Page 156 - HA Convention 2015

Masterclasses

MC9.2 Nursing — Rehabilitation and Patient Empowerment 13:15 Theatre 1

Tuesday, 19 May Nursing Paradigm in Cardiac Rehabilitation
Kaur S, Tang SW, Leung KC
Medical and Rehabilitation Department, Tung Wah Eastern Hospital, Hong Kong

In Hong Kong, the number of admission due to chronic heart disease (CHD) and acute myocardial infarction (MI) in Hospital
Authority (HA) has significantly increased by 45% and 54% respectively as compared to 2001 and 2010 (HA Statistical Report
2001-2002 and 2010-2011). It is projected that CHD patients to be treated in HA by 2017 will increase 26%. Therefore the
demand for cardiac rehabilitation is great in HA.

Established in 2003, Cardiac Rehabilitation and Resource Centre (CRRC) of Tung Wah Eastern Hospital (TWEH) provides
one-stop integrated, intensive, interdisciplinary ambulatory cardiac rehabilitation (CRP) for cardiac patients in Hong Kong
East Cluster (HKEC).

In view of the increasing service demand, we developed a Cardiology Nurse Clinic (Rehabilitation) with accreditation in 2011.
In CRRC, we offer expert care to patients including education and counselling on risk factors and lifestyle modifications,
monitoring clinical stability, medication and diet compliance; improving well-being and quality of life; and trying to decrease
the readmission rate by early follow-up after hospitalisation. Besides, cardiac specialty nurse offers individualised cardiac
rehabilitation programme for patients. It is more effective than usual care in reducing cardiovascular risks.

We work closely with acute setting to increase suitable referral for ambulatory CRP to amplify patients’ benefits. To ensure
patients can be referred and enrolled to CRP, a proactive nursing approach in recruiting patients to CR has been used that
Cardiac Specialist Outpatient Department (SOPD) will triage suitable patients to CRP during their regular medical follow-ups.
The nurse interviews all patients at SOPD and provides counselling, social support, and promotes the benefits of CR with
motivational approach. This approach can enhance the utilisation of CR resources and thus reduce the healthcare cost for
recurrent cardiac events, unnecessary hospitalisations and re-vascularisation.

Furthermore we collaborate with community partners to set up a Cardiac Community Rehabilitation Network at Hong Kong
East Cluster to facilitate early community reintegration.

MC9.3 Nursing – Rehabilitation and Patient Empowerment 13:15 Theatre 1

HOSPITAL AUTHORITY CONVENTION 2015 Empowerment through Participation: Children with Intestinal Failure
Leung TSF
Department of Paediatrics and Adolescent Medicine, Queen Mary Hospital, Hong Kong

Intestinal failure is a malabsorption disorder which occurs when a person’s intestine cannot digest food, and absorb
nutrients, electrolytes and fluid essential to live. In children, it is usually the result from extensive bowel resection due to
diseases such as necrotising enterocolitis, volvulus, and small bowel atresia, or dysfunction of long segment of bowel such
as long segment Hirschprung disease.

One of the challenges in the management of this group of infants and children is nutritional support. Children with intestinal
failure often require other sources of nutrition in addition to oral intake to survive and grow. Parenteral nutrition (PN) is an
imperative therapy to provide macronutrients as well as micronutrients. The goal is to restore intestinal function to minimise
and eliminate the need for PN ultimately. When a child does not need hospitalisation, home parenteral nutrition is an
alternative option for improving the quality of life of these children and their families.

Home PN programme has started in our department since 2001 and is supported by a multidisciplinary Advanced Nutritional
Team. So far 11 families with children of intestinal failure have participated in this programme. To facilitate a smooth transition
from hospital to home, the decision of home PN is reached with the parents through discussion. Parents will undergo a
structured training in all aspects of care and complications, and are counselled throughout the process to build up their
confidence. Commitment of parents is the key to the success of this programme. With continual support from the Advanced
Nutritional Team and collaboration with parents, children with intestinal failure can receive PN safely in home setting.

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