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BRIEF RESEARCH ARTICLE
Year : 2022  |  Volume : 66  |  Issue : 3  |  Page : 367-370  

Nurse-led cardiovascular diseases risk assessment and communication using WHO/ISH risk prediction chart in a tertiary care hospital of North India


1 M.Sc Nursing Student, National Institute of Nursing Education, Postgraduate Institute of Medical Education and Research, Chandigarh, India
2 Associate Professor, National Institute of Nursing Education, Postgraduate Institute of Medical Education and Research, Chandigarh, India
3 Professor, Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India
4 Professor, Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
5 Associate Professor, Department of Hospital Administration, Postgraduate Institute of Medical Education and Research, Chandigarh, India

Date of Submission15-Jul-2021
Date of Decision01-Aug-2022
Date of Acceptance03-Aug-2022
Date of Web Publication22-Sep-2022

Correspondence Address:
Kavita Kavita
National Institute of Nursing Education, Postgraduate Institute of Medical Education and Research, Chandigarh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijph.ijph_1539_21

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   Abstract 


Cardiovascular diseases (CVDs) contribute to most of the potentially preventable burden through early risk assessment. Nurse-led CVD risk assessment is an effective strategy to address the human resource crisis for CVD prevention. An interventional study was conducted in medicine wards of a tertiary care hospital in North India to train nurses in CVD risk assessment and its communication. All bedside nurses (n = 30) of selected wards were enrolled and trained in CVD risk assessment and communication using WHO/ISH risk prediction charts. Once fully trained, each nurse enrolled patients (>40 years of age) from their respective wards to assess and communicate CVD risk. To calculate the reliability of risk assessment, investigator simultaneously assessed CVD risk with nurses. The mean age of nurses was 32.07 ± 6.31 years. The results revealed that training significantly increased the knowledge of nursing personnel (P < 0.001). There was perfect inter-rater reliability agreement (Cohen's k = 0.929) between nurses and investigators while assessing CVD risk. Nurses demonstrated good communication skills. The study concluded that nurses can be trained successfully in CVD risk assessment and communication. The study recommends the task shifting of CVD risk assessment to nurses after providing proper training.

Keywords: Cardiovascular diseases, risk assessment and communication, task shifting, WHO/ISH risk prediction chart


How to cite this article:
Ankita A, Kavita K, Thakur J S, Suri V, Arora P. Nurse-led cardiovascular diseases risk assessment and communication using WHO/ISH risk prediction chart in a tertiary care hospital of North India. Indian J Public Health 2022;66:367-70

How to cite this URL:
Ankita A, Kavita K, Thakur J S, Suri V, Arora P. Nurse-led cardiovascular diseases risk assessment and communication using WHO/ISH risk prediction chart in a tertiary care hospital of North India. Indian J Public Health [serial online] 2022 [cited 2022 Sep 28];66:367-70. Available from: https://www.ijph.in/text.asp?2022/66/3/367/356591



Task shifting to nurses can be an effective way to prevent and control cardiovascular disease (CVDs).[1],[2] CVDs cause a high potentially preventable burden and assessment of risk factors at an early stage is important for prevention of CVDs. Assessment of CVD risk factors at an early stage is important for the prevention of CVDs.[3] The increasing burden of CVDs causes an increase in demand for health-care services including human resource. India is facing a great human resources for health (HRH) deficit which is a challenge in implementing CVD prevention programs. Nurses can play a bigger role in CVD prevention. However, there is limited evidence about nurses' involvement in CVD prevention programs from low–middle-income countries (LMICs). CVD risk assessment by nurses can optimize the use of existing human resources. Thus, the study was undertaken to train nurses in CVD risk assessment and communication.

An interventional research design was used in this study. The research study was conducted in the medicine wards of Nehru Hospital, PGIMER, Chandigarh. All bedside nurses of selected medicine wards (n = 30) were enrolled through the total enumeration sampling technique. The outcome of the study was the knowledge and skill of nurses in CVD risk assessment and communication.

The training package was developed which included an (i) information booklet for nursing personnel that included information on CVD its risk factors and preventive measures, (ii) pamphlets for patients with information on CVD risk factors and prevention, and (iii) flash book on CVD for nurses to educate patients on lifestyle modification. Sociodemographic profile was assessed using a questionnaire for nursing personnel and patients. The questionnaire was constructed and validated by experts; it had a total of 27 questions for the assessment of nurses' knowledge of CVD risk assessment and communication. The maximum score was 27 and scoring levels were categorized as excellent (>25), good (21–25), average (16–20), and poor (10–15).

All the enrolled nurses were trained using the package. One-to-one training was done by using lecture cum discussion and demonstration method. Case scenarios were used for the skill development of nursing personnel. A posttest evaluation was done after the training. After getting fully trained, each nursing personnel enrolled patients (>40 years of age) for CVD risk assessment and communication. A total of sixty-one patients were enrolled by the nursing personnel. All the patients were assessed by nurses for height, weight, body mass index (BMI), hypertension (HTN), smoking, alcohol intake, physical activity, and dietary pattern. CVD risk of the patient using WHO/ISH risk prediction charts was assessed by nurses as well as trained investigator. Inter-rater reliability was evaluated with Cohen's kappa among the assessed cases.

The communication skills of nurses were assessed when communicating CVD risk and lifestyle modification to patients by the KALAMAZOO communication checklist. The maximum score on the checklist was 45, higher score indicating better communication skills. Communication scores were categorized as excellent (>40), very good (31–40), good (21–30), and fair (10–20). Feedback was taken regarding the level of satisfaction from nursing personnel using a feedback opinionnaire.

Ethical clearance was taken from the Institutional Ethics Committee of PGIMER, Chandigarh. Written informed consent was taken from each participant. Data analysis was done using SPSS version 20.0. The study was registered in Clinical Trials Registry-India (CTRI) with registration number CTRI/2020/06/026138.

The results revealed that the mean age of nurses was 32.07 ± 6.31 years and 66.7% of them had 10–15 years of work experience. As per qualification, 2 (6.7%) had a diploma in nursing, 24 (80.0%) were graduates, and 4 (13.3%) of them were postgraduates.

The training was effective in increasing the knowledge of nurses regarding CVD risk assessment as there were more proportion of nurses with correct responses in posttest [Table 1]. Knowledge scores significantly increased from 17.100 ± 2.975 in pretest to 25.600 ± 1.248 in posttest with the mean change of 8.5 (P < 0.01). Inter-rater reliability of risk assessment by nurses and the trained investigator was measured by Cohan's Kappa. The results revealed perfect inter-rater reliability (k = 0.929) between scores generated by nurses and investigator. Nurses also showed good communication skills with a mean score of 26.11 ± 3.168 as per the KALAMAZOO communication checklist.
Table 1: Knowledge of nursing personnel regarding cardiovascular diseases risk assessment before and after training (n=30)

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A total of 61 admitted patients were enrolled by trained nurses, out of which 26 (41.9%) were female and 35 (56.5%) were male. The mean age of patients was 54.1 ± 8.6 years.

CVD risk profile of patients revealed that 32.8% had normal BMI and 6.6% were obese and 11.5% were underweight. Among enrolled patients, 27 (44.3%) had HTN and 26.2% had diabetes mellitus. As per the CVD risk prediction chart, majority of them (72.1%) had a CVD risk of <10% and 4.9% had a CVD risk of 30% to <40 [Table 2].
Table 2: Risk profile of patients enrolled by nursing personnel for cardiovascular diseases risk assessment and communication (n=61)

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CVDs account for most NCD deaths and its burden is higher in LMICs like India. CVD accounts majority of potentially preventable disease burden. However, HRH deficit is a major challenge in implementing prevention programs. The strategy of task shifting to nurses can help in utilization of existing qualified workforce to prevent this burden. Nursing personnel were selected for CVD risk assessment and communication in the current study as they are already available work force in every health-care setting. Nurses can motivate patients in adopting lifestyle modification for the prevention of these risk factors. Hayman et al. support that nurse-directed case management has the potential to effect positive change in both primary and secondary prevention of cardiovascular diseases worldwide.[4] However, there is limited evidence from LMICs related to nurses' involvement in CVD prevention programs.[5]

WHO/ISH risk chart was used in the current study as no country-specific CVD risk prediction charts are available in India. Many researchers in India have used this chart for the assessment of CVD risk.[6]

The training was provided through one-to-one interaction due to COVID-19 restrictions, using lecture-cum-discussion and demonstration method. After getting fully trained, each nurse performed a CVD risk assessment on admitted patients in their respective wards. The result of the present study revealed that there was perfect agreement between nursing personnel and investigator (k = 0.929). A study conducted by Kavita et al. on task shifting of cardiovascular risk assessment and communication by nurses also used Cohen's kappa to see the level of agreement between nurses and investigators revealed a high level of agreement (k = 0.84) between the risk scores generated by nurses with that of investigator.[7]

CVD risk profile of patients revealed that 72.1% of the patients were in low-risk category and 4.9% were in very high-risk category. Our findings are consistent with the study done by Muthunarayanan et al. among rural population of Tamil Nadu, which showed that 79.9% of population was in low-risk category and 2.5% population was in high-risk category.[8]

However, a study conducted by Ghorpade et al. using WHO/ISH risk prediction charts in a rural population of South India also shows that 86.0% of the population had CVD risk of <10%.[9] The different research methodologies used in both studies can be the reason for differences in the study results. The mean systolic and diastolic blood pressures of patients in the current study were 129.620 ± 16.320 and 78.130 ± 9.966, respectively. A study conducted by Norman et al. on the burden of CVD risk factors of a rural population in South India also reported the similar results where the mean systolic and diastolic blood pressures were 124.87 ± 18.48 and 81.49 ± 11.12, respectively, among the studied population.[10]

After the assessment of CVD risk, the communication skill of nursing personnel was assessed as per the KALAMAZOO communication checklist. The current study results revealed that the majority (86.9%) of them achieved good scores. This can be because they deal with patients on a daily basis, but still, there is room for improvement in some areas; it might be because of the inclusion of a new topic.

The study concluded that the task of assessment and communication of CVD risk can be done by nurses. The study recommends that the task of CVD risk assessment and communication can be shifted to nursing personnel after providing proper training.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

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Fulton BD, Scheffler RM, Sparkes SP, Auh EY, Vujicic M, Soucat A. Health workforce skill mix and task shifting in low income countries: A review of recent evidence. Hum Resour Health 2011;9:1.  Back to cited text no. 1
    
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Otgontuya D, Oum S, Buckley BS, Bonita R. Assessment of total cardiovascular risk using WHO/ISH risk prediction charts in three low and middle income countries in Asia. BMC Public Health 2013;13:539.  Back to cited text no. 6
    
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Kavita K, Thakur JS, Vijayvergiya R, Ghai S. Task shifting of cardiovascular risk assessment and communication by nurses for primary and secondary prevention of cardiovascular diseases in a tertiary health care setting of Northern India. BMC Health Serv Res 2020;20:10.  Back to cited text no. 7
    
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Muthunarayanan L, Russel JK, Hegde SK, Ramraj B. Ten years risk prediction of a major cardiovascular event in a rural block in Tamil Nadu. Heart India 2015;3:43-8.  Back to cited text no. 8
  [Full text]  
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Ghorpade AG, Shrivastava SR, Kar SS, Sarkar S, Majgi SM, Roy G. Estimation of the cardiovascular risk using World Health Organization/International Society of Hypertension (WHO/ISH) risk prediction charts in a rural population of South India. Int J Health Policy Manag 2015;4:531-6.  Back to cited text no. 9
    
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Norman G, George CE, Krishnamurthy A, Mukherjee D. Burden of cardiovascular risk factors of a rural population in South India using the WHO multivariable risk prediction algorithm. Int J Med Sci Public Health 2014;3:764-8.  Back to cited text no. 10
    



 
 
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