Cardiac rehabilitation teaching for paramedical courses in India

Dear Editor, Due to technological advancements, the quality of medical care has significantly increased over the past few decades, posing new challenges for the health-care industry. Health service delivery is now widely acknowledged as a team effort involving clinicians and nonclinicians and is not the sole responsibility of doctors and nurses. These professionals were historically referred to as paramedical staff, paraprofessionals, or health technicians.[1] As the Ministry of Health and Family Welfare states, Allied Healthcare Professionals (AHPs) provide health or health-care-related services, possessing the necessary qualifications, and skills to perform therapeutic, diagnostic, curative, preventive, and rehabilitative interventions. Professionals who can easily handle sophisticated tools and cutting-edge protocols are in high demand. Diagnosis has recently relied so heavily on technology that AHPs are crucial to delivering health-care services. They collaborate in multidisciplinary teams with doctors (physicians and specialists), nurses, and public health officials in various health-care settings to promote, protect, treat, and manage a person’s physical, mental, social, emotional, environmental, and holistic health.[2] The quality of education, training, and community health orientation received by all categories of health-care workers, as well as their ability to work as a cohesive team, are significant factors in the efficient delivery of health-care services. The Indian Government recognized the need to maintain education standards for AHPs and thus set up a National Health Policy in 2002.[3] Paramedical courses do not adhere to a uniform syllabus, unlike medical and dental programs in the country. As a result, some universities or colleges offer cardiac rehabilitation to Bachelor of Science in Cardiac Care Technology (B.Sc. CCT) students, whereas others do not. The World Health Organization defines cardiac rehabilitation as restoring a person to an optimal physical, psychological, social, emotional, and economic state.[4] Due to the increasing number of heart disease survivors, more and more patients require rehabilitation from medical professionals with the necessary knowledge and skills to ensure their patients’ better quality of life. According to a prior study by Mohammed and Shabana on patients with chronic heart failure, cardiac rehabilitation activities positively impact mortality rates, physical health, sociopsychological function, blood lipid levels, hypertension, dyspnea, weight loss, smoking, and stress levels. It also revealed that cardiac rehabilitation significantly decreased cardiovascular risk factors, increased functional capacity, and improved health-related quality of life in these patients.[5] Further, this supports the assertion of the importance of educating medical professionals regarding cardiac rehabilitation with the necessary knowledge and skills. Cardiac rehabilitation is an integrated, multidisciplinary approach that requires the coordinated efforts of multiple medical professionals to provide the patient benefit.[6] Cardiac rehabilitation requires a team of experts with diverse skills. This team includes a clinical nurse specialist, physiotherapist, occupational therapist, clinical nutritionist or dietitian, cardiac technologist (cardiac rehabilitation coordinator), and cardiologist or physician who leads the team. SPECIFIC ROLES AND RESPONSIBILITIES OF CARDIOLOGISTS REGARDING CARDIAC REHABILITATION The physician’s role in diagnosing, prescribing treatment, and supervising follow-up care is paramount Physicians are responsible for taking a thorough medical history, performing physical examinations, and examining the results of appropriate laboratory tests Concerning the patient’s medical and physical condition, consult other team members for further evaluation to assist in developing a treatment plan The quality of care for patients and the outcome of treatment programs shall be under the overall responsibility of physicians. For these reasons, the leader of the team should be a doctor. SPECIFIC ROLES AND RESPONSIBILITIES OF CARDIAC TECHNOLOGIST (CARDIAC REHABILITATION COORDINATOR) REGARDING CARDIAC REHABILITATION Open communication shall be the coordinator’s primary responsibility Ensuring that all professional team members are aware of the changes in a patient’s state of health, keeping everyone on the same path, identifying problems as they arise, and ensuring the mechanisms for their resolution are established and used effectively Organizing the team’s activities is the coordinator’s responsibility, track of which fields perform what and who bears the responsibility for which activities The coordinator’s responsibilities include adding new resources, choosing which disciplines should be included, connecting with potential outside agencies, and acquiring equipment supplies The coordinator should also assist the patient and family in making appropriate decisions and effectively utilizing available resources and facilitating the team’s performance Facilitating the team’s performance by fostering group support is another duty of the coordinator. SPECIFIC ROLES AND RESPONSIBILITIES OF CLINICAL NURSE SPECIALISTS REGARDING CARDIAC REHABILITATION Nurses are responsible for monitoring the patient’s postevent respiratory and circulatory status and medication treatment program during the immediate postoperative or postevent period Nurses should use every patient encounter to teach or perform one aspect of the teaching process. Items that should be covered in this time frame include cardiac risk factors, anatomy and physiology of the heart, atherosclerosis and coronary artery disease (CAD), myocardial infarction, and what to expect before, during, and after surgery or a heart attack Nurses have the potential to reduce the anxiety of the cardiac rehabilitation process by teaching the skills and knowledge required by the family. SPECIFIC ROLES AND RESPONSIBILITIES OF PHYSIOTHERAPIST OR OCCUPATIONAL THERAPIST REGARDING CARDIAC REHABILITATION The therapist first offers a safe, progressive walking program and an upper extremity exercise program to prepare the patient for later physical fitness training and a move to outpatient rehabilitation Other responsibilities of the physical therapist include maintaining and enhancing neuromuscular relaxation, promoting effective breathing patterns, and enhancing the patient’s venous circulation when they are inactive The physical therapist continuously monitors the patient for symptoms such as pain, dyspnea, fatigue, tachycardia, lightheadedness, a change in mood, and an unsteady gait pattern. SPECIFIC ROLES AND RESPONSIBILITIES OF CLINICAL NUTRITIONIST OR DIETITIAN REGARDING CARDIAC REHABILITATION Clinical nutritionists or dietitians provide information on the dietary risk factors related to cardiac disease and outline the advantages of eating sensibly and healthfully Clinical nutritionists describe the goals of the cardiac diet and specify which foods are allowed or should be avoided. Examples of such diets include calorie-restricted, high-fiber, low-cholesterol, and sodium-reduced The primary responsibility of the nutritionist is to instruct the patient and family on how to create balanced menus using nutritional principles.[7] Several studies have found that developing a cardiac rehab curriculum for students is essential for providing knowledge and skills to manage and deliver a CR program in a hospital and community setting.[8] A cardiac rehab curriculum model is provided below: Module-1 Basics and practice of clinical cardiology Cardiovascular diseases (CVDs) Cardiovascular intervention and therapeutics Chest physical therapy. Module-2 Exercise and the heart Exercise physiology Diet and physical activity for CVD prevention Cardiopulmonary exercise testing and its application. Module-3 History and definition of cardiac rehabilitation American Heart Association recommendations for cardiac rehabilitation Phases, stages, and components of cardiac rehabilitation. Module-4 Cardiac rehabilitation in valvular heart diseases Cardiac rehabilitation in congenital heart diseases Cardiac rehabilitation in CAD Cardiac rehabilitation in congestive cardiac failure Psychosocial management in cardiac rehabilitation. This model curriculum considered all aspects of CCT and the roles expected for different levels of cardiac technologists based on their qualifications and experience. The National Health Mission has implemented reforms in the health sector that prioritize multiskilling, patient satisfaction, and improving the standard of care.[9] The importance of aligning curricula with these reforms emphasizes the need to educate paramedical students on community needs. Before framing the (B.Sc. CCT) curriculum, it is crucial to include cardiac rehabilitation as a component. CONCLUSION Recent technological advancements in medical care have led to improved quality of care and new challenges for the health-care sector. AHPs, such as cardiac technologists, physiotherapists, occupational therapists, and clinical nutritionists, are now crucial in providing health-care services, particularly cardiac rehabilitation for heart disease survivors, which can improve outcomes and quality of life. The effectiveness of education, training, teamwork, and commitment to community health are important in providing health-care services. The cardiac technologists who serve as cardiac rehabilitation coordinators under the supervision of cardiologists have a lot of responsibility. Therefore, the cardiac rehab curriculum for paramedical students is vital in providing knowledge and skills to manage and deliver a cardiac rehabilitation program in both hospital and community settings. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.