demands of the occupation, experiencing burnout that may often consequent in job attrition. This, it seems to me, may particularly be the case with cardiac nursing where it is reported that approximately more than 300,000 Americans undergo coronary bypass surgery each year with another 920,000 suffering their first or subsequent heart attack and 80 million people having some sort of cardiovascular disease (Salmon, 20008).

This can make the ICU a harried, stress-driven place for any nurse where the patient's needs can easily be overlooked. I work at MGH as a perioperative nurse (surgical) in the cardiac service.My duties range from responsibilities for assuring competent, compassionate nursing care for my specific patients and families to technical aspects.I can perform the role as a circulator nurse or scrub nurse in various cardiac procedures.I take care of many cardiac MIS/Robotics patients. The surgeon that performs this type of surgery is Dr. Agnihotri.

The term 'competent, compassionate nursing' can be an oxymoron in terms, for 'competent' nursing often entails saving the patient no matter the degree of discomfort involved (although we attempt to attenuate that degree of discomfort) and this level of competence can, obviously, therefore often conflict with 'compassion'.

Dr.Agnihotri is a big stickler of compassion and his conduct is reminiscent of the American Association of Critical-Care Nurses (AACN) Synergy Model which maintains that nursing should be based on meeting the patient's needs and on qualitative care rather than on following a set of rigidly delineated methods (Hardin, 2005).

Although he has never defined his conduct as following that method, I have time and again paralleled his actions with that nursing orientation and considered myself fortunate to be his assistant and thus able to observe and learn from his compassionate approach that places people before medicine.

The AACN synergy model states that the patient possesses eight characteristics (resiliency, vulnerability, stability, complexity, resource availability, participation in care, participation in decision making, and predictability), and that the nurse possesses a corresponding eight skills (clinical judgment, advocacy and moral agency, caring practices, collaboration, systems thinking, response to diversity, facilitation of learning, and clinical inquiry). To the degree that nurses match their skills with patient's needs, thus is qualified nursing met (AACN, 2006).

From my experience, most surgeons, specifically in the cardiac ward focus on the minutiae of their skill and on saving the patient's life mo matter what. A failed surgery seems to them to cast aspersions on their skills. Dr. Agnihotri is, however, unique in that he places the patients needs first and foremost and ascertains that his assistants and interns do the same.

A case, at one time, for instance, that made ripples around the ward and impressed me intensely involved patient x who, at a great deal of pain and an advanced age with a surgery that seemed to promise only complications, just wanted to expire. Her family, however, endeavored to keep her alive, despite cost, level of pain, frequency, extension, and complications of surgery involved. Dr.

Agnihotri focused on the needs and holistic requirements of the patient during that specific time, and advocating for the patient, helped the family consider the patient's perspective and devise ways that they could reconcile themselves to enabling the patient to die in the most dignified manner. A task-driven surgeon would have focused on keeping the patient alive regardless of the manner.