Key-words:
Echocardiography - education - ethnicity - focused cardiac ultrasound - healthcare
access - nurse screening
Introduction
The Arab nation has a different culture from the rest of the world. The attitude and
behavior of females, especially the adolescents could be very complicated when it
comes to doing any clinical examination or medical procedure or investigation related
to their private body parts. They would feel much more relaxed when a female medical
or nursing staff examines them. This perception is because the adolescent females
are very sensitive to the extent that they may not give their consent, for example,
to do echocardiography procedure. Earlier studies on the role of nurses performing
echocardiography are feasible. In the United States, nurses assessed left ventricular
systolic function in the setting of predominant coronary artery disease.[[1]] Furthermore, in the middle-income countries, studies have concentrated on finding
of mild valvular changes because of asymptomatic rheumatic heart disease.[[2]],[[3]] This new nurse's role is to handle the probe during the echocardiography procedure
for the adolescent girls by a female nurse.
History of Echocardiography
History of Echocardiography
Echocardiography has a vital role in the diagnosis and management of clinical cardiology
both in adults and pediatrics since the application of ultrasound in the examination
of the heart by Inge Edler and Hellmuth Hertz in October 1953.[[4]] Since echocardiographic application and practice has been launched, the addition
of registered nursing personnel to the echocardiography team has improved the assessment
and diagnosis of cardiovascular diseases. In the 1980s, nurses started training in
clinical echocardiography. The training is accomplished by observing nursing functions,
then establishing proficiency under direct supervision by cardiologists. The performance
of echocardiography by nurses offers them a professional choice in helping the patients
and in assisting the practitioners.
Echocardiography Procedure
Echocardiography Procedure
Echocardiography or only heart ultrasound is a noninvasive and painless test to examine
the heart anatomy and function. It has an essential role in the diagnosis of cardiac
problems both acquired and congenital heart diseases (CHD). Echocardiography is a
cardiac ultrasound that uses phased array probes/transducers to get between the ribs
with high-frequency (2.5–10 MHz) sound waves to image the cardiac chambers' size and
function. It is used to visualize the atrioventricular valves and main great arteries
with their valves plus the inferior and superior vena cavae and pulmonary veins. Furthermore,
echocardiography can identify cardiac tumors and cardiomyopathies; it can be helpful
in assessing the complications of many systemic diseases such as mucocutaneous lymph
node syndrome, rheumatic fever, systemic lupus erythematosus, and renal failure to
detect pericardial effusion. It is also helpful during interventional cardiac catheterization,
for example, device closure of the atrial septal defect and patent ductus arteriosus
and in aortic and pulmonary balloon valvoplasties.
Nursing Responsibilities During Echocardiography
Nursing Responsibilities During Echocardiography
Nurses have an essential role and responsibilities before, during, and after echocardiography
procedure. They serve both hospital inpatients and clinic outpatients.[[5]] The nurse can take consents after the explanation of the procedure. Nurses' role
also include description of the procedure to the patients and their parents, do intravenous
access for sonicated saline, microsphere contrast, and medication administration,
for example, when echocardiography is performed under sedation. Nurses can help patients
to calm down and cooperate under the procedure, after the placement of the patients
in their left side and/or supine position in full privacy state, especially the females.
Furthermore, they help in applying the conductive gel to the chest area and remove
the gel after the procedure. Nurses monitor the vital signs and position patients
during transesophageal and stress echocardiography.[[6]] In this part of the world, the Arabic parents of female children and adolescents
regularly ask if there is a possibility for female nurses or female sonographers to
do echocardiography because of social and religious reasons. We have thought about
this and decided to engage our female registered nurse to do the echocardiography.
She has been attending and running the pediatric cardiac clinic at Al Ain Hospital
for more than 9 years.
The nurse acquired the necessary knowledge on how to explain the procedure and some
of the simple CHD to the parents. She carries out the electrocardiogram (ECG) and
organizes and collects the results of the 48-h Holter and Event ECG recorder monitors.
She is the main organizer and planner for the pediatric cardiac clinic plus communicates
with the parents. We started training this nurse on how to help more practically in
doing the echocardiography.
We describe a new contribution of registered nurses during the procedure of the echocardiography.
For the recent few years, we have started teaching the basic echocardiographic views
and interpretation of some cardiac defects. The nurse started placing and handling
the probe under the guidance of the pediatric cardiologist. The trained nurse is sitting
side by side with the mother in the front and to the left side of the patient to manipulate
the probe in the different known five basic echocardiographic views: left long parasternal
axis, left short parasternal axis, mitral or four chamber, suprasternal, and subcostal
views. The child feels more secure and relaxed when both the female nurse and her
mother sitting together on the left side and in front of the female child. The cardiologist
is seated behind and to the right of the patient looking at the echocardiography screen
[[Figure 1]]. The cardiologist's role is to advise the nurse regarding the manipulation of the
probe to get the best views and make the interpretation of the echocardiograms. We
have excellent feedback from the parents and their female children and adolescents
and are happy with the performance of the registered nurse.
Figure 1: The seating arrangements of the cardiologist behind the patient and both the mother/guardian
and the nurse on the left and front of the female child. The trained nurse positions
the probe at the agreed standard positions for the cardiologist to capture the appropriate
images and data. Thus, the patient is made to feel comfortable by not being exposed
to male operator
Conclusions
This report underscores a new role for nurses at clinical ultrasound in an ethnically
sensitive setting. A properly trained female nurse assisting a male cardiologist during
echocardiography could put at ease older female children and adolescents who are usually
very sensitive not to expose their chest to a male pediatric cardiologist. Therefore,
an experienced nurse can be a valuable asset when a qualified female cardiologist
or female echocardiographer technician is readily available.
Authors' contribution
The idea of the paper was conceived and developed by EHA. Both authors reviewed and
agreed on the final version.
Compliance with ethical principles
Not applicable, No patients are shown in the illustration.
