It is well known that heart failure is the most common discharge diagnosis in patients older than 65 years. (
A cardiology nurse more and more commonly meets patients who were shortly hospitalized and then released home, but their psychophysical capabilities for self-assistance are diminishing. An overall impression points towards a very ill patient. The family, along with the patient himself, is under heavy burden when taking care of such patients and is often exhausted.
Active participation of a cardiology nurse, as patient’s advocate, during hospitalization and discharge, can increase the quality of life of patient and his family. An active participation of a nurse in discharge papers is essential, so that the patient can be recognized as a palliative cardiology patient.
Our healthcare system recognizes palliative patient with diagnose Z515. During hospital care and discharge of a patient with chronic heart failure in a functional NYHA IV class, it is very useful to consider palliative care for the patient. It is crucial to involve and educate the patient and family in making the decision about accepting palliative care, as well as scope and form of palliative care which can then be planned after hospital discharge. Health care team is obliged to respect a patient’s right to make the decision after receiving adequate information. Using this approach writing a discharge letter will be easier and more useful for the patient and his family. That is the moment where continuous palliative care begins and agreed care continues. It is good to have in mind that a patient who is on a waiting list for mechanical heart support, surgical treatment or heart transplantation, can stop being palliated, but as living in the present we need to provide the assistance that is needed when it’s needed. Palliative care needs to be available with the possibility to choose the place of care.
The expert team that takes care about the patient in hospital (physicians, bachelor nurse, psychologist, physiotherapist, social worker, priest) is formed individually after involving the patient and the guardian. On a family meeting, which should be organized the moment patient is admitted, adequate care plan is made, adjusted to expectations and possibilities. Special care is made to provide information to the patient, to provide autonomy, dignity, respect, and a relationship based on truth and confidence. Part of the plan is to involve and educate daily visitors through active participation in patient management. Beside active participation in care, written materials about the hospital and taking care of difficult patient are given, and if needed, materials about urinary catheter care, bedsores, pneumonia prevention, contractures, preventing skin defects, PEG tube, tracheal cannula, suction devices, life with VAD etc. Bedsores presents during admission are photographed. They are integral part of planned intervention in medical care and, with a photo on the discharge day, are enclose into the medical documentation.