Guideline-directed medical therapy in heart failure patients: impact of focused care provided by a heart failure clinic in comparison to general cardiology out-patient department.

BACKGROUND: The usage of guideline-directed medical therapy (GDMT) in the treatment of heart failure (HF) has shown to reduce morbidity and mortality. However, majority of the HF patients do not receive GDMT or do not achieve the target dose. Literature has shown that the patients who are managed in HF clinics receive GDMT and target doses of disease-modifying drugs (DMD) when compared to those treated in other general cardiology outpatient departments (OPD's). It was a retrospective hospital-based study in which patients treated in HF clinic and other cardiology OPD in the year of 2017 were included (200 patients in each arm). The aim of this study was to assess the impact of heart failure clinics in medication therapy management including usage of guideline-directed medical therapy, if target dose specified by the guideline is achieved and time to reach target dose in comparison to other general cardiology OPD's. IRB and IEC approval were obtained before the commencement of the study. Data relevant to the study were obtained from the electronic medical record (EMR) and were compared between the study groups to see for the adherence to guideline and achievement of target doses. Data storage and analysis were performed using SPSS Version 24. A significance level of 5% was used. RESULTS: The usage of GDMT was higher in HF clinic when compared to other cardiology OPD (81% vs 55%, P = 0.001). A significantly higher number of patients in HF clinic achieved target dose when compared to other cardiology OPD (58% vs 29% -betablockers, 45% vs 9% -ACEI/ARB/ARNI, P = 0.000). Moreover, the number of eligible patients receiving DMD was found to be higher in HF clinic (98% vs 85% -betablockers, 69% vs 44% -ACEI/ARB/ARNI, 76% vs 44% -MRA). Also, the patients in HF clinic attained the target doses faster when compared to other cardiology OPD. In addition, there was better improvement in ejection fraction, as well as decreased rate of rehospitalisation and mortality in patients managed in HF clinic. CONCLUSION: HF clinics were compared with other cardiology OPD for various parameters and it was observed that HF clinics were better than other cardiology OPD in maintaining the medication therapy management.

The mentor as a role model and the importance of belongingness.

Nursing staff are frontline workers and service users are constantly observing their behaviour and what, how and when they do things. Being professional at all times is essential for nurses and other health professionals. Student nurses in the learning environment will emulate staff nurses and mentors as role models for their future practice. This article will focus on the importance of role modelling and 'belongingness' in practice, and how mentors may influence the pre-registration student nurse while in the learning environment. This is the final article in a series of five articles on mentoring.

The learning environment and learning styles: a guide for mentors.

The learning environment provides crucial exposure for the pre-registration nursing student. It is during this time that the student nurse develops his or her repertoire of skills, knowledge, attitudes and behaviour in order to meet competencies and gain registration with the Nursing and Midwifery Council. The role of the mentor is vital within the learning environment for aspiring nurses. The learning environment is a fundamental platform for student learning, with mentors key to identifying what is conducive to learning. This article will consider the learning environment and learning styles, and how these two essential elements guide the mentor in making sure they are conducive to learning.

Exploring failure to fail in pre-registration nursing.

Failing a student nurse can be a challenging task for mentors in the learning environment. It is often an unpleasant experience for all involved. However, mentors have a duty to uphold the reputation of the nursing profession and be the gatekeepers of the profession and the Nursing and Midwifery Council (NMC) professional register. Failing a student who is not meeting the required competence in the learning environment is a way of safeguarding the nursing profession and the future workforce. This article will look at the mentor's role when a student nurse is identified as not meeting competencies in the learning environment. The article explores the importance of following process when identifying weak students and the role that clinical educators and university staff have in supporting mentors when a student is deemed to be failing their learning experience.

Mentorship part 2: assessing pre-registration student nurses.

The role of the mentor has been evolving since it was introduced following Project 2000 in 1986. The role that mentors of pre-registration nursing students are tasked with on a daily basis is crucial to the overall assessment of the student nurse. Assessment and the importance of the mentor's role when assessing the students in practice will be discussed in this article. The reliability and validity of assessment and the mentor's responsibility in assessing the competencies in the learning environment is explored, together with the roles of formative and summative assessment. The introduction of the sign-off mentor and the ongoing achievement record as part of the assessment process will also be explored. It can be argued that mentoring is not a simple task, and that there are a number of barriers to successful assessment.

Mentorship part 1: the role in the learning environment.

Mentors play a vital role in the education of preregistration nursing students. Because the learning environments in which the students are placed are crucial for the development of the future workforce, it could be argued that mentors are the 'gatekeepers' of the nursing profession. However, the mentor's role is not an easy one and, with the added pressures of modern health care, there appear to be greater demands placed on nurses, which in turn affect the mentor's role. This article will be the first in a series of five looking at aspects of the mentor and the mentor's role in practice. This first article will focus on the mentor and the role of the mentor in practice, together with the identification of 'toxic mentors', who can hinder learning in the clinical environment. It is in working together with the mentor that students will learn the true nature of nursing from a 'hands-on' perspective, applying in practice the knowledge learned in class.

Evaluation of Makaton in practice by children's nursing students.

The number of service users with communication difficulties is increasing. Training in the use of alternative communication and aids, such as Makaton, is valuable and should be made available. to nurses and other healthcare professionals, in particular to students in the first year of their nursing degree. Early introduction of Makaton could encourage staff to be proactive in their communication skills throughout their career and inspire other workers to learn the same techniques. The author discusses the evaluation and use of basic signing in Makaton following a session for children's nursing students at one UK university.