The Nurse and Technician Programme at EuroPCR2007: May 22-25, 2007, Barcelona, Spain

The setting for this year was that beautiful city of Barcelona, in Spain. It is a city on the beautiful eastern coast of Spain, right on the Mediterranean sea, complete with crystal-clear turquoise waters, clean sandy beaches, warm breezy days, cool drinks and the most wonderful seafood dinners to share with the colleagues from all over the world. We were there to work, but who ever said that work had to be routine? But let me get back to the conference. As I said, all things must come to an end, and when we found out that the location of EuroPCR was changing from Paris, France to Barcelona, Spain, I was sad and excited at the same time. I found Paris and its people both elegant and efficient. The food and accommodations for the meetings were well-planned, and well-rehearsed. Barcelona would have a hard act to follow. Yet the people, location and faculty of the Barcelona EuroPCR were spectacular. I can't wait until the next meeting! EuroPCR will take place again in Barcelona from May 13-16, 2008. Behind the Scenes Programme Committee members Dr. Thomas Zeller, Emilie Yegikyan and Sandy Watson were assisted throughout the planning and the meeting by Sandra Rouge, Stephanie Saverine, and their staff. These organizers were tireless in their efforts to make sure that the Nurse Technologist Programme ran smoothly. They were the front-runners of a wonderful team of people who put together a three-day meeting for the continued education of the staff that work hand-in-hand in our invasive laboratories. Julie Logan, Ken Gorski and I were honored to be listed as the American staff faculty. The faculty committee members met at EuroPCR 2006, TCT, and via the cyberspace highways to plan for the 2007 meeting. The plans for the 2008 meetings were again started at the end of the 2007 meetings. The staff and accommodations at the Forum on the beautiful Mediterranean set the stage for a wonderful as well as beautiful setting for the meeting. The staff were seen everywhere, making sure the rooms were wired for appropriate taping and comfort for the participants. The faculty and the staff all spoke English, making any concerns about communication a non-issue. Being American myself, and able to speak a few words of Italian and Spanish, I was still very happy to know there would not be a language barrier. However, I plan to continue my language studies in order to keep up with my international colleagues' standards of being able to communicate with staff from all over the world. Programme Format: No chance of missing out The unique format allowed for the staff sessions was wonderful. Have you ever attended a large scientific session and had to pick and choose between excellent speakers? Have you had to pick and choose between hearing your nurse and technologist faculty present topics you really wanted to hear, and the physicians who also had topics and sessions you really wanted to hear? The format at the EuroPCR helps to ease that dilemma. The morning sessions are dedicated to staff development and education, with topics all across the patient care spectrum. Then, in the afternoon, the attendees are free to go to the physician sessions. This format was so wonderful that when we, on the other side of the pond (as the British say) were planning the New Cardiovascular Horizons Nurse Technologist Sessions in New Orleans (September 5-8, 2007), we unabashedly copied this same scheduling template. Not having to choose between attending staff education or physician education is truly the best way to spend time at these sessions. Our thanks to the planning committees for both meetings, because the whole point of these teaching symposiums is to share our knowledge with a common goal: finding new and better ways to provide excellent patient care. Session Topics The faculty at the EuroPCR Nurse and Technician Programme is lab staff, working in all areas of the patient care field, from direct patient care to the research and educational departments dedicated to the identification of educational areas for our staff. We started the first morning with Sandy Watson RN, BN, NFESC, as the opening speaker. Sandy spoke passionately about how we must all be dedicated to the education and development of our patient caregivers in order to provide good patient care. The first session then discussed the development of national guidelines for cath lab standards and education. The Society of Invasive Cardiovascular Professionals (SICP) standards were presented as an example. My task was to show how we went through the process of developing and then accepting the information that was identified as necessary into the Standards for Practice. (In previous years at EuroPCR, we had also had the chance to present the SICP Orientation Standards and Guidelines.) Attendees were directed to the www.sicp.com website for more information This session discussed the need to not only have identifiable standards, but how the process could lead to internationally-identified cath lab credentials with examination methods as part of our professional practice. The website for Cardiovascular Credentialing International, www.cci-online.org, was also shared, and there were many attendees who came up to faculty after the opening sessions asking for more information and help with their efforts to identify what is appropriate in their specific countries. The difference between the U.S. and the rest of the world is that the emphasis is on countries, not states, and all have individual needs and practices. Speakers Eleonore Feldkamp and Siro Buendia shared their input from Germany and Majorca. This session was a great way to start the conference. Emilie Yegikyan started the next session with a plan to show how we must focus our attention on patient needs in order to understand the best use for available technologies, along with follow-up care for the best outcomes. Next was patient-centered practice issues, with Vincent Gatt from Malta discussing how the need for patient pain and anxiety relief is universal, even though different cultures approach the need for medication differently. The role of the cath lab nurse is to meet patient needs, and importantly, reassure patients that those needs will be met. Marie Leahy, from the United Kingdom, discussed how our job does not end after the case patient compliance must be emphasized as well. This has been proven over and over when patients show up with a subacute thrombus because they could not afford clopidogrel after placement of their drug-eluting stent. This session also discussed the modalities we use to identify disease. Michela Mordasini gave a wonderful talk on MRI technologies. I was constantly reminded that our field is truly multidisciplinary, and it is vital to include all staff from all departments in order to deliver excellent patient care. Anne Parent discussed the role of the staff in patient education for those patients who have peripheral arterial disease, noting that again, our job does not end with the case, but the patients must be followed and records kept. Irene Drotningsvik from Norway expanded upon this point, stating that goals should be set not only to treat, but to prevent and rehabilitate our patients. Siro Buendia started the next session by building on the thought that the technology and education needs to be comprehensive. All staff have many different skills. Even the basic jobs in the lab cover three roles: monitoring, circulating, and scrubbing. Siro's talk was a nice segue into my presentation on identifying and preventing repetitive staff injuries in the lab. Ergonomic concerns are universal, and I have been involved in this research for a few years. We presented the preliminary results of an ergonomic staff survey, and the injury patterns that our staff is experiencing. This research is multidisciplinary, and the Society of Cardiovascular Angiography and Interventions (SCA&I) has an ongoing occupational health committee that I am honored to sit on as the staff liaison and voice for our team. Carol Dunham from Toronto showed how the division of labor has evolved over time in the lab. The shortage of trained professionals for the lab is a universal shortage, and covers all fields: radiology, nursing, respiratory and physiotherapists alike. New staffing models are being developed to help adjust to the shortage. Mireille Huchard from Massy showed how the models have evolved to a point where each person in the lab needs to learn aspects from all disciplines. There is a need for constant staff education to keep up with the field. A. Lugtigheid from The Netherlands showed how their program has allowed paramedics and medics to be trained to a new level of competence, and become fully cross-trained to work in the cath lab. Rachael Ramsamujh and the team from Canada dove right into the need for research in the lab. It is not only applicable to those working in medical research protocols, but to the everyday staff who are working in an ever-changing technological world. Without good quality research to identify which technology works and works well, we are left to try and figure it out each and every time. Outcomes-based medicine is necessary. Someone must take the time to develop the documentation tools, protocols and publish the data for all to share (the emphasis being on all to share.) Our friends Down Under sent Suzanne Crown, who shared how her Australian lab developed specialized training for staff to support carotid artery stenting procedures. We were blessed this year with a brilliant pharmacist from the United Kingdom, Helen Williams, who took us through the platelet issues that develop during the formation of thrombus during percutaneous coronary intervention (PCI). She was very clear in her session, and made pharmacology understandable and interesting. Pharmacology subjects continued, combining the pathophysiology of renal insufficiency and contrast-induced nephrotoxicity and the risks our patients face in the lab. J. Debono from Malta handled this subject clearly, reminding us again that all of our patients are at risk for this complication, and we need to be alert. Matin Ghorbati from Iran presented the care of the patient undergoing mitral valvuloplasty. Matin looked not only at the technology, but at the pathophysiology of the disease itself. Her movie clips and illustrations were beautiful. The patient care during this procedure could not be complete without a session on vascular access, hemostasis and the team approach to patient site recovery. I really appreciated Matin's point that the removal of the sheaths were done by manual compression and this approach was both not efficient from a time standpoint, but also the risk of bleeding at the site was also a potential patient complication. The more we look at the risks of repetitive stress injuries and the patient complication of hematoma development, the more we realize closure devices need to play a larger role. The final day was anything but anticlimactic. The morning started with structural heart disease topics presented by Sue Jimeno and her team. The sessions covered anatomy, physiology, pathophysiology and the research needed to develop good patient care practices. Sue talked about how developing a good program is vital to good outcomes. Patient care and education are a big part of any program and are an important part of a successful practice. The team approach between the different departments that must coordinate to develop a clinical pathway for these patients to follow is vital for good care. Rachael Ramsamujh (Canada) spoke on a subject not normally discussed, but one which should be discussed frequently: the topic of sterile technique and practice in the lab. It is always important; her session made us think again of the basics and just how vital they are, especially since we are now putting in all sorts of devices. Even basic sheath insertion needs to be considered from an operational room standpoint. Percutaneous aortic valve replacement started the technology session, which showed the centers involved in the development of this great device. The technology was able to develop because of a team approach to the care of the patient, anesthesia, staff monitoring, scrubbing, circulating, and the physician team, which could be 3 or more on the table at one time. At a minimum, that is 6 or 7 sets of eyes looking to help these patients get a successful outcome in the lab. This presentation represented beautiful work from a talented staff team member and educator. The faculty went back to the topic of research for the final segment of the Nurse and Technician Programme. Lene Kloevgaard from Denmark led her team members as she focused on how nurses can help meet the demands of highly structured research protocols. She later presented a specific session on research and the PCI patient to show actual practice for the session. Brenda Ridley from Canada spoke on how to take an idea from the hypothesis you are trying to prove, to the development of the research project, and ultimately preparing that research for publication. Robbert Vermeulen from the Netherlands presented a great session on how to develop good clinical practice, with 13 identified core principles. It is accepted practice that all research since 2005 in Europe must meet these core principles. Marianne Norgaard from Denmark argued that since nursing is identified as the ‘practice of nursing', the same as medical practice, we must as nurses develop a way of asking relevant questions, with the purpose of improving our practice with the answer. The pictures in this article are shared by Nicholas Masson, a speaker who reminded us that research starts in the animal lab. It would be a wonderful world if we did not need another animal to test our devices and procedures; however, the information gleaned from that level of practice is less than appropriate to humans. We do need animal models and a well-run, sincere animal lab uses those animals ethically and with kindness. His session reminded us again of the gift these animals give us, and he spoke eloquently on this important part of our healthcare practice. A Dynamic Exchange I would be remiss if I did not mention that the final session, held in the evening, was supported by the Organizing Committee for the purpose of gathering all attendees who wished to help identify ways to continue improving the Nurse and Technician Programme at EuroPCR. Sandy Watson again was a dynamic speaker, drawing in the participants at the meeting, and by the way, the dinner was excellent, the wine wonderful, and most of all, the collaboration was international. This was the point to begin with creating a system and offering a platform for the exchange of knowledge and experience. I hope to see you next year in Barcelona, May 13-16, at EuroPCR2008! More information is available at europcr.com. Marsha Holton can be contacted at marshasicp @ aol.com

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