‘Many people who have heart problems are afraid of being active’

A week in my . . . cardiac rehabilitation programmePauline Fitzpatrick runs the cardiac rehabilitation programme at Monaghan Hospital, helping people to get back on their feet after heart eventsIn conversation with Arlene Harris

Pauline Fitzpatrick, a nurse specialising in cardiac rehabilitation,  is based in Monaghan hospital. Photograph:  Philip Fitzpatrick.

Pauline Fitzpatrick, a nurse specialising in cardiac rehabilitation, is based in Monaghan hospital. Photograph: Philip Fitzpatrick.

 

I have been a nurse since 1983. I trained in the Royal Victoria Hospital in Belfast and joined Monaghan hospital in 1991.

Having completed a diploma in cardiac rehabilitation at Trinity College Dublin and Beaumont Hospital in 2002, I set up the cardiac rehabilitation programme here at Monaghan hospital and have been doing that for 12 years.

I am the only person doing this job in the hospital. I am responsible for co-ordinating and running the rehabilitation programme, which is an important part in the recovery from coronary heart disease (CHD), myocardial infarction and bypass surgery.

My two younger daughters and I have breakfast together and, once we are all sorted, we head our separate ways. We live 10 minutes away from the hospital and I start work at 8.30am.

The first patient today had been referred to me following a discharge from hospital last week.

He had suffered a heart attack and arrest and was successfully resuscitated by the paramedics in the ambulance.

His wife accompanied him to see me and the visit involved explaining his condition and having a discussion about his treatment and how to start him off with a gentle exercise programme.

Later, during the exercise programme with a group of patients, one felt faint and his pulse rate dropped to 29, so I had to have him admitted to the emergency department for investigation and a follow-up.

The rest of the patients carried on with their class and learned about the benefits of exercise, which is really important for rehabilitation.

 

Rehabilitation programme

I see about 20 patients a day, usually in groups of six, and go through the rehabilitation programme with them.

Many of them will have had a heart attack and, as well as my checking their blood pressure and following up any worries they might have, they also get risk-factor advice from the dietitian, advice about how to deal with stress from a psychologist, and a talk from the pharmacist about how to manage their medication.

Most people will need to come in three times a week for eight weeks. I will also take them through an hour of exercise.

This involves me checking their blood pressure and hooking them up to a monitor so I can check their heart rate as they do a workout on the treadmill, bicycle and weight lifting.

I will administer checks before and after they exercise and if their blood pressure or heart rate is not controlled, or their symptoms require medication adjustment, it is my responsibility to liaise with the relevant medical teams involved in their care.

I will oversee their workout and results, and talk to them about the need for exercise as so many people who have heart problems are afraid of being active in case it triggers something. So I will advise them on how fast they can go and how strenuous their exercises can be.

This will help with their overall confidence and this, together with the gentle exercise routine, will improve their quality of life.

As well as taking part in the exercise programme, the patients will undergo tests during their time with me. Their fasting lipid profile is repeated and their statin dose is titrated, so that their target LDL [bad cholesterol] is within the European Society of Cardiology (ESC) guideline recommendations.

Each patient is under the care of a consultant and, at the end of the programme, a discharge letter is sent to their GP informing them of the patient’s progress and of any change in their medication.

 

Education

Each group also participates in learning about their condition and being educated about the risk factors involved, so I co-ordinate talks from various colleagues who will help the patients to understand every aspect of their rehabilitation: this includes diet, stress and medication.

 

After my second group is finished, it’s time for lunch. Although I work on my own, I do have colleagues in the hospital so will often get together with someone at lunchtime for a chat or a walk.

After the third group session has finished, I have other work to do that involves documenting all the information from the patients I have seen during the day. I also have new referrals for whom I need to arrange appointments.

My working day finishes at 4.30pm but because there is no one else doing my job, I have to be very organised with my time and, of course, very punctual.

If I need a day off or want to take my holidays, I have to ensure that I have factored in the amount of people who are waiting to be seen and that everyone is catered for before I book my time.

There is no one else there to cover for me, so things can build up if I am off; being a lone worker is the most difficult part of my job.

It can also be stressful dealing with emergencies but, having said that, the positive side of it outweighs any negatives and I really love my job.

I would say the best part of it is being able to work on a one-to-one basis with my patients. There is great satisfaction in the contact I have with people and helping them to regain their confidence and supporting their recovery.

In the health industry, promotion can often lead to management roles that are office-based, so I am very happy that my job allows me to meet people and help them to get back on their feet.

Out of hours

We have dinner at 7pm, when my daughter Laura gets home from evening study and another daughter, Riona, is finished her basketball practice.

On my days off, I enjoy cooking, which is a good thing as teenagers always need feeding. They have a lot of activities going on, so I spend a lot of time taking them from one place to another.

Then there is the usual build-up of washing, ironing and housekeeping, which also keeps me busy.

Recently, though, I have started doing something for myself. I joined a cycling club a few months ago and I really enjoy going out with a friend every Saturday and Sunday morning for a two-hour cycle.

I also have a family history of heart problems, so I know the importance of exercise in maintaining a healthy heart.

On Sunday afternoons, we have lunch together as a family as Niamh and Ciara, the college girls, are usually home for the weekend and then it’s almost time to prepare for the working week.

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